[Spontaneous gallbladder rupture caused by "variceal hemorrhage"--an unusual complication of portal vein thrombosis].

Abstract

The post-mortem examination of a 50-year-old man, who had died suddenly, revealed a massive intraabdominal hemorrhage resulting from the rupture of an ectatic vein situated in the gall-bladder bed; the consecutive hemorrhage first led to a hematoma of the gall-bladder and secondarily to a tear of its wall. A macronodular alcoholic cirrhosis of the liver had caused a thrombosis in the hilar branches of the portal vein. The link in the pathogenesis between this portal vein occlusion and the venous bleeding into the gall-bladder is to be seen in a collateral circulation between the portal and caval system via the vena cystica. This unusual portal bypass using the veins of the gall-bladder extends the wide scope concerning the differential diagnosis of sudden natural death.