https://scholars.lib.ntu.edu.tw/handle/123456789/593246
Title: | Hemobilia associated with acute calculus cholecystitis successfully treated with endoscopic naso-biliary drainage and laparoscopic cholecystectomy - A case report | Authors: | Wang C.-C. CHUN-JEN LIU Chen C. Lin C.-H. |
Keywords: | Acute calculus cholecystitis; Endoscopic naso-biliary drainage; Hemobilia; Laparoscopic cholecystectomy | Issue Date: | 2006 | Journal Volume: | 18 | Journal Issue: | 2 | Start page/Pages: | 137-140 | Source: | Tzu Chi Medical Journal | Abstract: | Hemobilia is a rare condition and is difficult to diagnose clinically. It is sometimes confirmed during endoscopic procedures. We report a case of a 49-year-old man who had epigastralgia with radiation to the back and tea-colored urine for 2 days. The laboratory tests revealed leukocytosis and abnormal liver function tests (aspartate transaminase (AST) 643 U/L, alanine transaminase (ALT) 510 U/L, total bilirubin 3.5 mg/dL and alkaline phosphatase 295 U/L). An abdominal ultrasound showed a dilated common bile duct and irregular, hyperechoic material within the distended gallbladder. The wall of the gallbladder was thickened with accumulated peri-cholecystic fluid. An emergency endoscopic retrograde cholangiography was performed and fresh blood was flushed out upon cannulation of the papillae. A cholangiogram revealed some filling defects in the dilated common bile duct. Hemobilia was confirmed. Endoscopic naso-biliary drainage was performed immediately to relieve the biliary obstruction and to monitor the amount of bleeding. Computed tomography found small stones and a heterogenous lesion in the distended gallbladder. A hematoma was diagnosed. Angiography of the hepatic artery found no definite vascular abnormality. The patient had a laparoscopic cholecystectomy 3 days later. Pathology reported acute calculus cholecystitis and multiple ulcers with hemorrhage and fibrin deposition over the mucosal surface. In conclusion, hemobilia associated with acute calculus cholecystitis is rarely seen clinically and seldom reported in the literature. We successfully treated this patient with endoscopic naso-biliary drainage and a laparoscopic cholecystectomy. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-33745086540&partnerID=40&md5=614d68dd589a202059b6c7ff2abc5152 https://scholars.lib.ntu.edu.tw/handle/123456789/593246 |
ISSN: | 1016-3190 | SDG/Keyword: | antibiotic agent; cefazolin; gentamicin; acute cholecystitis; adult; angiography; article; case report; cholecystectomy; clinical feature; computer assisted tomography; disease association; endoscopy; follow up; hemobilia; human; laboratory test; male; ultrasound |
Appears in Collections: | 臨床醫學研究所 |
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