Hemobilia due to a tubulopapillary adenoma of the gallbladder
Küçük Resim Yok
Dosyalar
Tarih
2016
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Istanbul Medical Journal
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
Safra kesesi adenomları pediatrik yaş grubunda oldukça seyrek rastlanır. Adenomlar nadiren hemobilia nedeni olabilirler. 7 yaşındaki erkek hasta, üst GİS endoskopisinde ampulla vateride pıhtı ve aktif kanama görülmesi üzerine tarafımıza refere edildi. Vital bulgular stabildi. Konjuktivalarında ikteri bulunan hastanın, rektal tuşede melena görüldü. Dinamik karaciğer tomografisinde genişlemiş koledok mevcuttu. Yapılan sintigrafi ve anjiografide kanama odağı saptanamadı. Tanı sürecinde hemoglobin seviyesinde düşme ve hemodinamik instabilite gelişmesi üzerine hastaya hemobilia ön tanısıyla eksplorasyon kararı alındı. Laparotomide safra kesesi içerisinde kitle palpe edildi. Kolesistektomi yapıldı. Çıkarılan safra kesesinin intraoperatif incelemesinde fundusta birbirine komşu yaklaşık 1 ve 2 cm çaplarında, üzeri pıhtılı, yüzeyi düzensiz 2 adet polipoid kitle olduğu görüldü. Hasta postoperatif 13. gün şifayla taburcu edildi. Kolesistektomi materyalinin histopatolojik incelemesinde safra kesesindeki polipoid lezyonların tubulopapiller adenoma olduğu rapor edildi. Hemobilia safra yollarında kan varlığını tanımlamak için kullanılan bir terim olup, GİS kanamasının nadir görülen bir nedenidir. Hemodinamik instabiliteye yol açan kanama ile ortaya çıkmış safra kesesi polipleri hekimler için zor bir sınavdır. Ayrıca her zaman ameliyat öncesi kanama odağı saptanamayabilir. GİS kanaması ile birlikte biliyer semptomların varlığında çocukluk çağında da hemobilia akla gelmelidir.
Adenoma of the gallbladder is an uncommon bening tumor in pediatric population. It can be rarely cause of the hemobilia. A 7 year old boy was referred to our clinic due to active bleeding of the ampulla vateri which detected with upper gastrointestinal endoscopy. Initial hemodynamic parameters were stabile. Conjunctival icterus and melena were observed on physical examination. Computed tomography revealed dilatation of the common bile duct. Bleeding point was not detected on scintigraphy and angiography. During diagnosis course, hemoglobin level decreased and hemodynamic instability occurred and exploratory laparatomy was planned due to suspicion of the hemobilia. A mass of gallbladder was detected and cholecystectomy was performed. Intraopereative evaluation of gallbladder was revealed two irregular polypoid mass with coagulum, approximately 1 and 2 cm in diameter on fundus. The patient was discharged on the postoperative 13th day uneventfully. A tubulopapillary adenoma of the gallbladder was diagnosed on histopathological examination. Hemobilia is a term which used to describe the blood in the biliary tract and it is a rare cause of gastrointestinal bleeding. The clinical presentation of gallbladder polyps with haemodynamic instability due to tumoral hemorrhage is a challenging course for physicians. Also preoperative determination of the source of bleeding is not always possible. Hemobilia due to gallbladder polyps must be kept in mind for the presence of gastrointestinal bleeding in pediatric patients.
Adenoma of the gallbladder is an uncommon bening tumor in pediatric population. It can be rarely cause of the hemobilia. A 7 year old boy was referred to our clinic due to active bleeding of the ampulla vateri which detected with upper gastrointestinal endoscopy. Initial hemodynamic parameters were stabile. Conjunctival icterus and melena were observed on physical examination. Computed tomography revealed dilatation of the common bile duct. Bleeding point was not detected on scintigraphy and angiography. During diagnosis course, hemoglobin level decreased and hemodynamic instability occurred and exploratory laparatomy was planned due to suspicion of the hemobilia. A mass of gallbladder was detected and cholecystectomy was performed. Intraopereative evaluation of gallbladder was revealed two irregular polypoid mass with coagulum, approximately 1 and 2 cm in diameter on fundus. The patient was discharged on the postoperative 13th day uneventfully. A tubulopapillary adenoma of the gallbladder was diagnosed on histopathological examination. Hemobilia is a term which used to describe the blood in the biliary tract and it is a rare cause of gastrointestinal bleeding. The clinical presentation of gallbladder polyps with haemodynamic instability due to tumoral hemorrhage is a challenging course for physicians. Also preoperative determination of the source of bleeding is not always possible. Hemobilia due to gallbladder polyps must be kept in mind for the presence of gastrointestinal bleeding in pediatric patients.
Açıklama
Anahtar Kelimeler
Adenoma, Hemobilia, Safra kesesi, Gallbladder
Kaynak
Istanbul Medical Journal
WoS Q Değeri
Scopus Q Değeri
Cilt
17
Sayı
2
Künye
Tardu, A. Yağcı, M. A. Karagül, S. Işık, B. Yılmaz, S. (2016). Hemobilia due to a tubulopapillary adenoma of the gallbladder. Istanbul Medical Journal.
