A Case of Emergency Surgery for Biliary Hemorrhage during Chemotherapy for Sigmoid Colon Cancer Accompanied by Myelocarcinomatosis

Abstract

A 63-year-old man, who was diagnosed with DIC, sigmoid colon cancer, multiple bone and lymph node metastases, and myelocarcinomatosis, was admitted to our hospital. He received chemotherapy with mFOLFOX6 ; 22 days later, right hypochondriac pain and hematemesis were observed. Due to acute hemorrhagic cholecystitis and DIC, emergency surgery was performed. Gallbladder necrosis and blood clots in the common bile duct were observed. Intraoperative cholangioscopy revealed diffuse mucosal redness and fluid oozing from the intrahepatic duct to the lower bile duct. Cholecystectomy was performed, and a biliary decompression tube was placed in the common bile duct via the remaining cystic duct (C tube). It was considered that acute hemorrhagic cholecystitis occurred due to coagulopathy caused by myelocarcinoma. Moreover, increased pressure in the gallbladder led to necrosis, clotting, and obstructive cholangitis. After surgery, biliary bleeding stopped completely, and chemotherapy was restarted. Even in patients with myelocarcinomatosis, cholecystectomy may be a treatment option in patients with relatively good ADL before the onset of acute cholecystitis and in cases where prognosis can be prolonged and chemotherapy can be restarted after cholecystectomy.