Hemorrhagic emphysematous cholecystitis presenting as obstructive jaundice and hemobilia - 26/04/12
Doi : 10.1016/j.gie.2007.12.049
| Commentary Hemobilia was first described by Glisson (of capsule fame) who, in 1654, described the clinical course of a young nobleman who was stabbed in the right upper quadrant with a sword and died as a consequence of massive hemorrhage. The modern diagnostic triad of hemobilia was described by Quincke (of pulse fame) and includes right upper quadrant pain, jaundice, and upper GI bleeding; all 3 elements are present in only 30% to 40% of cases. The causes of hemobilia are many, but redolent of the unfortunate nobleman, perforating iatrogenic trauma such as percutaneous liver biopsy is quite common (also percutaneous cholangiography and instillation of drainage tubes), along with accidental blunt or penetrating trauma, gallstones, vascular disorders (eg, aneurysm and vasculitis), inflammatory biliary diseases (eg, ascariasis), and neoplasms (eg, hepatocellular carcinoma, cholangiocarcinoma). Hemobilia also may result from severe cholecystitis, as in this case. Bleeding may be scanty or profuse, intermittent or continuous, and clots in the biliary tree may dissolve, persist, or be expelled from the duct depending on the rate of bleeding: slow bleeding is more likely to be associated with durable clots and biliary obstruction, whereas clots usually do not form in the presence of rapid bleeding; clot lysis depends on bile being able to flow past the clot. Treatments vary with cause, but in this case cholecystectomy is just what the doctor ordered. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 1
P. 151-152 - luglio 2008 Ritorno al numero
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