• Xiaolei Liu, Jia Huang, Haidong Tan, and Zhiying Yang.
• Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13285.

RationaleHemobilia caused by arteriovenous malformation is extremely rare but could be lethal. To date, most reports have been single-case reports, and no literature reviews are available.Patient ConcernsA 47-year-old man presented to the emergency department with abdominal pain and fever. He complained of abdominal pain and weight loss for the past 2 months.DiagnosesContrast-enhanced computed tomography and magnetic resonance imaging showed a heterogenous lesion located in pancreatic head and tumor was suspected.InterventionsEndoscopic retrograde cholangiopancreatography was performed and bleeding from papilla of Vater could be viewed. Nasobiliary drainage was placed to alleviate the pain and jaundice. Emergency laparotomy was performed due to the recurrence of severe pain and bleeding, and pancreatoduodenectomy was then performed. Macroscopic examination showed the ulceration connected with collected vessels which were located in pancreatic head and microscopic examination confirmed the presence of arteriovenous malformation.OutcomesThe patient recovered uneventfully and was discharged 10 days after the surgery. He is asymptomatic on 4-month follow up.LessonsArteriovenous malformation is a rare cause of hemobilia, but it could lead to life threatening bleeding. Transarterial embolization could be effective to control the bleeding temporarily, however repeated hemorrhage may occur. Surgical resection may be a better option.

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