Massive Hemobilia and Pancreatitis Due To Benign Gallbladder Polyp: Report of A Case

Abstract

Gallbladder polyps with concomitant hemobilia is a very rare pathological event. In this case, a gallbladder polyp causing pancreatitis due to massive upper gastrointestinal bleeding was presented. A 58 years old woman was admitted to the hospital with an upper right abdominal quadrant pain radiating to the back and right shoulder. Right upper quadrant tenderness and generalized jaundice has been detected on physical examination. Laboratory evaluation revealed an increased serum amylase, direct and indirect bilirubin levels and leukocytosis. She was diagnosed as pancreatitis. A massive upper gastrointestinal bleeding was seen on the second day of admission. After stabilization of general condition of patient by supportive therapy for pancreatitis, she went to operation. It was found that the bleeding was secondary to a gallbladder polyp and cholecystectomy was performed. She had an uneventful postoperative period and discharged from the hospital on the postoperative 14th day. As a conclusion, a gallbladder polyp can rarely be a cause of massive upper gastrointestinal bleeding and subsequent pancreatitis.©2008, Firat University, Medical Faculty

Keywords

• -

Benign Safrakesesi Polipine Bağlı Ağır Hemobili ve Pankreatit: Vaka Sunumu

Öz

Hemobili ile birlikte safra kesesi polipi nadir bir patolojidir. Bu vaka sunumunda safra kesesi polipinden kaynaklanan ağır bir üst gastrointestinal sistem kanaması sonrası meydana gelen pankreatit olgusu sunuldu. 58 yaşında bayan hasta hastanemize sırta ve sağ omuza yayılan sağ üst karın ağrısı şikayeti ile başvurdu. Karın sağ üst kadranda hassasiyet ve sarılık fizik muayenedeki bulgulardı. Laboratuar bulgularında amilaz, direk ve indirek bilirübin yüksekliği ve lökositoz mevcuttu. Hastaya pankreatit teşhisi konuldu. Yatışının ikinci gününde ağır bir üst gastrointestinal sistem kanaması görüldü. Pankreatit için destek tedavisi sonrasında genel durumu stabilleşen hasta ameliyata alındı. Kanamanın safrakesesindeki polipe bağlı olduğu anlaşıldı ve kolesistektomi uygulandı. Postoperatif dönemde problem gözlenmeyen hasta 14. gününde taburcu edildi. Sonuç olarak, safra kesesi polipi nadiren de olsa ağır üst gastrointestinal sistem kanaması ve pankreatitin bir nedeni olabilir.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Safra kesesi polipi, hemobili, pankreatit

References

1. Bazzoni C, Serini M, Ongari M, Sguazzini C, Alleva M, Lombardi C. Massive hemobilia caused by necrotic hemorrhagic cholecystitis. Report of a case. Minerva Chir 1993; 48: 857-860.
2. Ellington RT, Seidel RH, Burdick JS, Peterson WL, Harford WV. Acalculous cholecystitis presenting as hemobilia and jaundice. Gastrointest Endosc 2000; 51: 218-220.
3. Eric SS, Kim R. Geisinger: Case of the day 3. Diagnosis: hemobilia: Đntraluminal gallbladder hematoma. J Ultrasound Med 1993; 4: 240-249.
4. Yi Xue Za Zhi Kuo CM, Kuo CH. Changchien CS.Sequential sonographic changes of the gallbladder in hemobilia: case report of a patient with intrahepatic duct stones. Changgeng 1999; 22: 541-545.
5. Cappell MS, Marks M, Kirschenbaum H.Massive hemobilia and acalculous cholecystitis due to benign gallbladder polyp.Dig Dis Sci 1993; 38: 1156-1161.
6. van Dijk LC, Beishuizen A, Bronsveld W, van Dijk HA.Hemobilia, a rare and difficult diagnosis. Ned Tijdschr Geneeskd 1991; 135: 901-904.
7. Adam R, Fabiani B, Bismuth H.Hematobilia resulting from heterotopic stomach in the gallbladder neck. Surgery 1989; 105: 564-569.
8. Coelho JC, Bonin EA, da Costa MA, da Cunha AG, Sartor MA. Acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. Dig Surg 2001; 18: 227-229.

9. Jaeger M, Willimann P. Spontaneous hemobilia in the differential diagnosis of upper gastrointestinal hemorrhages. Schweiz Med Wochenschr 1976; 106: 1392-1395.