Haemobilia from ruptured right hepatic artery aneurysm: a complication after aortic valve replacement

A patient with a ruptured hepatic artery aneurysm which developed after aortic valve replacement is described. Suture of multiple gastric erosions, vagotomy, pyloroplasty, cholecystectomy, exploration and gastrostomy followed by total gastrectomy were performed before the correct diagnosis was made. Arteriography, which should be a valuable adjunct in cases of massive upper gastrointestinal bleeding, was finally diagnostic. Approaches to the problem of haemobilia are discussed and the available operative techniques reviewed.