<prompt> Causes of Hemobilia AllExcept -Trauma to AbdomenMalignancyRupture of hepatic artery aneurysmHepatitis  <response>: Ans. is d ie Hepatitis Ref. Sabiston, 18e pl515 17e, p 1561, 16e, p 1056; Maingots 10e, p 300Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct.Causes of hemobilia:Trauma most commoniatrogenic trauma is the most common causeincludes interventional radiological procedures, percutaneous liver biopsy, percutaneous transhepatic bil- iary drainage, operations on gallbladder and bile ductblunt trauma is more common cause than penetrating traumaGall stonesVascular pathologies - aneurysms, angiodysplasias, hemangiomas.Uncommon causesMalignant tumors of liver, biliary tree, gall bladder, pancreas parasitic infection heaptic abscess cholangitisClinical presentationClassical triad consists ofUpper abdominal pain biliary colicObstructive jaundice obstruction by blood clotsUpper gastrointestinal haemorrhageHematemesismelenaDiagnosisDiagnosis of hemobilia is typically made on upper endoscopy with findings of bleeding from the ampulla of vater.Arterial angiography is the investigation of choice as it will reveal the source of bleeding in about 90 of cases.ManagementIn majority of cases, transarterial embolization TAE is curative.Surgery is indicated when TAE has failed, it consists of:ligation of bleeding vessels 