A 42-year-old haemophiliac who presented with a cholestatic jaundice and repeated gastro-intestinal haemorrhage is described. The bleeding was initially thought to be due to the severity of the haemophilia itself rather than from any local cause and the jaundice thought to be due to a serum hepatitis. The correct diagnosis of ampullary carcinoma was eventually made after numerous barium studies, fibre-optic endoscopy and two laparotomies. A carcinoma was discovered at a second endoscopy some 12 months after initial presentation. Attention is brought to the rare association of ampullary carcinoma and haemophilia, and to the difficulties involved in diagnosis.
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