A CASE OF GALLBLADDER BLEEDING PROBABLY CAUSED BY ANGITIS DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS
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概要
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A 39-year-old woman who had been diagnosed as having systemic lupus erythematosus (SLE) at the age of 23 and had a one-month history of increased activity of SLE with increased PSL was seen at the emergency clinic because of intensifying epigastric pain which started 6 days earlier. On physical examination, there were localized tenderness and rebound soreness in the right upper quadrant of the abdomen. The WBC was 10, 800 and CRP was 2.2, showing mild inflammatory reaction. Abdominal CT scans revealed the contents of the gallbladder was composed of high and low density areas concomitantly. Ultrasonic study showed the gallbladder tightly filled with debris. After admission to the hospital the pain was aggravated and muscle guarding over the entire abdomen appeared. Generalized peritonitis was considered and an emergency surgery was carried out on the same day. During surgery, massive clots and bloody ascites in the abdomen and clots filled gallbladder were identified. Cholecystectomy and irrigation drainage were carried out. On pathological examination, bleeding from the full thickness of gallbladder wall, infiltration of inflammatory cells to small arteries under the muscular layer, and destroyed internal elastic lamella on EVG staining were noted. Gallbladder bleeding associated with aggravation of angitis due to SLE was considered.Since gallbladder bleeding caused by angitis associated with collagen diseases rarely occurs, this case is reported together with some bibliographical review.
- 日本臨床外科学会の論文
日本臨床外科学会 | 論文
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