Hemobilia is relatively rare among hemorrhages in the digestive tract, and
hemobilia caused by tumors of the biliary tract is particularly rare. We tr
eated a 74-year-old-man with undifferentiated carcinoma of the gallbladder
presenting with hl:mobilia. During hospitalization for neurogenic bladder a
t the Department of Urology, he showed progressive anemia. Since hemorrhage
in the digestive tract was suspected, endoscopy of the upper gastrointesti
nal tract was performed, and bleeding from the papilla of Vater was observe
d. On ultrasound examination, findings were indicative of cholecystic cance
r, and hemorrhage from the cystic duct was found on percutaneous transhepat
ic cholangioscopy. On perioral cholecystoscopy, however, masses of coagulat
ed blood were found only in the gallbladder. Abnormalities such as dense st
aining of tumors or extravasation were not found on angiography. The patien
t died of hepatic failure due to rapid invasion of the liver by the tumor,
associated with biliary infection and disseminated intravascular coagulatio
n. At autopsy, a nodal tumor was found in the gallbladder, and the cavity o
f the gallbladder was filled with coagulated masses of blood. Direct invasi
on of the tumor to the liver, diaphragm, and transverse colon was found. Th
e histopathological diagnosis was undifferentiated carcinoma (pleomorphic l
arge-cell type).