56-year-old male with combined arterial-portal and portal-biliary fistulas. Patient underwent percutaneous transhepatic biliary drain (PTBD) placement for a biliary leak. One week later, he developed significant hemobilia. (A) Pullback cholangiogram through a sheath (thin black arrow) showed opacification of the biliary tree (thin white arrow) and portal vein (curved black arrow). (B) Hepatic artery angiogram showed a fistula between a branch of the right hepatic artery (dashed white arrow) and branch of the right portal vein (curved black arrow). (C) After transarterial embolization with coils (dashed white arrows), the arterial-portal fistula resolved. A new biliary drain was placed with proximal side holes central to the site of portal vein traversal. The patient’s hemobilia resolved. The portal vein and hepatic artery travel alongside the bile ducts in the portal triad and are at risk of injury during PTBD placement.