
Keywords
- hemorrhagic cholecystitis, anticoagulant therapy, hematoperitoneum, abdominal CT, emergency surgery
How to Cite

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Abstract
Background: Hemorrhagic cholecystitis is an infrequent complication of acute cholecystitis associated with high mortality rate. Recognition of this acute abdominal condition is often challenging. Authors present a case of acute intraluminal gallbladder bleeding with a consequential gallbladder wall perforation and hematoperitoneum requiring emergency surgery in a patient on anticoagulant therapy.
Case Presentation: An 80-year old woman with atrial fibrillation on warfarin was presented to abdominal surgeon due to acute abdominal pain with hemodynamic instability and active intraluminal gallbladder bleeding on CT-scan. An emergency laparotomy with cholecystectomy was performed. Despite intensive treatment patient died on the third postoperative day.
Conclusions: Hemorrhagic cholecystitis is a potentially life-threatening condition. Patients on anticoagulant therapy with clinical signs of acute cholecystitis are more prone to develop bleeding into the gallbladder. Contrast-enhanced CT of the abdomen is the diagnostic modality of choice and cholecystectomy definitive therapy in patients with hemorrhagic cholecystitis.
References
- Jenkins M, Golding RH, Cooperberg PL. Sonography and computed tomography of hemorrhagic cholecystitis. AJR AM J Roentgenol. 1983; 140: 1197-8.
- Vijendren A, Cattle K, Obichere M. Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy. BMJ Case Rep 2012.
- Pandya R, O’Malley. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging 2008; 33:652-3.
- Chen YY, Yi CH, Chen CL, Huang SC, Hsu YH. Haemorrhagic cholecystitis after anticoagulant therapy. Am J Med Sci. 2010; 340: 338-9.
- Kwok A, Chern TY, Winn R. Acute cholecystitis and gallbladder perforation leading to massive haematomeritoneum in a patient taking rivaroxaban. BMJ Case Rep. 2018.
- Nural MS, Bakan S, Bayrak IK, Baydin A, Danaci M. A rare complication of acute cholecystitis: transhepatic perforation associated with massive intraperitoneal hemorrhage. Emerg Radiol 2007; 14: 439-41.
- Tavernaraki K, Sykara A, Tavernaraki E, Chondros D, Lolis ED. Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings. Abdom Imaging. 2011; 36:565-8.
- Mechera R, Graf L, Oertil D, Viehl CT. Gallbladder perforation and massive intra-abdominal haemorrhage complicating acute cholecystitis in a patient with haemophilia A. BMJ Case Rep. 2015.
- Tsai JL, Tsai SF. Gallbladder bledding-related severe gastrointestinal bleeding and shock in a case with end-stage renal disease. Medicine. 2016; 95:23.
- Polse S, Stoney RJ, Baldwin JN. Hemorrhage from gallbladder. A report of tree cases. Calif Med 1967; 107:51-3
- Ku J, DeLARosa J, Kang J, Hoyt D, Coimbra R. Acute cholecystitis with a hemocholecyst as an unusual presentation of gallbladder cancer: report of a case. Surg Today. 2004; 34:973-6.
- Heise CP, Giswold M, Echhoff D, Reichelderfer M. Cholecystitis caused by hemocholecyst from underlying malignancy. Am J Gastroenterol. 2000; 95: 805-8.
- Parekh J, Corvera CU. Hemorrhagic cholecystitis, Arch Surg 2010. 145(2); 202-4.
- Kim YC, Park MS, Chung YE, Lim JS, Kim MJ, Kim KW. Gallstone spillage caused by spontaneously perforated hemorrhagic cholecystitis. World J Gastroenterol. 2007. 13 (41): 5525-6.
- Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin N Am. 2003. 41: 1203-16.