A haemorrhagic cholecystitis presenting as obstructive jaundice
A 63-year-old female suffered right upper quadrant pain for 5 days, and icteric sclera for 3 days. Her Laboratory examinations revealed a normal blood routine and abnormal bilirubin levels: total bilirubin 222.0 µmol/L, direct bilirubin 131.8 µmol/L. Stool occult blood was negative. Abdomen/pelvis CT (Panel A) and MRCP (Panel B) showed cholecystolithiasis and lower choledocholithiasis.
In endoscopic retrograde cholangiopancreatography (ERCP), a large filling-defect was found blocking the common bile duct (Panel C). A dark red clot was taken out with reticular basket (Panel D), following by flow of blood. The bleeding stopped spontaneously soon. An endoscopic nasobiliary drainage (ENBD) was performed.
The day after ERCP, dull-red bile was drain from her ENBD tube. A new nebulous high-density shadow in cholecyst was observed by enhanced abdomen/pelvis CT, which revealed active hemorrhage (Panel E). This patient underwent an emergency operation. Intraoperatively, there was necrosis and perforation on the gallbladder wall, multiple gallstones, clot and blood in lumen of gallbladder.
Acknowledgments
We thank numerous colleagues from Sir Run Run Shaw Hospital for their useful case data which have greatly improved the manuscript.
Funding: None.
Footnote
Provenance and Peer Review: This article is a standard submission to the editorial office, Hepatobiliary Surgery and Nutrition. The article has been sent for external peer review.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.org/article/view/10.21037/hbsn-20-737/coif). The authors have no conflicts of interest to declare.
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