Abstract
A 76-year-old man presented to us with upper abdominal pain of sudden onset. Plain abdominal CT revealed a high-density mass (68.4 HU) in the gallbladder, suggestive of an acute hematoma formed as a result of gallbladder hemorrhage. Enhanced abdominal CT showed no extravasation of contrast material in the gallbladder. Under the diagnosis of acute cholecystitis due to gallbladder hemorrhage, we selected conservative management. By two days after admission, the patient's symptoms improved. Repeat enhanced CT revealed disappearance of the gallbladder hematoma and localized thickening of the gallbladder wall. Diffusion-weighted MRI revealed the affected region as a hyper intensity. Under a tentative diagnosis of gallbladder hemorrhage due to gallbladder carcinoma, we planned surgery, and cholecystectomy with gallbladder bed resection was performed. As histopathological examination during the surgery confirmed the diagnosis of gallbladder carcinoma with subserosal invasion, we additionally performed regional lymph node dissection. He was discharged on day 9 after the surgery with no postoperative complications. A review of the literature revealed that gallbladder carcinoma presenting as hemorrhagic cholecystitis is rare. In this case, gallbladder carcinoma as the cause of the gallbladder hemorrhage was suspected based on the findings on preoperative CT and MRI, and we successfully provided appropriate treatment.
