Publication:

Gallbladder carcinoma presenting as hemobilia and overt gastrointestinal bleeding: a rare case report

Gallbladder carcinoma (GBC) rarely presents as hemobilia or hemocholecyst. Intraluminal hemorrhage as the initial manifestation of gallbladder cancer is extremely uncommon, reported in nearly 1% of cases, with only a handful of cases described in the literature over the last three decades. A 54-year-old female presented with recurrent abdominal pain, melena, jaundice, and severe anemia requiring multiple blood transfusions. Repeated upper gastrointestinal endoscopies, colonoscopies, and contrast-enhanced computed tomography scans failed to identify the bleeding source initially. A subsequent upper gastrointestinal endoscopy demonstrated active blood ooze in the second part of the duodenum, raising suspicion of hemobilia. Further imaging revealed a gallbladder mass with common bile duct involvement. Exploratory surgery identified a gallbladder tumor with intraluminal blood clots extending into the common bile duct. The patient underwent radical cholecystectomy with liver wedge resection and en bloc excision of the common bile duct followed by Roux-en-Y hepaticojejunostomy. Histopathology confirmed grade 1 mucinous adenocarcinoma of the gallbladder (pT2a pN0). Postoperative recovery was uneventful, with no further episodes of gastrointestinal bleeding. This case highlights the diagnostic challenges of hemobilia in the absence of prior biliary intervention or trauma and emphasizes the importance of persistent evaluation and high clinical suspicion for early diagnosis of gallbladder malignancy presenting with obscure gastrointestinal bleeding.