CHRONIC ACALCULOUS CHOLECYSTITIS COMPLICATED BY MASSIVE HEMOBILIA

Objective: To report a case of massive haemobilia in association with chronic acalculous cholecystitis. Design: A single patient case report and a review of the literature. Setting: Gastroenterology unit in a university hospital. Patient: A 56-year old man, on oral anticoagulant treatment, presented with pain in the right upper abdomen and a distended gallbladder. Liver function tests were normal. After normalization of the blood coagulability, liver function tests deteriorated and melena was produced. Haemobilia was suspected because of these pathognomonic symptoms. The gallbladder, filled with blood clots, was resected during an operation but no gallstones were found. Histological examination showed chronic active inflammation of the gallbladder. Outcome: The patient is totally free of symptoms. Conclusion: To our knowledge, this is the first case of massive haemobilia to be reported in association with chronic acalculous cholecystitis. This report emphasizes the necessity of considering the biliary tract as a source Of gastrointestinal blood loss, especially in the presence of cholestasis.