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

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.

Haemocholecyst related to gallbladder malignancy

“…1 Its many causes include gallstones, gallbladder cancer, polyps, cystic artery aneurysm, parasites, ischemia, the presence of heterotopic gastrointestinal mucosa within the gallbladder, coagulation disorder and trauma (including iatrogenic causes, such as liver biopsy and radiofrequency ablation). 2–8 The diagnosis of haemocholecyst is difficult. There is no specific clinical feature.…”

Vascular disorders of the gallbladder and bile ducts: Imaging findings

“…Hemorrhage into the gallbladder lumen may occur in a variety of settings including trauma, gallbladder tumors, biliary parasitic infection, bleeding diathesis, 20 cholecystectomy, 33 and anticoagulant therapy. 34 Rarer causes include vascular malformations and cystic artery aneurysms. Gallbladder hemorrhage itself may result in cystic duct obstruction and secondary cholecystitis.…”

“…34 Pathologically there is transmural inflammation of the gallbladder wall with resultant infarction and erosion of the mucosa, which in turn may cause hemorrhage into the gallbladder lumen. 34 In some cases, the inflammation may involve the wall of the cystic artery, 35 resulting in damage to the adventitia with localized weakness in the vessel wall 33 and pseudoaneurysm formation. 36 Fujimoto et al 35 cystic artery pseudoaneurysms secondary to cholecystitis.…”

“…36 On US, gallbladder wall thickening and intraluminal membranes may be seen. 34 Clots within the gallbladder appears as non-shadowing echogenic material and may appear masslike 36 (Figure 6a). Nonenhanced CT images may show highattenuating material layering in the gallbladder or fluid-fluid levels 20 (Figure 7).…”

Adenocarcinoma of the Gallbladder (Classical Gallbladder Cancer)

“…Mucin-containing RokitanskyAschoff sinuses with extracellular mucin deposits may mimic mucinous adenocarcinoma of the gallbladder (Albores-Saavedra et al 2009). Pseudotumorous lesions, e.g., intramural gallbladder hematomas (Tan et al 2005) and gallstone granulomas (Tham and Ng 2001;Jung et al 2011), may also mimic CG. Rare massproducing specific inflammations of the gallbladder can produce presentations similar to that of cancer, including gallbladder tuberculosis (Hegler 1925;Ramia et al 2006;Soufi et al 2011;Verma et al 2012Verma et al ), brucellosis (Ögredicie et al 2010, and actinomycosis (Hefny et al 2005;Lee et al 2007).…”