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Case Reports
. 2013 Apr 7;19(13):2126-8.
doi: 10.3748/wjg.v19.i13.2126.

Obstructive jaundice and melena caused by hemocholecyst: a case report

Ying Fan  1 , Shuo-Dong Wu, Jing Kong
Affiliations
Case Reports

Obstructive jaundice and melena caused by hemocholecyst: a case report

Ying Fan et al. World J Gastroenterol. .

Abstract

A hemocholecyst (HC) is a clot-filled gallbladder caused by bleeding into its lumen. Obstructive jaundice caused by the compression of HC to the hilar biliary tract is likely to be misdiagnosed as cholangiocarcinoma and is extremely rare. We herein report a case of obstructive jaundice and melena caused by HC. A 57-year-old male patient presented with right upper quadrant pain associated with icteric sclera and melena was suspiciously diagnosed as having malignant cholangiocarcinmoa by abdominal ultrasonography, computed tomography and magnetic resonance imaging. Laparotomy found a hematoma in the gallbladder. The hematoma spread to the left hepatic lobe forming an exogenous mass which compressed the hilar biliary tract. Radical cholecystectomy and bile duct exploration with T-tube drainage were performed. Histopathological examination revealed massive necrosis of the gallbladder mucosa with inflammatory cells infiltration as well as intraluminal hematoma formation. One month after operation, a T-tube cholangiography revealed a normal biliary tree. We suggest that HC should be considered in patients with obstructive jaundice and melena after common causes are ruled out.

Keywords: Biliary tract; Hemocholecyst; Jaundice; Melena; Obstruction.

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Figures

Figure 1
Figure 1
Preoperative imaging findings. A: Ultrasonography revealed a mass with heterogenous echo at the gallbladder region (arrows); B: Computed tomography (CT) showed thickening of the fundus and body of gallbladder wall (arrow); C: CT showed a mass with high-density shadow located at the gallbladder neck without clear demarcation from the left hepatic lobe (arrows); D: Magnetic resonance imaging (MRI) showed a mass located at the gallbladder neck and left hepatic lobe (arrows); E: MRI showed slight dilation of intrahepatic ducts and an obscure image of hilar biliary tract (arrow).
Figure 2
Figure 2
Schema of the hematoma found at the neck of the gallbladder during operation. The arrow indicates hematoma.
Figure 3
Figure 3
T-tube cholangiography revealed a normal biliary tree after operation.
See this image and copyright information in PMC

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