Hemobilia Due to Spontaneous Arterioportal Fistula in a Patient With Liver Abscess: A Rare Presentation

Hemobilia is a rare cause of gastrointestinal bleeding, most commonly resulting from trauma or iatrogenic injury. Vascular complications such as arterioportal fistula (APF) are extremely uncommon, especially when occurring spontaneously in the setting of a liver abscess. We report a case of a 59-year-old man who presented with fever, abdominal pain, and later developed melena and biliary obstruction after percutaneous drainage of a presumed amoebic liver abscess. Endoscopic retrograde cholangiopancreatography revealed active bleeding from the biliary orifice, confirming hemobilia. Computer tomography angiography identified an APF in segment VIII of the liver. The patient was successfully managed with endoscopic stenting followed by transarterial coil and glue embolization of APF, resulting in complete resolution of symptoms. This case underscores the importance of maintaining a high index of suspicion for vascular complications like APF in patients with liver abscesses who develop signs of gastrointestinal bleeding and biliary obstruction. A multidisciplinary, image-guided approach is essential for prompt diagnosis and life-saving management.