Hemorrhagic cholecystitis: report of a case

Abstract

Hemorrhagic cholecystitis is an uncommon cause of abdominal pain that can be fatal. We report a case of hemorrhagic cholecystitis in a 75-year-old male taking an anticoagulant. The patient was brought to the hospital with uncontrolled right upper quadrant abdominal pain. On computed tomography, mild gallbladder wall thickening and high density with gallstones in the gallbladder suggested acute calculous cholecystitis or hemorrhagic cholecystitis. An urgent laparoscopic cholecystectomy was performed that revealed a gallbladder filled with large blood clots and two black stones. Patients who develop hemorrhagic complications were often receiving anticoagulation therapy or had pathologic coagulopathy. An early diagnosis of this potentially fatal condition is important to facilitate urgent surgical treatment.

Keywords: Anticoagulation; Cholecystitis; Hemorrhagic; Laparoscopic cholecystectomy; Urgent.

Fig. 1. Preoperative CT scan. (A) A non-contrast CT revealed highly attenuated materials in the gallbladder and extra-hyperdense gallstones. (B) An enhanced CT image obtained in the arterial phase demonstrated streaks-like enhancement along the gallbladder wall (arrow). (C) The coronal arterial phase CT showed that the gallbladder (curved arrow) and common bile duct (CBD) (straight arrow) were distended and contained high density fluid. The gallbladder fluid was confirmed as a large amount blood clots and CBD dilatation due to sludge and tiny stones.

Fig. 2. A gross photograph of the gallbladder specimen (about 8.4×4.1 cm) with wall thickening is filled with the remaining intraluminal organized blood clots (total about 50 g) and two black stones.