Spontaneous Hemocholecyst in an End-Stage Renal Failure Patient on Low Molecular Weight Heparin Hemodialysis

Abstract

The present paper describes a case of spontaneous hemocholecyst in a patient with end-stage renal failure on low molecular weight heparin hemodialysis. The patient presented with acute right upper quadrant pain. An initial ultrasound scan demonstrated a distended gallbladder containing echogenic bile without stones. During hospitalization the patient became febrile, and jaundiced, developed leukocytosis, and had an elevation in serum bilirubin, transaminases, and alkaline phosphatase. A new ultrasound demonstrated a thick-walled gallbladder containing echogenic bile and pericholecystic fluid. MRI depicted a distended gallbladder containing material of mixed signal intensity and a normal biliary tract. Open cholecystectomy revealed a gallbladder filled with blood and clots, and transcystic common bile duct exploration flushed blood clots out of the bile duct. To our knowledge this is the second case of spontaneous hemocholecyst reported in the literature as a consequence of uremic bleeding and LMWH hemodialysis in the absence of other pathology.

Hemocholecyst complicated in a hemodialysis patient with microscopic polyangiitis

“…Hemocholecyst, which refers to bleeding confined to the gallbladder, is quite rare but is caused by various etiologies [6,7]. The main causes of hemocholecyst include cholecystitis, tumors, and iatrogenic complications.…”

“…The main causes of hemocholecyst include cholecystitis, tumors, and iatrogenic complications. Other rare causes include anticoagulation therapy, hemodialysis, and vasculitides [7][8][9]. Anticoagulation therapy can cause hemocholecyst similarly to gastrointestinal bleeding.…”

¿Cómo utilizamos los puntajes de riesgo?

“…Su etiología es diversa, asociándose a diversas etiologías como neoplasisas biliares, colecistitis, aneurisma de la arteria cística, hemobilia, coagulopatías, manipulación iatrogénica, isquemia y traumatismos abdominales. 1,2 Por esta última causa, los casos descritos son aún más escasos, y se deben normalmente a grandes politraumatismos, o traumatismos abiertos. Esta baja frecuencia se debe a la ubicación profunda de la vesícula en el abdomen, estando protegida por el hígado y la parrilla costal, aunque puede haber vesículas de localización más anteroinferior con mayor exposición.…”