Common bile duct blood clot: An unusual cause of ductal filling defects for calculi

We report a case of obstructive jaundice caused by a blood clot in the comm on bile duct in a 75-year-old man with cirrhosis. Five years prior to his a dmission, he had undergone a left hepatectomy for hepatocellular carcinoma. At the present admission, he appeared icteric, and endoscopic retrograde c holangiography revealed filling defects in the common bile duct. Choledocho tomy was therefore performed for possible common duct stones, and explorati on of the duct showed blood clot casts filling the duct. The casts were eas ily removed, and the patient's postoperative course was uneventful. However , he developed ascites and jaundice 1 month later and died of liver failure approximately 3 months after undergoing the choledochotomy. Autopsy reveal ed hemorrhagic necrosis in the proximal intrahepatic duct of the posterior segment, which was considered to be the cause of the observed hemobilia, as well as the blood clot in the common bile duct at surgery. We report this rare case and discuss the cause of hemobilia.