This report details the first Japanese case of spontaneous gallbladder bleeding occuring in a maintenance hemodialysis patient, treated by urgent cholecystectomy. Maintenance hemodialysis was started in this 53-year-old man with gouty nephropathy in July, 1992. On July 13, 1995, he was admitted to San-ai Memorial Clinic because of an acute upper abdominal pain. Laboratory tests showed high GOT/GPT (132/60IU/l) levels. Abdominal ultrasonography revealed an enlarged gallbladder filled with hyperechoic material. On July 15, serum bilirubin and K levels increased to 6.6mg/dl and 7.5mEq/l, respectively. After hemodialysis, the patient was examined through a midline incision. A large tense gallbladder was found and was excised. Intraoperative sectioning revealed a thickened inflammatory gallbladder wall and a large blood clot that filled the lumen indicating hemorrhagic cholecystitis.
Intraoperative cholangioscopy revealed viscous hemobilia obstructing the common bile duct as the cause of janudice. A T-tube drain was placed in the bile duct. The patient recovered slowly, and was discharged after one month. There has been only one report on a hemodialysis patient in Japan who died due to gallbladder bleeding. Prognosis of this disease is good if an appropriate urgent treatment is carried out, and one should consider this disease in differential diagnosis of an acute abdomen in patients on hemodialysis.