Tago K, Ohwada S, Nakamura S, Kawashima Y, Ishikawa S, Morishita Y
Second Department of Surgery, Gunma University School of Medical, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):1020-3.
A 50-year-old man with hemobilia after percutaneous transhepatic gallbladder drainage (PTGBD) for cholecystitis is presented. PTGBD had been performed for acute cholecystitis following aortic valve replacement. A combination of aspirin and warfarin as anticoagulant therapy had been administrated with the prothrombin time of approximate 40%. Six months later, the patient was again admitted to our hospital because of jaundice, high fever and digestive bleeding. PTGBD was again attempted under the diagnosis of acute cholecystitis. Endoscopic retrograde cholangiopancreatography revealed coagula which were excreted from the papilla of Vater, thus followed by a cholecystectomy accompanying with a choledochotomy. Three ulcers were observed in the cut surface of the resected gallbladder. Microscopic examinations of the gallbladder showed hemorrhage and inflammation. We reported out patient because hemobilia in the chronic phase after aortic valve replacement is rare.
本文报道了一名50岁男性，因胆囊炎接受经皮经肝胆道引流术（PTGBD）后出现胆道出血。该患者在主动脉瓣置换术后因急性胆囊炎接受了PTGBD。当时联合使用阿司匹林和华法林作为抗凝治疗，凝血酶原时间约为40%。六个月后，患者因黄疸、高热和消化道出血再次入院。在诊断为急性胆囊炎后再次尝试进行PTGBD。内镜逆行胰胆管造影显示有从十二指肠乳头排出的凝血块，随后进行了胆囊切除术并伴胆总管切开术。在切除胆囊的切面上观察到三个溃疡。胆囊的显微镜检查显示有出血和炎症。我们报告该病例是因为主动脉瓣置换术后慢性期出现胆道出血的情况较为罕见。
