J Korean Surg Soc.  2011 Sep;81(3):216-220. 10.4174/jkss.2011.81.3.216.

Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 55-year-old male patient

• Jung YM
• Son BK
• Ahn SB
• Kim DH
• Kim EK

• KMID: 2212200
• DOI: http://doi.org/10.4174/jkss.2011.81.3.216

Abstract

Hemorrhage in the gallbladder (GB) is usually associated with cholecystitis, GB neoplasm, trauma, hemobilia, and cystic artery aneurysm. Our patient had not experienced any previous abdominal trauma, and GB hemorrhage was unlikely to result from cholecystitis or bleeding diathesis. A 55-year-old male was admitted because of right upper quadrant pain. Both prothrombin time and partial thromboplastin time were normal. Abdominal computed tomography, endoscopic ultrasound and magnetic resonance cholangiopancreatography were performed. Image studies revealed GB wall thickening and an intraluminal mass. Laparoscopic cholecystectomy was performed. Upon opening the GB postoperatively, a large amount of fresh blood and old blood clot was noted. The incidence of GB hematoma is very rare. GB hematoma should always be considered in the differential diagnosis of GB tumor. In such a situation, surgical intervention is needed for further patient evaluation and management. We present a rare case of intramural GB hematoma, of which we were unable to make a definitive diagnosis preoperatively.

Keyword

Gallbladder; Intramural hematoma

MeSH Terms

Aneurysm
Arteries
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy, Laparoscopic
Cholecystitis
Diagnosis, Differential
Disease Susceptibility
Gallbladder
Gallbladder Neoplasms
Hematoma
Hemobilia
Hemorrhage
Humans
Incidence
Male
Middle Aged
Partial Thromboplastin Time
Prothrombin Time

Figure

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  Fig. 1 Enhanced CT shows luminal high density in gallbladder.

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  Fig. 2 Endoscopic ultrasonography shows diffuse wall thickening of the gallbladder with a fixed echogenic polypoid mass (arrow) in the gallbladder lumen.

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  Fig. 3 MRCP shows (A) heterogenous multiple filling defects in gallbladder with diffuse gallbladder wall thickening (arrow) and (B) mild diffuse biliary tree dilatation without demonstrable obstructive lesion.

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  Fig. 4 Grossly the mucosal epithelium of gallbladder is covered by unwashed blood clots without any masslesion.

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  Fig. 5 Microscopic finding shows diffuse transmural hemorrhage with mucosal necrosis and infiltration of chronic inflammatory cells (H&E, ×40).

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