A Case of Cardiac Arrest Associated with Biliary Hemorrhage and Obstruction with Non–traumatic Intramural Hematoma of the Duodenum Caused by Gallbladder Cancer

Abstract

A 68–year–old man complaining of right back pain was referred to a local doctor. Laboratory studies revealed elevation of the liver and biliary enzymes. MRCP showed a filling defect in the lower common bile duct. ERCP was subsequently performed, but the presence of stones was not confirmed. The patient recovered well and was discharged. On the day after discharge, he was discovered lying on the floor at his house and was transferred to our hospital. At arrival, he went into cardiopulmonary arrest, and was revived by cardiopulmonary resuscitation. Blood tests showed prolongation of the prothrombin time and elevation of the levels of hepatobiliary enzymes. Plain abdominal computed tomography showed biliary obstruction caused by gallbladder hemorrhage. An upper gastrointestinal series revealed duodenal stenosis. It was considered difficult to perform ERCP for adequate drainage because of duodenal stenosis. Therefore, we had no choice but to select conservative therapy. We performed resection of the gallbladder under a tentative diagnosis of gallbladder hemorrhage due to gallbladder carcinoma. The patient was discharged without postoperative complications. While biliary obstruction caused by gallbladder carcinoma via hematoma formation has been reported, there is no report of biliary obstruction leading to cardiopulmonary arrest. Herein, we report the case of a patient who was revived from cardiopulmonary arrest complicating biliary obstruction due to hematoma.