RESUMO
Gallbladder cancer that presents as acute cholecystitis associated with hemocholecyst and hemobilia is a rare entity. There are few cases reported in the literature. We present a case of gallbladder carcinoma diagnosed after emergency cholecystectomy, performed due to hemobilia and acute cholecystitis due to hemocholecyst.
El cáncer de vesícula biliar que se presenta como una colecistitis aguda asociada a hemocolecisto y hemobilia es muy infrecuente. Hasta la fecha hay pocos casos informados en la literatura. Presentamos un caso de carcinoma de vesícula biliar diagnosticado tras colecistectomía de urgencia, realizada por hemobilia y colecistitis aguda por hemocolecisto.
Assuntos
Colecistite Aguda , Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar , Hemobilia , Colecistectomia , Colecistite Aguda/complicações , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Hemobilia/etiologia , Hemobilia/cirurgia , HumanosRESUMO
Introducción: La hemobilia es por definición una causa de hemorragia digestiva alta, donde existe una comunicación de la vía biliar en cualquiera de sus segmentos con vasos sanguíneos que desembocan a través de la ampolla de Vater. Su presentación es infrecuente y no sospechada en la práctica clínica diaria de gastroenterólogos, cirujanos, hepatólogos, clínicos e intensivistas, con un difícil manejo diagnóstico-terapéutico y una elevada morbi-mortalidad. Objetivo: Describir tres casos de pacientes con diagnóstico de hemobilia. Desarrollo: Se presentan tres casos con hemobilia que tuvieron una elevada mortalidad y con diferente etiología; en el primer caso por trombosis de la arteria hepática postrasplante hepático, el segundo secundario a un colangiocarcinoma de la unión hepatocística y el tercero con diagnóstico de un aneurisma de la arteria hepática derecha confirmado y parcialmente tratado por angiotomografía, posteriormente intervenido quirúrgicamente y único sobreviviente. Conclusiones: Resultaron tres casos con hemobilia de diferentes causas, con una elevada mortalidad por la intensidad de la hemorragia digestiva alta y las comorbilidades asociadas, además de señalar que ninguno de ellos presentó la tríada clásica reportada por Quincke(AU)
Introduction: Hemobilia is, by definition, a cause of upper gastrointestinal bleeding, where there is a communication of the bile duct in any of its segments with blood vessels that flow through the ampulla of Vater. It is rare and it is not suspected in the daily clinical practice of gastroenterologists, surgeons, hepatologists, clinicians and intensivists, hence the diagnostic-therapeutic management is difficult and it has high morbidity and mortality. Objective: To report three cases of patients with a diagnosis of hemobilia. Case report: We report three cases of hemobilia of high mortality and different etiology. The first case had post-liver transplantation hepatic artery thrombosis, the second had asecondary cholangiocarcinoma of the hepatocystic junction and the third had diagnosis of confirmed right hepatic artery aneurysm partially treated by CT angiography, subsequently operated on and the only survivor. Conclusions: These three hemobilia cases had different causes, and high mortality due to the intensity of the upper gastrointestinal bleeding and the associated comorbidities, in addition to noting that none of them exhibited the classic triad reported by Quincke(AU)
Assuntos
Humanos , Masculino , Fístula Arteriovenosa/epidemiologia , Colangiocarcinoma/epidemiologia , Hemobilia/diagnóstico , Hemobilia/etiologiaRESUMO
Hemobilia is defined as the presence of blood in the biliary tree characterized by the triad: jaundice, right hypochondrium pain (RH) and upper gastrointestinal bleeding (UGB). Among the etiologies highlighted in order of frequency there are: liver trauma (accidental and iatrogenic), inflammatory causes (acute and chronic cholecystitis), infections (cholangitis, liver abscesses, parasitic infections) and vascular diseases (aneurysms, vasculitis, arteriovenous malformations). There exist many complementary tests for the diagnosis of hemobilia, such as imaging (abdominal ultrasound, CT scan, angio CT), videoendoscopy, endoscopic retrograde cholangiopancreatography and angiography, the latter being considered the diagnostic tool and therapeutic modality of choice. We report the case of a 52-year-old male patient with hemobilia secondary to apseudoaneurysm ofthe hepatic artery, along with a review of the existing literature.
Assuntos
Falso Aneurisma/complicações , Hemobilia/etiologia , Artéria Hepática , Falso Aneurisma/diagnóstico , Evolução Fatal , Hemobilia/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A patient presents with abdominal pain associated with jaundice and upper gastrointestinal bleeding (hematochezia, melena) caused by hemobilia secondary to rupture of pseudoaneurysm of a branch of the right hepatic artery. The diagnosis was made by upper endoscopy, performing arteriography with selective embolization ceased bleeding.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Hemobilia/etiologia , Artéria Hepática/diagnóstico por imagem , Falso Aneurisma/complicações , Aneurisma Roto/complicações , Angiografia Digital , Endoscopia do Sistema Digestório , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Hemobilia é rara e potencialmente fatal. A suspeita de sangramento em trato biliar é maior em casos recentes de trauma hepático ou cirurgia hepatobiliar. Ruptura de pseudoaneurisma de artéria hepática é causa comum de hemobilia. Relatamos 3 casos de hemobilia em indivíduos jovens, acometidos por trauma abdominal, que evoluíram com ruptura de pseudoaneurisma e necessidade de embolização angiográfica de vaso sangrante.
Hemobilia is rare and potentially fatal. Suspect bleeding in the biliary tract is higher in recent cases of liver trauma or hepatobiliary surgery. Rupture of hepatic artery pseudoaneurysm is a common cause of hemobilia. We report 3 cases of hemobilia in young individuals suffering from abdominal trauma, who developed pseudoaneurysm rupture and need for angiographic embolization of bleeding vessel.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Adulto Jovem , Ruptura , Hemobilia , Sistema Biliar , Falso Aneurisma , Diagnóstico Diferencial , Embolização Terapêutica , Hemobilia/etiologia , Hemorragia Gastrointestinal/cirurgia , Artéria HepáticaRESUMO
La enfermedad de Caroli, o ectasia comunicante de las vías biliares intrahepáticas, es una entidad congénita, caracterizada por múltiples dilataciones saculares o quísticas de las vías biliares intrahepáticas. En este trabajo se hace presentación de un nuevo caso portador de enfermedad de Caroli. Se trata de una paciente de raza blanca, de 26 años de edad, con antecedentes de buena salud anterior, que ingresa por fiebre elevada de 39 ºC, hepatomegalia dolorosa e imágenes hipoecoicas en el hígado, detectadas en la ultrasonografia, con aminotransferasas hepáticas ligeramente elevadas. En el segundo ingreso sufre complicaciones febriles y de sangramiento digestivo alto por hemobilia importante, que compromete la hemodinamia y junto a la sepsis dan al traste con su vida. La paciente ingresa por crisis de colangitis y presentó un hemobilia importante que la llevó a complicaciones hemodinámicas, colangitis ascendente, y finalmente a sepsis generalizada como causa de muerte.
Caroli´s disease, or communicant ectasia of the intrahepatic biliary ducts, is a congenital entity, characterized by multiple saccular or cystic dilatations of the intrahepatic biliary ducts. In this work we present a new case of a carrier of Carolis disease. It deals with a female patient, aged 26 years, with antecedents of good health status, who entered the hospital with high fever of 39oC, painful hepatomegaly and hyper echoic images in the liver, detected in the ultrasonography, with slightly raised hepatic aminotranferases. During the second staying in the hospital she suffered fever complications and high digestive bleeding caused by important hemobile that compromised the hemodynamics and together with sepsis caused her to die. The patient entered the hospital because of cholangitis and presented an important hemobile leading her to hemodynamic complications, ascendant cholangitis, and finally a generalized sepsis as death cause.