Ruiz-Tovar Jaime, Mingol Fernando, Oller Inmaculada, Santos Jair, Calpena Rafael
Department of General and Digestive Surgery, General University Hospital Elche, Alicante, Spain.
Acta Gastroenterol Belg. 2013 Mar;76(1):57-8.
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.
A 74-years-old woman complained of right upper quadrant pain during the last 48 hours, associated to fever of 38 degrees C 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 gallbladder. CT scan showed a mass adhered to the fundus and the body of the gallbladder without wall infiltration and contrast enhancement, suggestive of hemocholecyst. Laparoscopic cholecystectomy 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 adenocarcinoma, 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 neoplastic infiltration.
以急性胆囊炎伴胆囊积血形式出现的胆囊癌是一种罕见情况。截至目前，文献中仅报道了2例。急性胆囊炎可能继发于肿瘤本身对胆囊管的阻塞或血凝块对胆囊管的阻塞。
一名74岁女性在过去48小时内主诉右上腹疼痛，伴有38摄氏度发热和呕吐。体格检查显示墨菲氏征阳性。实验室检查数据显示白细胞增多和肝酶轻度升高。超声检查显示胆囊底部和体部有一个可移动的广泛占位。CT扫描显示一个肿块附着于胆囊底部和体部，无壁浸润和对比增强，提示胆囊积血。进行了腹腔镜胆囊切除术，观察到胆囊炎体征，无任何其他相关特征。病理检查显示胆囊内有大量凝血块，其中一些阻塞了胆囊管；在胆囊壁发现一处不规则，其显微镜检查显示为胆囊腺癌，浸润至浆膜层（T3NxMx）。患者接受了第二次手术，切除胆囊床并进行肝门淋巴结清扫，未发现肿瘤浸润迹象。
