A Case of a Gallbladder Aneurysm with Biliary Hemorrhage and Perforation

Abstract

A 70-year-old man had been on hemodialysis for chronic renal failure and was taking warfarin, clopidogrel and steroid. He presented to our hospital with upper abdominal pain, and his blood test showed elevated hepatobiliary enzymes and inflammatory reaction. An esophagogastroduodenoscopy revealed bleeding from the major duodenal papilla, and an endoscopic retrograde cholangiopancreatography showed a translucent image of a suspected hematoma in the common bile duct. Anemia progressed after examination and a contrast enhanced computed tomography was performed. Due to suspected biliary and intraperitoneal hemorrhage, an emergency laparotomy was performed. A large amount of hematoma was found in the abdominal cavity, and the body of the gallbladder was perforated by 5 mm long cholecystectomy was carved out. Histologically, the resected gallbladder revealed a saccular artery exposed in the gallbladder lumen, which was consistent with a gallbladder aneurysm. The became necrotic, Necrosis was observed in the vessel wall and surrounding subperitoneal layer. Here, we report this rare case of a gallbladder aneurysm with biliary hemorrhage and perforation, who was saved by emergency cholecystectomy.