A Case of Hemobilia Associated with Spontaneous Gallbladder Hemorrhage / 대한소화기내시경학회지

ABSTRACT

Hemobilia is a hemorrhage into the biliary tract that may follow trauma (including surgical and percutaneous techniques in hepatobiliary system), aneurysms of the hepatic artery (and its branch), tumors of the biliary tract, hepatoma, inflammation, liver abscess, and gallstone disease. But, a case has not been reported involving of hemobilia associated with gallbladder hemorrhage without obvious predisposing factors or causes. A 62-year-old woman was admitted to Kyunghee Medical Center due to intermittent nausea, and right upper quadrant pain for 2 days before admission. She had no history of abdominal trauma. On the second and third day of her stay, she experienced melena of which the amount was about 300 ml. Abdominal ultrasonography revealed a gallbladder with a 8 mm sized cystic lesion attached to the fundus. Computed tomographic (CT) evaluation of the abdomen demonstrated a highly enhanced 7~8 mm sized nodular mass in the lumen of the gallbladder. The gallbladder, cystic duct, and CBD were dilated due to the filling of blood clots or sludge material. An ERCP was performed and bleeding from the papilla of Vater was confirmed. Subsequently, emergent laparoscopic cholecystectomy was conducted. Pathologic evaluation revealed a grayish-red gallbladder that had a ruptured vessel. The ruptured vessel showed a severe hypertrophic state but there was no evidence of vasculitis, aneurysm, arterio-venous malformation, or malignancy. The case is here in reported of hemobilia associated with spontaneous gallbladder hemorrhage.