Angioleimyoma of the gall-bladder, a rare cause of haemobilia in patients on renal dialysis

History and findings: Acute colicky upper abdominal pain occurred in a 47-y ear-old man on renal dialysis who also had chronic recurrent pancreatitis. On physical examination he was noted to be slightly jaundiced and he had sl ight pain when the liver edge was palpated. A few days later melaena develo ped and the haemoglobin concentration fell from normal levels to 6,9 g/dl. Investigations: Serology gave no evidence of acute pancreatitis, but bioche mical tests indicated cholestasis. Ultrasonography revealed widening of the intra- and extrahepatic biliary tract. Endoscopic retrograde cholecystopan creatography demonstrated bleeding from the biliary tract (haemobilia) as t he source of the bleeding. Selective angiography of the coeliac trunk showe d extravasation in the region of the gallbladder. Treatment and course: As a vascular anomaly in the gallbladder was suspected, a cholecystectomy was performed. The surgical specimen revealed an angioleimyoma of the gallbladd er. The postoperative course was without complications and there was no fur ther haemobilia. Conclusions: Haemobilia is a relatively rare cause of uppe r gastrointestinal bleeding. It is usually due to trauma (accidental or iat rogenic) to the liver or the biliary tract. Rarely, as in this case, it can be caused by a benign mesenchymal neoplasm. Clotting disorder in uraemia o r intermittent heparin administration for dialysis may in this patient have contributed to the bleeding.