A rare presentation of haemobilia with acute pancreatitis: a case report

Haemobilia, caused by hepatic artery aneurysms leading to acute pancreatitis is a rare presentation. Pancreatitis is hypothesized to result from a similar mechanism to gallstone obstruction at the ampulla of Vater. Herein, we report a large common hepatic artery (CHA) and right hepatic artery (RHA) aneurysm with a common bile duct (CBD) fistula causing acute pancreatitis and upper gastrointestinal bleeding. A 61-year-old male, with nicotine use disorder and hypertension, presented to the emergency department for the first time with a sudden onset of severe epigastric pain radiating to the back, relieved by bending forward, and two episodes of haematemesis and melena. His laboratory findings showed anaemia, elevated amylase and bilirubin with predominant direct component. Imaging revealed a partially thrombosed fusiform CHA aneurysm extending to the RHA and porta hepatis with a fistula into the CBD. Following stabilization, operative management was carried out, which included CBD exploration with clot evacuation, fistula oversewing, cholecystectomy, Roux-en-Y hepaticojejunostomy, and ligation of the common hepatic artery proximal to the aneurysm after ensuring the presence of a replaced left hepatic artery and collateral supply to the liver. One-year post-operative follow-up angiogram showed complete thrombosis of the aneurysm with preserved hepatic perfusion. This case highlights haemobilia as a rare cause of acute pancreatitis, emphasizing the need for high clinical suspicion and timely surgical intervention.