Abstract
An 85-year-old man visited a hospital because of a one-week history of right lateral abdominal pain revealed increases in the hepatobiliary enzymes and jaundice in bolld examinations. The patient was referred to our hospital with a suspicion of acute cholecystitis. Abdominal CT scan showed a swollen gallbladder and wall thickening. MRCP showed a low intensity area suggestive of hematoma inside of the gallbladder. Duodenal endoscopic study showed outflow of blood from the papilla of Vater. Cholangiography showed translucent filling defect in the bile duct. Abdominal angiography revealed extraversation of contrast medium at the fundus of the gallbladder. Hemorrhagic cholecystitis and obstructive jaundice due to hemobilia were diagnosed and emergency laparotomy was performed. Intraoperative Doppler ultrasound disclosed the bleeding site at the gallbladder fundus, and cholecystectomy was performed. Pathology revealed findings of gangrenous cholecystitis and a ruptured artery that had exposed in the ulcerated lesion at the gallbladder fundus.
Although hemorrhagic cholecystitis is a relatively rare entity, hemobilia can rapidly worsen the disease so that early treatment is important.
