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Case of the Month

August 2012

Patient Data: Male patient 87 years old

Clinical Info: Patient conservatively treated for a cholecystitis with acute onset of severe pain in the right upper abdomen

Gallbladder of the same patient a few weeks earlier

There are stones in the neck and the gallbladderwall is slightly thickened

There is also some thickened bile in the gallbladder. The patient didn't want any invasive treatment and was therefore treated with antibiotics

Gallbladder of the same patient a few weeks later. After an acute onset of severe abdominal pain. The gallbladderwall is thickened the lumen filled with echogenic material

Another part of the gallbladder with echogenic contents

With color doppler there is a pulsatile jet into the gallbladder

44545-1740691_20120220__0020.swf arterial flow in the gallbladder

44546-1740691_20120220__0021.swf arterial flow in the gallbladder

44547-gallbladder_hemorrhage_1.swf CT scan arterial phase there is contrast in the gallbladder lumen

44548-gallbladder_hemorrhage_2.swf CT scan late phase the amount of contrast in the gallbladder lumen has increased

Arterial hemorrhage in the gallbladder in a patient with a cholecystitis
Bleeding into the biliary tree or hemobilia is a rare cause for upper gastro-intestinal bleeding that was first described by Francis Glison in 1654. Most commonly hemobilia is the result of trauma or investigatory interventions but inflammation, vascular malformation, malignancy and coagulopathy were also described as potential causes of hemobilia.

see also

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