A Case of Gallbladder Cancer with Essential Thrombocythemia Discovered by Hemobilia

Yuji Fujita, Takashi Nakamura, Tadahiko Enoki^* and Shinji Noshima^*

Department of Surgery, Hagi Civil Hospital
1st. Department of Surgery Yamaguchi University School of Medicine^*

A 72-year-old woman seen for severe back pain and epigastralgia found in computed tomography (CT) to have a slight high-density area in the gallbladder (GB), suggesting GB hemorrhage. She was treated for essential thrombocythemia (ET) for 3 years at another hospital. Abdominal ultrasonography (US) and magnetic resonance imaging (MRI) showed hemobilia and GB wall irregular and thickening. Gastrointestinal fiberscopy showed fresh hemobilia from the papilla of Vater. Based on a preoperative diagnosis of GB hemorrhage and cholecystitis with bile duct occlusion, we conducted emergent surgery due to rapidly deteriorating. Cholecystectomy, microwave coagulation therapy (MCT) of the liver bed, D1 lymph node dissection, and bile duct irrigation were done to relieve hemorrhagic symptoms. Operative cholangiography showed the intrahepatic bile ducts and common bile duct clearly. Resected specimens showed a Borrman II tumor with a clot in the GB fundus. The patient's course remains uneventful after 5 months of follow-up.

Key words
essential thrombocythemia, gallbladder cancer, hemobilia

Reprint requests
Yuji Fujita Department of Surgery, Social Insurance Tokuyama Central Hospital 1-1 Kouda-cho, Tokuyama-city, 745-8522 JAPAN

Accepted
January 22, 2003

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