CHRONIC CHOLECYSTITIS FOLLOWING HEMOBILIA DUE TO TRAUMATIC INTRAHEPATIC INJURY

We report a patient who presented with colicky abdominal pain, hematem esis, and melena following a blunt abdominal injury sustained in an au tomobile accident. Serologic tests suggested liver dysfunction and com puted tomography (CT) revealed dilatation of the intrahepatic bile duc t. Duodenoscopy demonstrated hemobilia originating from the duodenal p apilla of Vater. Angiography revealed a pseudoaneurysm of the hepatic artery and angiographic embolization successfully stopped the hemorrha ging. However, even following the angiographic embolization, the patie nt remained symptomatic and repeat CT demonstrated thickening of the g allbladder wall and a lesion resembling a blood clot. We strongly susp ected cholecystitis and performed a laparoscopic cholecystectomy, Gros sly, the resected specimen revealed wall thickening with a congested m ucosa and three blood clots; histologically, these changes were consis tent with a diagnosis of chronic cholecystitis. The clinical message o f this paper is that patients should be observed for this usual compli cation of hemobilia after liver injury.