Hemorrhagic cholecystitis with rare imaging presentation: a case report and a lesson learned from neglected medication history of NSAIDs

Abstract

Background: Gallbladder carcinogenesis, frequently occurredin chronic cholecystitis patients, requires radical resection. We herein describe a hemorrhagic cholecystitis case that failed to be differentiated from gallbladder cancer preoperatively owing to the neglected medication history of long term oral nonsteroidal anti-inflammatory drugs (NSIADs) intake.

Case presentation: A 57-year-old Chinese female was admitted for right upper quadrant pain with the initial diagnosis of cholecystitis. Radiological studies were unable to exclude the differential diagnosis of suspected gallbladder cancer. During the scheduled radical resection of the suspected lesions, the gross dissection showed an interesting presentation of hemorrhagic cholecystitis, without any pathological evidence of malignancies. Additional postoperative investigation revealed a neglected medication history of long-term NSAIDs use.

Conclusions: This case suggests the importance of preoperative review of medication history and patient education on prescription drug abuse.

Keywords: Case report; Gallbladder cancer; Hemorrhagic cholecystitis; Medication history; NSAIDs abuse.

Fig. 1

Preoperative ultrasound result indicating the thickened gallbladder wall and hyperechoic structure inside the gallbladder

Fig. 2

Preoperative CT investigation with a non-enhanced, b arterial phase, and c venous phase transversal images, and d coronal view

Fig. 3

Preoperative MRI evaluation with a T1-weighted, b T2-weighted, c Gd-DTPA contrasted, and d DWI images

Fig. 4

Gross dissection of the gallbladder. a The operation field before resection. b The resected gallbladder with adjacent liver tissues. c The dissected gallbladder with layered content of a slightly rough gallbladder wall, a solid mixture of clot and gallbladder sludge, and a central jelly-like clot