Fatal hemoperitoneum due to bleeding from gallbladder varices in an end-stage cirrhotic patient A case report and review of the literature
Riccardo Pravisani 1, Walter Bugiantella 2, Dario Lorenzin 1, Vittorio Bresadola 1, Cosimo Leo 1
Affiliations
Article Info
1 General Surgery and Transplantation Unit, Medical and Biological Sciences Department, University of Udine, “Santa Maria della Misericordia” University Hospital, Udine, Italy.
2 General Surgery, “San Giovani Battista” Hospital, AUSL Umbria 2, Foligno, Italy. PhD School of Biotechnologies, University of Perugia, Italy.
Abstract
Gallbladder perforation with hemorrhage may be the source of massive hemoperitoneum under rare and extreme circumstances. In cirrhotic patients the bleeding may be associated with the tearing of gallbladder varices and represents a fatal complication, as reported in all the cases available in literature. The incidence of gallbladder varices in the setting of portal hypertension ranges 12-30%, although literature data are limited. We describe the case of an end-stage cirrhotic patient without portal thrombosis awaiting for orthotopic liver transplantation, who developed a fatal hemoperitoneum caused by massive bleeding from ruptured varices of both gallbladder wall and cholecystic fossa. The review of the literature was also performed.
Keywords
- Cirrhosis
- Gallbladder
- Hemoperitoneum
- Perforation
- Portal hypertension
- Varices