Gallbladder Lumen Research Articles

Gallstone causing pseudoaneurysm of accessory right hepatic artery

A 64-year-old man presented with pain in abdomen, jaundice and melena; physical examination revealed a palpable gallbladder. Ultrasonography was suggestive of gallbladder (GB) mass. CECT abdomen showed pseudoaneurysm of accessory right hepatic artery arising from superior mesenteric artery (Fig. 1) with rupture into GB lumen. There was extension of GB lumen into cavity within segments 5 and 4 of liver with large calculus within GB. Two units of blood were transfused. CT angiography showed pseudoaneurysm of accessory right hepatic artery arising from superior mesenteric artery as first branch (Fig. 2). Embolization of accessory hepatic artery was done. After few days, he presented with pain abdomen, fever and jaundice. Diagnostic laparoscopy showed large calculus occupying the entire GB. The stone was extracted and cholecystectomy was done by excising the GB up to Hartman pouch. We did not explore the area around the aneurysm. The patient made an uneventful recovery. Hemobilia should be considered in patients presenting with upper abdominal pain and upper gastrointestinal bleeding. Less than a third of patients present with Quinke’s triad: abdominal pain, jaundice and melena

Magnetic resonance demonstration of gall bladder ascariasis

A 40-year-old man presented with right hypochondrial and epigastric pain and tenderness. There was no history of jaundice or vomiting. Serum alkaline phosphatase was mildly elevated (170 IU/L). His ultrasound was suggestive of gall bladder worms or stones. MRI revealed curvilinear hypointense structure in the gall bladder (Fig. 1); this suggested the diagnosis of gall bladder ascariasis. Common hepatic and bile ducts were normal. Stool examination revealed ova of Ascaris lumbricoides. The patient was given analgesics and albendazole (400 mg single dose). Three days later, he reported relief of symptoms and passage of worm in the stools. Ultrasound done 4 days later showed no worm in the gall bladder. The adult worm of ascariasis usually resides in the small bowel. It can occasionally migrate into biliary system. Involvement of gall bladder is rare because of the small size of cystic duct [1]. Ultrasound is the usual imaging modality for diagnosing gall bladder ascariasis which demonstrates it as curvilinear echogenic structure [1]. In cases which are inconclusive on sonography, MRI may show curvilinear hypointense structure in the gall bladder lumen, while gall stones typically appear as rounded objects of signal void [2]. MRI also allows simultaneous visualization of common hepatic and common bile ducts. Gall bladder ascariasis is usually treated by surgery and endoscopy. Occasionally, medical therapy may lead to spontaneous passage of worm, as happened in our case.

Ablación con láser de la vesícula biliar en un modelo animal

IntroductionAttempts to remove the gallbladder by non-surgical means began in the 1980's, by applying chemicals, heat or laser to remove its mucosa and reduce it to an innocuous scar. The aim of this work is to determine whether complete ablation of this organ is possible using total ablation by applying a diode laser. Material and methodsThirty rabbits were divided into 3 groups of 10 animals. The gallbladder was surgically accessed and a 980nm diode laser was applied endoluminally using fibre optics until it shrunk. Ethanol was used as a sclerosing agent plus a fibrin tail to seal the gallbladder lumen in one of the control groups, and a physiological solution was used in the rest. The animals were slaughtered at 65 days and the results of the procedure were observed macroscopically and histologically, evaluating the remains of the gallbladder lumen, fibrosis, and areas of re-epithelialisation. Statistical analysis was made using the Fisher test. ResultsEight of the gallbladders treated by laser disappeared leaving a small sub-hepatic scar. There were no complications during or after surgery. The results were successful in only case in the ethanol group, and there was no ablation with physiological solution. The comparison of the results showed a significant positive difference in the group treated with laser compared to those with ethanol plus fibrin tail (P<.0055) and the physiological solution (P<.0007). ConclusionsAblation of the gallbladder using a diode laser was possible in this experimental model.

Determination of cystic duct patency using hepatobiliary MRI with gadoxetate disodium: Is T1 precontrast imaging necessary?

To determine the need for precontrast T1-weighted imaging in determining cystic duct patency using hepatobiliary phase imaging with gadoxetate disodium-enhanced magnetic resonance imaging (MRI). MRI exams using gadoxetate disodium from October 4, 2008 to April 14, 2010 were reviewed in a retrospective fashion. Two reviewers independently reviewed only the 20-minute T1-weighted delayed postcontrast images to determine the presence of excreted contrast in the gallbladder lumen. Contrast was deemed present if hyperintense signal material was seen in the antidependent portion of the gallbladder lumen. The actual presence of contrast in the gallbladder was determined by directly comparing the pre- and postcontrast T1-weighted images using consensus review. In all, 187 cases were included. Three (1.6%) were deemed indeterminate due to complete homogeneous opacification of the gallbladder. All three cases were identified as indeterminate by both reviewers. Of the remaining 184 cases, 136 filled (74%) and 48 did not fill (26%). Both reviewers correctly identified 136/136 cases of gallbladder filling. Reviewer A identified 47/48 cases of nonfilling and reviewer B identified 46/48 cases of nonfilling. Sensitivity and specificity were 100% and 98% for reviewer A and 100% and 96% for reviewer B, respectively. The presence of excreted contrast in the gallbladder lumen can be determined using gadoxetate disodium-enhanced MRI without precontrast T1-weighted imaging.

Isolation of Salmonella typhi from apparently healthy liver

It is suggested that Salmonella typhi resides mostly in hepatobiliary system especially in gallbladder in chronic typhoid carriers. It is not very clear whether in gallbladder lumen or on its wall or in liver. However, we had been successful in detecting S. typhi in liver by PCR targeting flagellin gene sequences. Therefore, in the present study, we tried to isolate the bacterium from liver tissue collected from dead bodies brought for post mortem examination. We could isolate S. typhi in 2 of 20 such liver tissues examined by using conventional isolation techniques. The isolates were identified by routine phenotypic characters and were confirmed by amplification and sequencing of two conserved genes i.e. 16S rDNA and flagellin (fliC) gene followed by blasting on www.ncbi.nlm.nih.gov.

Mucin-producing gallbladder carcinoma.

A 54-year-old Japanese woman presented with epigastralgia. Physical examination revealed tenderness in the epigastrium. Laboratory test results showed elevated levels of AST (103 mU/ml), ALT (203 mU/ml), gamma GTP (642 mU/ml), and ALP (2,132 mU/ml). Ultrasonography (US) using a SSD-5500 (Aloka, Tokyo, Japan) showed a hyperechoic protrusion in the fundus of the gallbladder, with diffuse and mild wall thickening (Fig. 1). Spotty and linear hyperechoic contents were seen in the enlarged gallbladder lumen and intraand extrahepatic bile ducts (Fig. 2). Contrast-enhanced CT depicted a papilla-like protrusion with mild enhancement (Fig. 3). Dilatation of the intraand extrahepatic bile ducts was observed. Endoscopic retrograde cholangiopancreatography showed variable filling defects in the gallbladder and common bile duct, suggesting the presence of mucin, and pancreaticobiliary maljunction (Fig. 4). Cytological examination of the bile showed the presence of malignancy. Carcinoma of the gallbladder being diagnosed, gallbladder and bile duct resection, as well as lymph node dissection, was performed. The resected gallbladder contained a massive amount of mucin together with the tumor, which showed a papillary growth pattern. Histopathological examination using immunostaining revealed a papillary tumor consisting of an adenoendocrine cell carcinoma containing mucus. The postoperative course in this patient was uneventful.

Echogenic Lesions Replacing Gallbladder Lumen: Various Causes and Radiologic Findings

1. To know the various causes of echogenic lesions replacing the gallbladder lumen. 2. To review the radiologic findings of various echogenic lesions replacing the gallbladder lumen, including gallstones, bile sludge, hemobilia after liver biopsy, hemorrhagic cholecystitis, hemobilia with small papillary adenocarcinoma, large undifferentiated carcinoma and air from cholecystoduodenal fistula. 3. To understand the clues for differential diagnosis of echogenic lesions replacing the gallbladder lumen.

Multiseptate gallbladder as a cause of recurrent abdominal pain in a child

Dear Editor, The congenital malformations of the gallbladder are classified as anomalous forms, abnormal position, and absence. Multiseptate gallbladder is a quite rare condition, which was first described by Simon and Tandon in 1963 [1-3]. A 10-year-old female was admitted to the hospital with recurrent attacks of abdominal pain for about one year duration. There was no history of sickle cell disease or any other blood disorders. Physical examination revealed a healthy young girl with no other abnormalities. Laboratory tests showed leucocytosis and a slight increase in transaminases and total bilirubin. Other laboratory tests were normal. Abdominal ultrasound revealed a multiseptate gallbladder with normal wall thickness, which resulting in a multi-compartment feature (Figure 1). No calculi were present. There were no gallstones or dilatation of the intrahepatic and extrahepatic bile ducts. On the basis of ultrasound study, a diagnosis of multiseptate gallbladder was made. The patient was treated conservatively. After the first week of treatment, she had complete relief of abdominal pain and her laboratory test results returned to normal. Follow-up sonography was performed and no change was found in the sonographic signs. Multiseptate gallbladder is a quite rare condition, which commonly causes symptoms suggestive of cholecystitis. Most patients are female adults though it can occur in children and men. Previously reported multiseptate gallbladder cases have been characterised by the presence of multiple thin septa dividing the gallbladder lumen into various sized chambers, often with a honeycomb appearance. Recurrent abdominal pain in childhood due to gallbladder disease is often misinterpreted as intestinal and genitourinary pathologies. Cholelithiasis and cholecystitis are very rare before puberty. If it is present, it is mostly related to bacterial and parasitic infections, hemolytic conditions and chronic gastrointestinal diseases [3-6]. The mechanism of pain in these patients is not well known. The symptoms are probably due to increased intraluminal pressure of the gallbladder and the mechanical effect of septa impairing normal bile flow. Biliary calculi are usually absent in multiseptate gall-bladder while choledochal cysts have been associated [1, 2, 4, 5]. In conclusion, gallbladder abnormalities, although rare should always be considered in the differential diagnosis of children presenting with recurrent attacks of abdominal pain, and abdominal ultrasound should form part of their investigations.

Intestinal and chronic infections: Salmonella lifestyles in hostile environments

The main disease syndromes caused by Salmonella serovars in immunocompetent individuals are gastroenteritis and typhoid fever. These syndromes differ with regard to the host niches in which Salmonella serovars grow and survive to ensure their transmission. During gastroenteritis, non-typhoidal Salmonella serovars such as Salmonella enterica serovar Typhimurium (S. Typhimurium) use their virulence factors to elicit acute intestinal inflammation, thereby creating a novel luminal niche. Reactive oxygen species produced by phagocytes in the intestinal lumen oxidize endogenous sulfur compounds to produce a new respiratory electron acceptor, tetrathionate. Respiration of tetrathionate confers a growth advantage to S. Typhimurium over competing microbes. This growth advantage ensures transmission of the pathogen by the faecal-oral route. In typhoid fever, S. enterica serovar Typhi (S. Typhi) establishes a chronic infection in the gall bladder, and perhaps in additional niches. Studies using the mouse model of typhoid fever suggest that survival and proliferation in the gall bladder may involve several strategies. Invasion of the gallbladder epithelium and formation of biofilms on gallstones may protect the pathogen from the bactericidal activities of bile salts. In the gallbladder lumen, activation of bile defence responses may permit survival of planktonic Salmonella cells. Individuals developing chronic carriage after an episode of typhoid fever can transmit the disease for the remainder of their lives by shedding the pathogen through the cystic duct. Shedding promotes S. Typhi transmission to new susceptible hosts. Here we review Salmonella virulence strategies for growth and survival in host niches that represent reservoirs for transmission.

Carcinosarcoma of the Gallbladder Arising in a Patient with Pancreaticobiliary Maljunction: A Case Report and Review of the Literature

Background: Carcinosarcoma of the gallbladder is a very uncommon malignancy. We present a case of gallbladder carcinosarcoma arising in a 38-year-old female patient with pancreaticobiliary maljunction where FNA documented recurrence of this very unusual tumor. Case: A 38-year old woman presented with signs and symptoms of acute pancreatitis due to gallstones (biliary pancreatitis) Further investigations, including abdominal ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP), revealed an ill-defined mass in the gallbladder, in addition to pancreaticobiliary maljunction. At laparoscopic cholecystectomy, a mass was found within the gallbladder lumen itself. A biphasic malignant neoplasm was diagnosed in a free lying, polypoid mass within the gallbladder lumen. This carcinosarcoma was considered to have been locally confined to the gallbladder, equivalent to a stage T1a, and further surgery was not undertaken. The patient re-presented under a year later with dyspnoea; and a large subdiaphragmatic mass was noted that underwent ultrasound-guided fine needle aspiration (FNA) biopsy. The cytomorphologic findings showed a tumor comprising malignant glandular structures and pleomorphic stromal cells in a metachromatic background, compatible with the previous diagnosis of carcinosarcoma. Conclusion: Carcinosarcomas are uncommon malignancies and can arise in almost any site where carcinomas arise. Careful attention to morphology will allow the biphasic nature of this lesion to be determined but ancillary investigations may be required. Carcinosarcoma is a biphasic malignant neoplasm with both malignant epithelial (carcinomatous) and stromal (sarcomatous) elements. Carcinosarcoma occurring in the gallbladder is a rare malignancy of which there have been fewer than seventy reports in the worldwide literature to date, with thirty two of these in the English literature [1-14]. We present a case of gallbladder carcinosarcoma in a young patient with pancreaticobiliary maljunction, treated with cholecystectomy, with subsequent local recurrence diagnosed on image-guided fine needle aspirate (FNA). There appears to be only one other reported case of FNA of a carcinosarcoma of the gallbladder in which an initial diagnosis of a high-grade spindle cell sarcoma was made cytologically.

Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings

Hemorrhagic cholecystitis with subsequent gallbladder rupture and torrential bleeding is a very rare but life-threatening complication of acute biliary tract diseases. Its clinical presentation may be dubious and therefore Computed Tomography (CT) imaging plays a crucial role in a prompt and accurate diagnosis. We present a case of a 64 year-old male who was admitted to the emergency department with clinical findings of acute cholecystitis. During the following hours the patient became hemodynamically unstable and an emergency abdominal CT scan was performed. CT revealed massive hemoperitoneum containing free gallstones. In addition, active extravasation of iv contrast material inside the gallbladder lumen was demonstrated. Based on these findings hemorrhagic cholecystitis with gallbladder rupture was suspected and the patient underwent urgent laparotomy. We describe specific CT findings of this rare condition, thus emphasizing the role of imaging in facilitating urgent surgical treatment.

Gallbladder carcinoma with a large monolocular cystic cancerous component

The monolocular cystic formation associated with gallbladder carcinoma is an extremely rare condition. A 79-year-old female suffering from upper abdominal pain and distention was admitted to our hospital. Ultrasonography and computed tomography revealed a monolocular cyst with an irregular wall thickness of 15 cm in diameter concomitant with a solid mass of 8 cm in diameter around the gallbladder bed. During celiotomy, the tumor was found to have a large pale gray cystic component at the fundus of the gallbladder, and disseminated nodules were observed in the peritoneum. We diagnosed the patient with gallbladder carcinoma and performed a simple cholecystectomy that included the tumor without systematic lymphadenectomy. On the cut face of the gallbladder, the lumen was occupied by a solid neoplasm. The cyst included a large amount of serous fluid and protruded continuously from the body of the gallbladder, but it did not communicate with the gallbladder lumen. Although the mechanism responsible for the development of cyst-forming papillary carcinoma of the gallbladder remains unknown, the present case is crucial for understanding the mechanism of cystogenesis in gallbladder carcinoma.

Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecystitis

A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and around the gastrohepatic ligament. A thick haemorrhagic pus, from which Escherichia coli was cultured, was drained from the gastrohepatic collection. An elective coeliac angiogram demonstrated a solitary pseudo-aneurysm of the medial branch of the cystic artery. Selective catheterisation of this artery with a micro-catheter enabled complete exclusion of the pseudo-aneurysm by a single micro-coil. Histological examination of the gallbladder, which was ultimately removed at open cholecystectomy, demonstrated xanthogranulomatous cholecystitis.

The significance of the wall echo shadow triad on ultrasonography: a case series

Abstract Background The wall echo shadow (WES) triad, also known as the double-arc-shadow sign consists of a well-defined near wall, echos from stones immediately beneath the wall, and posterior shadowing caused by strong echoes from stones in the gallbladder fossa. It has been used for over 20 years as a nonspecific finding suggestive of a gallbladder lumen filled with either multiple stones or one large stone (Miller et al. J Emerg Med 30(1):69–74, 2006; Blaivas et al. Acad Emerg Med 10(6):1020–1023, 1999; Raptopoulos et al. AJR Am J Roentgenol 138(2):275–278, 1982). In the past, the WES triad has been correlated with underlying chronic cholecystitis. However, there are no studies that compare clinical findings to a gold standard such as surgical pathology. Case reports Three cases of the WES triad were reviewed at New York Medical Hospital of Queens over a 16-month period.

Right Hepatic Artery Pseudoaneurysm Ruptured Into the Gallbladder Demonstrated by Magnetic Resonance Angiography

Rupture of a right hepatic artery pseudoaneurysm into the gallbladder is very rare. We demonstrated a 20-mm dumbbell-shaped pseudoaneurysm in the gallbladder lumen by using contrast-enhanced magnetic resonance angiography in a 73-year-old man with acute right upper abdominal pain. Inflammation of the gallbladder caused by calculous cholecystitis, which leads to biliary leakage and erodes the right hepatic artery, could have been the cause.

Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen

Virtual Touch tissue quantification is an implementation of ultrasound (US) Acoustic Radiation Force Impulse (ARFI) imaging that provides numerical measurements (wave-velocity values) of tissue stiffness. The aim of this study was to define the normal values of shear-wave speed for the healthy liver, gallbladder, pancreas, spleen and kidneys. Thirty-five young healthy volunteers underwent Virtual Touch tissue quantification after having signed an informed consent form. All upper abdominal organs were examined by two independent operators. A phantom fluid model was also evaluated. All mean wave-velocity values were analysed and compared. Results. One hundred and forty measurements of liver, pancreas, spleen and kidneys, and 70 measurements of the gallbladder lumen were performed. Twenty measurements on the phantom were also performed. Comparing all measurements separately made by each operator in different parts of the organs, no statistically significant differences were observed. A "XXXX/0" value was always obtained from all measurements performed on the gallbladder lumen and on the phantom fluid model. Liver, pancreas, spleen and kidney mean values were 1.59 m/s, 1.40 m/s, 2.44 m/s and 2.24 m/s, respectively. Virtual Touch tissue quantification is a new, promising implementation of the US ARFI technique, which provides numerical measurements of tissue stiffness. The mean shear-wave speed is lower in the pancreatic parenchyma than in the liver and kidney, whereas the spleen is characterised by the highest mean value. In simple fluids such as water, the value identified by the system with "XXXX" or 0, is always measured.

Diagnostic imaging in the study of human hepatobiliary fascioliasis

Fascioliasis is a rare zoonotic disease caused by the trematode Fasciola hepatica. We present the typical patterns of hepatobiliary fascioliasis observed in ten patients studied with multimodality imaging. Between 2002 and 2005, ten women with fascioliasis were admitted to the Brigham and Women's Hospital, Harvard Medical School (BWH), with abdominal pain and mild fever. All imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance (MR) imaging (n = 2) and endoscopic retrograde cholangiopancreatography (ERCP) (n = 1) were reviewed by two expert radiologists working in consensus. In all patients (10/10, 100%), US showed parenchymal heterogeneity characterised by multiple subcapsular and peribiliary hypoechoic nodular lesions that were ill-defined and coalesced into tubular or tortuous structures. In six patients (6/10, 60%), the lesions appeared hypoechoic, whereas in four patients (4/10, 40%), there was an alternation of hyperechoic and hypoechoic nodules. On CT, all patients (10/10, 100%) showed hypodense patchy lesions in subcapsular, peribiliary or periportal locations, which coalesced to form tubular structures and were more evident during the portal phase. Lesion diameter ranged from 2 cm to 7 cm. Capsular enhancement was seen in four cases on CT (4/10, 40%) and in one also at MR imaging. MR imaging, performed in two patients, confirmed the presence of the lesions, which appeared hyperintense on T2-weighted images and were characterised by mild peripheral enhancement after gadolinium administration. Four patients had gallbladder wall thickening (4/10, 40%), with parasites in the gallbladder lumen. Although rare, hepatobiliary fascioliasis should be considered in the differential diagnosis in the appropriate clinical scenario, especially in patients coming from endemic areas. The typical imaging pattern of fascioliasis is the presence of subcapsular, peribiliary or periportal nodules that are usually ill-defined and coalesce, giving rise to a tubular or tortuous appearance.

Duplicación de la vesícula biliar: Vesícula doble de tipo Y operada. Reporte de un caso

Gallbladder duplication. Report of one case The duplication of the gallbladder is a rare malformation, seen in one every 3.000 necropsies. It is detected preoperatively by abdominal ultrasound. We report a 28 years old female consulting for abdomi- nal pain. An abdominal ultrasound showed the presence of cholelithiasis and a complete septum in the gallbladder lumen. During surgery, a distended and inflamed gallbladder was found with a septum that divided it in two parts, and one biliary stone. There was also a double cystic duct. The pathological study confirmed the gallbladder duplication with inflammation.

Endoscopic Translumenal Cholecystoscopy and Gallbladder Drainage Using a Novel Lumenal Apposition Device in the Porcine Model

Introduction: The gallbladder is the “final frontier” of biliary endoscopy. Peroral transpapillary cholecystoscopy followed by lithotripsy was recently reported (Chen et al, GIE 2008;67:132). Endoscopic ultrasound (EUS) guided gallbladder drainage has been reported in several case series for acute cholecystitis. This is the first report of translumenal cholecystoscopy and gallbladder drainage using a novel Lumenal Apposition Device (LAD). Aim: Evaluate the feasibility of translumenal cholecystoscopy and gallbladder drainage in the porcine model using the LAD. MATERIALS: The prototype LAD consists of nitinol wire braided heat-set into a dual flange configuration. Fully expanded, the flange and body diameters measure 20 mm and 10 mm, respectively. The body is covered with a coating to prevent leakage and in-growth. The LAD is constrained onto a 10.5Fr delivery catheter. Methods: Four survival pigs were studied under general anesthesia. The gallbladder was located transgastrically using a 3.7 mm channel curved array echoendoscope (Olympus) and punctured with a 19G FNA needle under EUS guidance at a site of abutment against the gastric wall. At least two T-tags (Cook) were deployed to retain apposition of the gallbladder against the gastric wall. The gallbladder was re-punctured at a site adjacent to the T-tags, and a guidewire was inserted through the 19G needle and looped in the gallbladder. Keeping the T-tag sutures under constant traction, the cholecystgastrostomy tract was dilated with a 4 mm non-compliant balloon (Boston Scientific). The LAD (Xlumena) was deployed across the cholecystgastrostomy tract under combined EUS and endoscopic guidance. The deployed LAD lumen was easily intubated with a constrained balloon catheter and dilated to 10mm. Vigorous bile drainage into the stomach was observed after dilation. The echoendoscope was exchanged for a 5.9 mm diagnostic endoscope (Fujinon). The LAD lumen was traversed and the gallbladder lumen entered to perform cholecystoscopy. The cystic duct orifice and deployed T-tags were visualized. The T-tag sutures were cut using endoscopic scissors before withdrawing the endoscope. Results: No acute complications, including bleeding or perforation, occurred. The LAD did not migrate, dislodge or otherwise change position after deployment. There was no evidence of acute tissue injury. Survival data in 4 animals will be presented. Conclusion: EUS guided deployment of the LAD is feasible and enables cholecystoscopy and gallbladder drainage. Further studies are warranted. The LAD can extend the boundaries of interventional biliary endoscopy into the gallbladder.

Acute Hemobilia and Hemocholecyst in 2 Dogs with Gallbladder Carcinoid

Acute Hemobilia and Hemocholecyst in 2 Dogs with Gallbladder Carcinoid