Laparoscopic Cholecystectomy for Ruptured Gallbladder Varices Diagnosed by Preoperative Endoscopic Ultrasonography: A...

Gallbladder varices (GBV) are a rare form of ectopic varices associated with portal hypertension. They are often difficult to diagnose prior to rupture, which carries a high mortality rate. We report a case of ruptured GBV successfully treated with laparoscopic cholecystectomy following a definitive preoperative diagnosis by endoscopic ultrasonography (EUS).

A 43-year-old male with a history of alcoholic cirrhosis presented with epigastric pain. Contrast-enhanced CT revealed massive ascites and extravasation from the gallbladder wall, indicating active intra-abdominal hemorrhage. However, the specific etiology remained unclear. Transabdominal ultrasonography was suboptimal due to massive ascites and intestinal gas. Given the patient's high risk for emergency laparotomy in a resource-limited setting and stable hemodynamics, we opted for overnight conservative management. The following morning, EUS was performed to definitively identify the bleeding source and exclude other upper gastrointestinal bleeding. EUS revealed prominent blood flow around the gallbladder neck suggestive of varices. Based on these comprehensive findings, a diagnosis of ruptured GBV was established. This definitive diagnosis allowed us to select a minimally invasive laparoscopic cholecystectomy. The postoperative course was uneventful, and the patient was discharged on POD 7. Although strict follow-up was planned, the patient was lost to follow-up. He died 1 year later from another gastrointestinal hemorrhage.

Blood flow evaluation with EUS is valuable for the definitive diagnosis of ruptured GBV, especially when other imaging modalities are inconclusive. Accurate preoperative diagnosis by EUS enables the selection of laparoscopic cholecystectomy as a safe and effective therapeutic option, avoiding high-risk emergency open surgery in patients with liver cirrhosis.