Korean J Gastroenterol.  2017 Jan;69(1):79-82. 10.4166/kjg.2017.69.1.79.

Hemoperitoneum from Spontaneous Rupture of a Metastatic Abdominal Lymph Node in Gallbladder Cancer: A Case Report

• Choi YM
• Jeong SU
• Jwa HY
• Choi EK
• Kim MJ

• KMID: 2383436
• DOI: http://doi.org/10.4166/kjg.2017.69.1.79

Abstract

Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.

Keyword

Gallbladder cancer; Hemoperitoneum; Nodes; Rupture

MeSH Terms

Diagnosis
Gallbladder Neoplasms*
Gallbladder*
Hemoperitoneum*
Humans
Lymph Nodes*
Neoplasm Metastasis
Rupture
Rupture, Spontaneous*

Figure

• 

  Fig. 1. Gallbladder cancer with metastatic portocaval lymph node. (A) A mass with a size of 2.5 cm in the gallbladder (arrow) and high density fluid collection are located near the gallbladder bed (arrowhead). (B) CT shows a soft-tissue mass with a size of approximately 5 cm at the portocaval space (arrow) and high density fluid around the mass (arrowhead). (C) A gallbladder polyp and a soft tissue mass show intense hypermetabolism on the PET scan finding.

• 

  Fig. 2. Sequential changes of hemoperitoneum at the same level on coronal view of precontrast CT. (A) At admission, fluid collection is noted in the perihepatic space (arrowheads). (B) After 3 days, fluid collection is decreased without any interventions.

• 

  Fig. 3. Open cholecystectomy and lymph node dissection. (A) Hemoperitoneum is seen around the gallbladder (arrow) and ruptured lymph node (arrowhead). (B) Gallbladder wall is intact (arrow), but a metastatic lymph node is ruptured (arrowhead). (C) The surgically resected specimen shows 2.5 cm sized gallbladder cancer and 5cm sized ruptured metastatic lymph node.

Reference

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