Colecistectomía de emergencia con diagnóstico intraoperatorio de hemobilia: reporte de un caso / Emergency cholecystectomy with an intraoperative hemobilia diagnosis: case report

RESUMEN

RESUMEN La hemobilia (HB) es la presencia de sangre en o a través del tracto biliar. Las causas más comunes son iatrogénica, traumática, neoplasias y fístulas colangiovenosas o arteriobiliares. Y los cálculos biliares representan del 5-15 % de las causas. Presentamos el caso de una mujer 28 años, sin antecedentes, ni uso de anticoagulantes, diagnosticada inicialmente de colecistitis aguda, que requirió colecistectomía abierta de emergencia. Durante la operación se evidencia un coágulo adherido a la luz de la vesícula y dos cálculos. Confirmando el diagnóstico con los hallazgos histopatológicos. Debido a su similitud clínica, debe considerarse en pacientes con antecedentes de terapia anticoagulante, trauma, malignidad, o hallazgos compatibles con colecistitis alitiásica. Pero puede presentarse en pacientes sin antecedentes y estar asociado a colelitiasis. El tratamiento depende del estado hemodinámico y la etiología. Requiriendo cirugía en caso de colecistitis, ya que conlleva una alta tasa de mortalidad, y perforación vesicular (2-15 %).

ABSTRACT

ABSTRACT Hemobilia (HB) is the presence of blood in or through the biliary tract. Its most common causes are iatrogenic, traumatic, neoplasms, and cholangiovenous or arterio-biliary fistulas. Also, gallstones account for 5-15% of such cases. We present the case of a 28-year-old woman, with no remarkable history or anticoagulant use, who was initially diagnosed with acute cholecystitis, and required emergency open cholecystectomy. During the operation, a clot adhered to the gallbladder lumen and two calculi were evidenced. The diagnosis was confirmed with histopathological findings. Due to its clinical similarity, HB should be considered in patients with a history of anticoagulant therapy, trauma, malignancy, or with findings consistent with alithiasic cholecystitis. HB may also occur in patients with no remarkable history, and it be associated with cholelithiasis. Treatment depends on the patient's hemodynamic status and etiology. Surgery is required in cholecystitis, because of its high mortality rate and occurrence of gallbladder perforation (2-15%).