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Volume 76 - 2013 - Fasc.1 - Case reports

Acute cholecystitis caused by hemocholecyst : Unusual clinical manifestation of gallbladder cancer

Gallbladder cancer presenting as acute cholecystitis associated with a hemocholecyst is a rare entity. Up to date there are only 2 cases reported in literature. Acute cholecystitis may appear secondary to an obstruction of the cystic duct by the tumour itself or to an obstruction of the cystic duct by blood clots. Case report : A 74-years-old woman complained of right upper quadrant pain during the last 48 hours, associated to fever of 38oC and vomits. Physical examination revealed a positive Murphy's sign. Laboratory data showed leukocytosis and mild increasement of liver enzymes. Ultrasonography revealed a mobile extense formation located antigravitatorily in fundus and body of the gall- bladder. CT scan showed a mass adhered to the fundus and the body of the gallbladder without wall infiltration and contrast en- hancement, suggestive of hemocholecyst. Laparoscopic cholecys- tectomy was performed, observing cholecystitis signs without any other relevant features. Pathology revealed a large amount of clotted blood inside the gallbladder, some of them obstructing the cystic duct ; an irregularity was discovered in the gallbladder wall, whose microscopic analysis revealed a gallbladder adenocarcino- ma, infiltrating up to the serosa (T3NxMx). The patient underwent a second operation with resection of the gallbladder bed and lymph node dissection of the hepatic hilium, without evidence of neoplas- tic infiltration. (Acta gastroenterol. belg., 2013, 76, 57-58).


Colonic tuberculosis or Crohn's disease ? An important differential diagnosis

Abdominal tuberculosis can mimic any disease affecting the gastrointestinal tract such as infectious processes, tumors, peri- appendiceal abscess, and Crohn's disease. The differential diagno- sis of Crohn's disease and intestinal tuberculosis is a dilemma to clinicians and pathologists as both are chronic granulomatous dis- orders with similar clinical features. Lower gastrointestinal bleed- ing is an infrequent presentation of both intestinal tuberculosis and Crohn's disease. Herein, we report a 56-year-old woman present- ing with massive hematochezia due to isolated colon tuberculosis in whom the initial diagnostic work-up suggested Crohn's disease and review the current literature. Our report highlights the need for awareness of colonic tuberculosis in the differential diagnosis of massive hematochezia from Crohn's disease, especially before ini- tiating treatment with immunosuppressive agents. (Acta gastro- enterol. belg., 2013, 76, 59-61).


Spontaneous liver bleeding in a patient with congenital arterioportal fistulisation Presentation of a casus princeps and review of the literature

We present the first case reported in the literature describing spontaneous liver haemorrhage due to diffuse arterioportal fistu- lae. A 48-year old Caucasian woman was admitted to the hospital complaining of acute epigastric pain eradiating to the right shoul- der. Patient never had any penetrating or blunt abdominal trauma in the past nor any intervention on the liver. CT scan of the abdo- men revealed a subcapsular haematoma originating from two bleeding sites in the right liver lobe. Arteriography of the common hepatic artery showed opacification of the portal branches, indica- tive of an arterioportal fistula. A hypertrophic feeding branch of the right hepatic artery was then embolized, resulting in disappear- ance of the fistula. After complete resolution of the haematoma, investigations to detect underlying liver lesions were repeatedly negative. Therefore we conclude that a diffuse congenital arterio- portal fistula was the cause of spontaneous bleeding. This is to our knowledge the first case in whom a spontaneous liver bleeding secondary to diffuse arterioportal fistulisation is reported. A review of the literature regarding arterioportal fistulas and regarding the possible aetiology of spontaneous liver haematomas is provided. (Acta gastroenterol. belg., 2013, 76, 62-65).