Intrahepatic arterioportal fistula (IAPF) is a rare vascular malformation and cases of hemobilia caused by it are extremely rare. The article describes a case of hemobilia in an elderly woman with IAPF. The patient was admitted for sporadic upper abdominal pain lasting 3 days. Choledocholithiasis was initially diagnosed based on upper abdominal CT and MRCP. Hemobilia and sedimentary clot were identified during ERCP microscopy. CT enhancement after ERCP revealed an intrahepatic arterioportal fistula. Based on a multidisciplinary consultation, transcatheter arterial embolization (TAE) was performed, after which the patient recovered well and the bleeding stopped. The case shows IAPF as a rare cause of biliary bleeding and the value of imaging methods for diagnosis in elderly patients with complex biliary diseases.