Acute cholecystitis caused by hemocholecyst: unusual clinical manifestation of gallbladder cancer.

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.

METHODS

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.