%0 Journal Article
%T Gallbladder ulcer erosion into the cystic artery: a rare cause ofupper gastro-intestinal bleeding Case report
%A Offir Ben-Ishay
%A Mouad Farraj
%A Pavel Shmulevsky
%A Benjamin Person
%A Yoram Kluger
%J World Journal of Emergency Surgery
%D 2010
%I BioMed Central
%R 10.1186/1749-7922-5-8
%X 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 [1]. 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. A gallbladder ulcer eroding into the cystic artery is very rare, and only a handful of case reports of this entity are reported in the literature. When diagnosed, angioembolization followed by cholecystectomy is the recommended treatment.We present a patient who was admitted due to melena and eventually was diagnosed as having hemobilia resulting from bleeding into the lumen of the gallbladder due to erosion of the cystic artery by gallstones.A 68 year old man, with past history of ischemic heart disease, hypertension, hypercholesterolemia, fatty liver and gallstones presented to the Emergency Department complaining of colicky pain in the right upper abdominal quadrant and black tarry stools. On admission, the patient was hemodynamically stable with a heart rate of 80 beats per minute, a blood pressure of 140/80 mmHg, and Oxygen saturation of 98%. Physical examination revealed jaundice and marked tenderness in the right upper abdominal quadrant. Digital rectal examination revealed melena with no fresh blood. Laboratory results showed leukocytosis, slight elevation in total bilirubin (3.25 mg/dl), elevated gamma glutamyl transpeptidase (738 U/l) and alkaline phosphatase-B (391 U/l). Ultrasonography showed a gallbladder with features compatible with cholecystitis containing large stones. No dilatation of the intra and extra-hepatic bile ducts was noted. Upper endoscopy with a side view endoscope revealed blood coming through the duodenal papilla with no evident papillary pathology. Angiographic computerized tomography (Figure 1) revealed active bleeding into the lumen of the gallbladder that contained two large stones.
%U http://www.wjes.org/content/5/1/8