[Angioleiomyoma of the gallbladder: a rare cause of hemobilia in a patient on dialysis].

HISTORY AND FINDINGS: Acute colicky upper abdominal pain occurred in a 47-year-old man on renal dialysis who also had chronic recurrent pancreatitis. On physical examination he was noted to be slightly jaundiced and he had slight pain when the liver edge was palpated. A few days later melaena developed and the haemoglobin concentration fell from normal levels to 6.9 g/dl.

INVESTIGATIONS: Serology gave no evidence of acute pancreatitis, but biochemical tests indicated cholestasis. Ultrasonography revealed widening of the intra- and extrahepatic biliary tract. Endoscopic retrograde cholecystopancreatography demonstrated bleeding from the biliary tract (haemobilia) as the source of the bleeding. Selective angiography of the coeliac trunk showed 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 angioleiomyoma of the gallbladder. The postoperative course was without complications and there was no further haemobilia.

CONCLUSIONS

Haemobilia is a relatively rare cause of upper gastrointestinal bleeding. It is usually due to trauma (accidental or iatrogenic) 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 or intermittent heparin administration for dialysis may in this patient have contributed to the bleeding.