Metastatic Uterine Adenosarcoma Presenting as Haemobilia and a Rare Cause of Gastrointestinal Haemorrhage: A Case Report and Review of the Literature

TL;DR

A rare case of metastatic uterine adenosarcoma causing gastrointestinal bleeding is reported, highlighting the importance of considering metastatic disease in similar cases.

Contribution

This is the first reported case of uterine adenosarcoma metastasis to the gallbladder causing haemobilia.

Findings

Metastatic uterine adenosarcoma was confirmed in the gallbladder and small bowel through histopathological examination.

The case emphasizes the diagnostic and management challenges of metastatic haemobilia.

A multidisciplinary approach including surgery and chemotherapy was crucial for treatment.

Abstract

Haemobilia, defined as bleeding into the biliary tract, is a rare but significant cause of upper gastrointestinal haemorrhage. While its aetiology commonly includes trauma, vascular malformations, and primary hepatobiliary malignancies, haemobilia secondary to metastatic disease is exceedingly rare. Uterine adenosarcomas are uncommon mesenchymal malignancies, and, to our knowledge, metastasis to the gallbladder has not been previously reported.

This case report describes a 53-year-old female with a history of uterine adenosarcoma, who presented with haemobilia caused by metastatic disease. Initial symptoms included abdominal pain and melena, with imaging revealing gallbladder wall thickening and small bowel intussusception. The patient underwent urgent laparoscopic cholecystectomy and subsequently required further surgeries for recurrent bowel obstructions due to metastatic lesions. Histopathological examination confirmed metastatic uterine adenosarcoma in the gallbladder and small bowel. This rare case highlights the challenges in diagnosing and managing metastatic haemobilia, emphasizing the importance of considering metastatic disease in patients with gastrointestinal bleeding and a history of uterine sarcoma. A multidisciplinary approach, including surgery and palliative chemotherapy, proved crucial for treatment. This case underscores the need for awareness regarding such rare presentations to ensure timely intervention and improve patient outcomes.

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