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.
Highlights
Intraluminal bleeding of the gallbladder is a seldom described condition usually arising from the acute gallbladder inflammation
On warfarin was presented to abdominal surgeon due to acute abdominal pain with hemodynamic instability and active intralu- How to cite this article: minal gallbladder bleeding on CT-scan
Presence of gallstones acalculose scan the site of gallbladder perforation can be hemorrhagic cholecystitis has been described in the literature. [3,4] Factors predisposing a patient to spontaneous detected, hematoperitoneum can be observed as hyperdense fluid surrounding the gallbladder. [14, 15]
Summary
Intraluminal bleeding of the gallbladder is a seldom described condition usually arising from the acute gallbladder inflammation. It presents a potentially fatal complication of acute cholecystitis.[1] Use of anticoagulants may increase the risk of hemorrhage. Authors present the clinical and radiological findings in a patient on anticoagulant therapy with intraluminal bleeding from gangrenous gallbladder wall due to the acute cholecystitis leading to gallbladder wall perforation with hematoperitoneum and hemodinamic instability. Exploration of the abdominal cavity was performed and no additional source of active bleeding was discovered. Follow-up CT of the abdomen revealed a small, localized fluid collection in the area of removed gallbladder with no signs of active bleeding in the abdominal cavity.
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