A 91-year-old African-American woman was referred to our out-patient gastroenterology (GI) clinic for evaluation of mild epigastric pain and intermittent melena. Melena had been occurring for a week. Our patient denied any history of nausea, vomiting, early satiety, weight loss, hematemesis, heartburn, or alcohol use, and had never had any previous episodes of abdominal pain. Her vital signs showed no signs of orthostasis. An abdominal examination revealed a soft, non-tender abdomen. Rectal examination revealed hemoccult-positive dark colored stool. Laboratory test results revealed anemia (hematocrit 30%, white blood cell count 4.7 cells/mL, platelet count of 243 cells/mL) and abnormal liver function tests (LFTs; total bilirubin of 0.8 mg/dL, alkaline phosphatase of 664IU/L, aspartate aminotransferase (AST) 54 U/L, alanine aminotransferase (ALT) 188 U/L), consistent with cholestasis. Her alpha-fetoprotein, carbohydrate antigen (CA) 19-9, and hepatitis serologies were normal. Abdominal computed tomography (CT) studies were remarkable for multiple hepatic cysts, but malignancy could not be excluded (Figures 1,2,3). On esophagogastroduodenoscopy (EGD), the esophagus, gastric and duodenal mucosas were normal, whereas multiple blood clots were revealed at the ampulla of Vater. Hemobilia was suspected as the cause of melena and occult biliary obstruction. Our patient underwent an ERCP procedure that showed a single 18 mm large filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The obstructing blood clots (Figures 4 and 5) were removed with a 9 mm balloon and a 7-French 10 cm stent was placed in the proximal common hepatic duct. Cytology brushing results were negative for malignancy. The presence of blood clots in the common hepatic duct (CHD) as well the adjacent localization of a hepatic cyst were strong indications that the cause of hemobilia was the hepatic cyst. Our patient's hospitalization period was uneventful and she was well one month after the intervention with no signs of hemobilia recurrence.