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Gallbladder bleeding associated with microscopic polyangiitis: a case report
Daichi Kitaguchi1, Masanao Kurata1, Osamu Shimomura1
1Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
Abstract:
A 71-year-old male who had a 6 years history of microscopic polyangiitis (MPA) was admitted to our hospital with a chief complaint of upper abdominal pain and nausea. Abdominal contrast-enhanced CT revealed extravasation of contrast medium in the gallbladder, and the patient was diagnosed with gallbladder bleeding. Although we started conservative treatment, anemia, hypotension and tachycardia had progressed gradually. Therefore, we performed emergent laparoscopic cholecystectomy on the following day. Intraoperative findings showed a remarkably distended gallbladder due to interior clots; however, the cholecystitis itself was not significant. Histopathological findings showed infiltrations of inflammatory cells around the blood vessels and vascular rupture. The postoperative course was uneventful. MPA is a type of ANCA-associated vasculitis. To the best of our knowledge, this is the first report of gallbladder bleeding associated with MPA. Spontaneous hemostasis cannot be expected, instead, surgical treatment must be performed promptly.
Insights
Microscopic polyangiitis (MPA) can cause rare gallbladder bleeding, presenting as abdominal pain. Prompt surgical intervention, like laparoscopic cholecystectomy, is crucial for managing this serious condition.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Immunology
Background:
- Microscopic polyangiitis (MPA) is a systemic autoimmune disease characterized by inflammation of small blood vessels.
- ANCA-associated vasculitis (AAV) encompasses several conditions, including MPA, often affecting multiple organs.
Observation:
- A 71-year-old male with a 6-year history of MPA presented with upper abdominal pain and nausea.
- Contrast-enhanced CT revealed gallbladder bleeding, with conservative management leading to worsening anemia, hypotension, and tachycardia.
Findings:
- Emergent laparoscopic cholecystectomy was performed due to the patient's deteriorating condition.
- Intraoperative findings revealed a distended gallbladder with internal clots but no significant cholecystitis.
- Histopathology confirmed perivascular inflammatory cell infiltration and vascular rupture as the cause of bleeding.
Implications:
- This case represents the first reported instance of gallbladder bleeding associated with MPA.
- Gallbladder bleeding in MPA is a critical condition requiring prompt surgical management, as spontaneous hemostasis is unlikely.
- Highlights the importance of considering vasculitis in unexplained gastrointestinal bleeding and the need for timely surgical intervention.
