Abstract
A 92-year-old woman was admitted to our hospital because of right upper quadrant pain. An abdominal ultrasonography revealed no stones in the gallbladder and an abdominal CT scan showed a collapsed gallbladder and massive ascites around it. Hematoma at the gallbladder neck was also suspected because of high density area at there. The patient was diagnosed with acute cholecystitis with perforation of the gallbladder due to impaired blood circulation, and an emergency laparotomy was performed. No signs of apparent perforation were found in the gallbladder and the intestine, however, there were hematoma at the neck and a necrotic change at the fundus and body of the gallbladder. Bile leakage was confirmed mainly in the right upper quadrant of abdomen. The patient underwent cholecystectomy, because no causative lesion was found except the gallbladder. Grossly no perforation was seen in the resected specimen but hematoma and nodules suggestive of thrombi were present at the gallbladder head. Pathologically, we found thrombi in the vein of the gallbladder wall and hemorrhagic necrosis around it. Therefore, necrotic cholecystitis due to venous thrombosis was diagnosed. Such a case of biliary peritonitis due to transudation of bile from the gallbladder caused by venous thrombosis is very rare, as only 4 cases including ours have been reported domestically. We herein review the literature and describe pathological features of this disorder.
