Chronic cholecystitis following hemobilia due to traumatic intrahepatic injury

Abstract

We report a patient who presented with colicky abdominal pain, hematemesis, and melena following a blunt abdominal injury sustained in an automobile accident. Serologic tests suggested liver dysfunction and computed tomography (CT) revealed dilatation of the intrahepatic bile duct. Duodenoscopy demonstrated hemobilia originating from the duodenal papilla of Vater. Angiography revealed a pseudoaneurysm of the hepatic artery and angiographic embolization sucessfully stopped the hemorrhaging. However, even following the angiographic embolization, the patient remained symptomatic and repeat CT demonstrated thickening of the gallbladder wall and a lesion resembling a blood clot. We strongly suspected cholecystitis and performed a laparoscopic cholecystectomy. Grossly, the resected specimen revealed wall thickening with a congested mucosa and three blood clots; histologically, these changes were consistent with a diagnosis of chronic cholecystitis. The clinical message of this paper is that patients should be observed for this usual complication of hemobilia after liver injury.

Posttraumatic Acute Cholecystitis Caused by Intra-Gallbladder Hemorrhage in a Patient with Anticoagulant Therapy

“…Acute cholecystitis resulting from hemobilia was reported by Lee & Caruso [4] and Counichan et al [5]. There are a few previous case reports describing cholecystitis after posttraumatic intra-gallbladder hemorrhage, but none presented with acute cholecystitis [6,7]. We report the case of a patient who sustained an apparent minor trauma and presented a few days later with acute cholecystitis.…”