**Question:** All are seen in hemobilia except

A. Intussusception
B. Cholangitis
C. Hepatitis
D. Choledocholithiasis

**Core Concept:** Hemobilia refers to the presence of blood within the biliary system due to rupture of a blood vessel into the liver or biliary tree. Hemobilia can be categorized into primary and secondary types.

**Why the Correct Answer is Right:**
Primary hemobilia is caused by spontaneous rupture of a blood vessel into the liver or biliary tree, typically due to underlying vascular lesions such as arteriovenous malformations, aneurysms, or traumatic injuries. In this context, the correct answer options reflect the presence of a vascular lesion in the liver or biliary tree.

**Why Each Wrong Option is Incorrect:**
A. Intussusception is a condition where one part of the intestine telescopes into the adjacent part, causing blockage. It is not associated with blood and does not involve the biliary system.
B. Cholangitis is an inflammation of the bile ducts, usually caused by bacterial infections. It is not a vascular lesion and does not fit the criteria for hemobilia.
C. Hepatitis is an inflammation of the liver, often caused by viral infections. It does not involve a rupture of a blood vessel into the biliary tree and is therefore not a hemobilia etiology.
D. Choledocholithiasis refers to the presence of stones in the bile ducts, particularly the common bile duct. It is a condition caused by stone formation and does not involve a rupture of a blood vessel into the biliary tree, making it irrelevant to hemobilia.

**Clinical Pearl:** Hemobilia should be considered in the differential diagnosis of patients presenting with acute abdominal pain, cholestasis, or cholangitis with an abnormal liver function test. The correct answer options (A, B, C) are not related to the rupture of a blood vessel into the biliary tree, while option D is not a vascular lesion but rather a condition caused by stone formation.

**Correct Answer:** D. Choledocholithiasis (Option D) - Hemobilia is typically caused by rupture of a blood vessel in the liver or biliary tree and is not related to the presence of bile duct stones.