A Case of Hemorrhage of the Gallbladder Complicated with Cholecystitis

Abstract

A case of hemobilia in a 72-year-old woman is reported. The patient was admitted to our hospital with acute cholecystitis caused by cholelithiasis in October 1990. Three days after admission the patient vomited large amount of blood. A diagnosis of hemobilia was made at emergency gastroendoscopy when blood was seen spurting from the papilla of Vater. Ultrasonography and computed tomography of the abdomen showed a large and expansive gallbladder. On the celiac arteriogram, active bleeding was not demonstrated. Seven days after admission sudden hematemesis recurred. Percutaneous transhepatic gallbladder drainage was performed, and massive old and fresh blood flowed out through the drain. Under the diagnosis of hemorrhage of the gallbladder, surgical exploration was performed. The gallbladder was very large and tense, and it measured 15 cm in length by 7 cm in diameter. The gallbladder was removed. The common bile duct was explored and endoscopic examination of the biliary tract was carried out. There was no evidence of bleeding arising from parts of the other biliary tract. There were four mixed gallstones in the gallbladder. The mucosa of the gallbladder was necrotic and denuted, but was not ulcerated. Microscopic examination showed a gallbladder thickened wall with severe inflammation, edema and hemorrhage. There was no evidence of neoplasm or arteriosclerotic changes. Hemorrhage of the gallbladder is rare. We found sixty one cases in the Japanese literature. If hematemesis or melena are found, hemobilia should be considered a possible cause.