Signet ring cell carcinoma of the gallbladder, especially the disease associated with a hematoma in the ligamentum teres hepatis, is rare. This paper deals with a case of signet ring cell carcinoma of the gallbladder in a patient who developed huge hematoma formation in the ligamentum teres hepatis during examination for cholelithiasis and cholecystitis which demanded emergency operation.
A 72-year-old woman brought into the emergency clinic in our hospital by ambulance for acute abdomen was admitted to the department of internal medicine with a diagnosis of cholelithiasis and cholecystitis. Conservative treatment resulted in temporary remission, but she had an attack of severe upper abdominal pain and the levels of WBC and CRP were elevated again. Computed tomography (CT) showed a large low density area at the surface of the left lobe of the liver and moderate amount of ascites. Perforation of the gallbladder was suggested, and so emergency operation was performed on the same day. At laparotomy a hematoma was present in the ligamentum teres hepatis and the gallbladder was firmly applied to the surrounding organs. After dissecting these adhesions, cholecystectomy and drainage of the hematoma were performed. Entire mucosa surface of the gallbladder presented tumorous appearance and invaded the liver. Histopathological diagnosis was signet ring cell carcinoma of the gallbladder.