A Case of Gallbladder Carcinoma with Hemorrhage Causing Hemobilia and Cholangitis

Gen Sugawara, Akihiro Yamaguchi, Masatoshi Isogai, Tohru Harada, Yuji Kaneoka, Masahiko Suzuki, Atsushi Akutagawa, kiyoshi Suzumura and Tatsuya Usui

Department of Surgery, Ogaki Municipal Hospital

A 70-year-old female was admitted for right hypochondralgia. Blood biochemistry studies revealed evidence of inflammation, liver dysfunction, and jaundice. Abdominal ultrasonography (US) showed gallbladder wall thickening and common bile duct dilatation, suggesting acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed clotted blood in the papillary region, and 3 filling dafects were detected in the common bile duct. An endoscopic nasobiliary drainage (ENBD) tube was inserted for drainage, and cholecystography was performed through the ENBD tube. The fundus of the gallbladder was not visualized, suggesting retention of blood clots in the gallbladder. Angiography revealed a tumor stain in the superficial cystic artery during the late phase. Therefore, a preoperative diagnosis of gallbladder cancer with hemorrhage was made, and hepatectomy (S4a+5+6a), bile duct resection, and lymph node dissection were performed. The resected specimens showed a papillary-infiltrating tumor measuring 30×20 mm with a newly clotted blood in the gallbladder fundus. The histological diagnosis was atypical well-differentiated ductal adenocarcinoma.

Key words
gallbladder cancer, hemobilia, acute cholangitis

Reprint requests
Gen Sugawara Department of Surgery, Ogaki Municipal Hospital 4-86 Minamikawa-cho, Ogaki, 503-0864 JAPAN

Accepted
October 31, 2000

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