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Precordial pain caused by a hemocholecyst due to gallbladder cancer: A case report
1Department of Gastroenterological Surgery, Koga Community Hospital, Yaizu, Shizuoka, Japan.
Insights
A rare case of gallbladder cancer (GBC) presented as a hemocholecyst, causing precordial pain. Early diagnosis and surgery are crucial to prevent gallbladder perforation.
Area of Science:
- Gastroenterology and Oncology
- Diagnostic Imaging and Pathology
Background:
- A hemocholecyst, defined as gallbladder hemorrhage, is an uncommon manifestation.
- Gallbladder cancer (GBC) can present as intraluminal hemorrhage, leading to hemorrhagic cholecystitis.
- Symptoms of hemorrhagic cholecystitis often mimic classic acute cholecystitis, with precordial pain being an atypical presentation.
Observation:
- An 86-year-old woman presented with sudden-onset precordial pain, severe anemia, and abnormal gallbladder findings on CT.
- Laparoscopic cholecystectomy revealed a gallbladder lumen filled with blood clots and an infiltrating lesion.
- Histopathology confirmed moderately differentiated gallbladder adenocarcinoma.
Findings:
- The patient's precordial pain resolved postoperatively after cholecystectomy.
- This case highlights a rare presentation of GBC as a hemocholecyst causing precordial pain.
- Gallbladder adenocarcinoma was confirmed as the underlying cause.
Implications:
- Nonspecific precordial pain warrants consideration of abdominal imaging to rule out conditions like hemocholecyst.
- Gallbladder cancer should be considered in the differential diagnosis of hemocholecysts.
- Prompt diagnosis and surgical intervention (cholecystectomy) are essential for hemocholecyst management to avoid complications such as perforation.
Introduction And Importance:
A hemocholecyst refers to hemorrhage originating from and confined to the gallbladder. Intraluminal hemorrhage of the gallbladder is a rare symptom of gallbladder cancer (GBC), which can cause hemorrhagic cholecystitis. The symptoms of hemorrhagic cholecystitis are similar to those of classic acute cholecystitis where precordial pain is atypical. Here, we report a case of a precordial pain-inducing hemocholecyst due to GBC.
Case Presentation:
An 86-year-old woman was admitted to the emergency department due to persistent, sudden-onset precordial pain. Electrocardiogram (ECG) findings and cardiac enzyme levels were normal; however, severe anemia (hemoglobin 6.4 g/dL) was noted. Computed tomography (CT) showed a tense gallbladder with a heterogeneous, high-density area. Contrast-enhanced CT did not reveal contrast extravasation or obvious mass lesions. Considering the risk of hemorrhagic cholecystitis, we performed laparoscopic cholecystectomy. Operative findings were normal, however, the gallbladder lumen was filled with blood clots, while the gallbladder body had a papillary, infiltrating-type lesion.
Clinical Discussion:
Histopathological examination confirmed the diagnosis of moderately differentiated gallbladder adenocarcinoma. The precordial pain disappeared postoperatively. Due to the patient's age and general condition, no additional gallbladder bed resection or S4/5 hepatic bisegmentectomy and lymphadenectomy were performed.
Conclusion:
A hemocholecyst can cause precordial pain; therefore, abdominal imaging may be useful for diagnosing patients with nonspecific precordial pain. In addition, GBC should be considered as a potential cause of hemocholecysts. Early diagnosis and urgent cholecystectomy should be performed to prevent gallbladder perforation in patients with hemocholecysts.
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