Hemorrhagic Cholecystitis in a Patient with Cirrhosis and Rectal Cancer

Abstract

Hemorrhagic cholecystitis is a rare presentation of acute calculous cholecystitis which presents with abdominal pain, jaundice, and gastrointestinal bleeding. It is a challenging diagnosis to make because it present similar to other common disorders such as calculous cholecystitis. We present a unique case of hemorrhagic cholecystitis in a patient with cirrhosis and rectal cancer. A 66-year-old male with a history of rectal cancer, alcohol-induced cirrhosis, esophageal varices, stroke, paroxysmal atrial fibrillation, and hypertension presented to the emergency department with complaints of abdominal pain. Patient's computed tomography (CT) scan revealed bleeding from the gallbladder with hemoperitoneum and thickening of the ascending colon. The patient underwent emergent surgery for hemorrhagic cholecystitis. Hemorrhagic cholecystitis is associated with risk factors, including trauma, malignancy, renal failure, cirrhosis, and anticoagulation therapy. Imaging is not always reliable, but ultrasound and CT scan are the preferred options. Treatment options are surgical or nonsurgical approach depending on patient's hemodynamic stability.

Keywords: cholecystitis; cirrhosis; hemoperitoneum; hemorrhagic cholecystitis; rectal cancer.

Figure 1. CT of the abdomen and pelvis without contrast

Cholelithiasis with enlarged gallbladder or liver mass

Figure 2. CT of the abdomen and pelvis without contrast

Hemorrhage within the gallbladder resulting in a subcapsular hematoma