A Rare Cause of Hemoperitoneum

Masuda, Hiro; Gill, Anthony J.; Samra, Jaswinder S.

doi:10.1053/j.gastro.2022.02.044

Cited by 1 publication

(2 citation statements)

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“…Uremic bleeding may also be a risk factor for a Dieulafoy lesion but there are few reports of this lesion being found in the stomach in patients on dialysis [ 12 – 14 ]. Furthermore, a Dieulafoy lesion occurring within the gallbladder has rarely been reported in the literature, with only eight previously published cases [ 15 – 17 ], and ours is the first case of a Dieulafoy lesion in the gallbladder in a patient on hemodialysis.…”

Section: Discussionmentioning

confidence: 87%

“…Gallbladder hemorrhage is difficult to diagnose on the basis of clinical findings alone because its symptoms mimic those of other common hepatobiliary diseases [ 3 ]. However, it is associated with high morbidity and mortality rates because of gallbladder perforation and massive hemorrhage [ 17 ]. Early diagnosis is important to facilitate urgent surgical management.…”

Section: Discussionmentioning

confidence: 99%

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Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report

et al. 2023

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Background Patients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy. Case presentation The patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion. Conclusions A Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.

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