Case Report of International Journal of Case Reports
Acute cholecystitis with intraluminal gallbladder bleeding: Case report and literature review
Jerica Novak, MD, PhD, Aleksander Göntér, MD, Jurij Janež, MD, PhD
Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia, University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia.
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.
Keywords: hemorrhagic cholecystitis, anticoagulant therapy, hematoperitoneum, abdominal CT, emergency surgery.
How to cite this article:
Jerica Novak, Aleksander Göntér, Jurij Janež. Acute cholecystitis with intraluminal gallbladder bleeding: Case report and literature review. International Journal of Case Reports, 2021; 5:228. DOI: 10.28933/ijcr-2021-06-2005
1. Jenkins M, Golding RH, Cooperberg PL. Sonography and computed tomography of hemorrhagic cholecystitis. AJR AM J Roentgenol. 1983; 140: 1197-8.
2. 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.
3. Pandya R, O’Malley. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging 2008; 33:652-3.
4. Chen YY, Yi CH, Chen CL, Huang SC, Hsu YH. Haemorrhagic cholecystitis after anticoagulant therapy. Am J Med Sci. 2010; 340: 338-9.
5. Kwok A, Chern TY, Winn R. Acute cholecystitis and gallbladder perforation leading to massive haematomeritoneum in a patient taking rivaroxaban. BMJ Case Rep. 2018.
6. 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.
7. 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.
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.
9. Tsai JL, Tsai SF. Gallbladder bledding-related severe gastrointestinal bleeding and shock in a case with end-stage renal disease. Medicine. 2016; 95:23.
10. Polse S, Stoney RJ, Baldwin JN. Hemorrhage from gallbladder. A report of tree cases. Calif Med 1967; 107:51-3
11. 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.
12. Heise CP, Giswold M, Echhoff D, Reichelderfer M. Cholecystitis caused by hemocholecyst from underlying malignancy. Am J Gastroenterol. 2000; 95: 805-8.
13. Parekh J, Corvera CU. Hemorrhagic cholecystitis, Arch Surg 2010. 145(2); 202-4.
14. 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.
15. Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin N Am. 2003. 41: 1203-16.