Haemorrhagic cholecystitis: a case report—focus on the optimal diagnosis and management algorithm

Abstract

Haemorrhagic cholecystitis refers to an inflammatory process of the gallbladder, complicated by bleeding into the gallbladder or biliary system (haemobilia). Approximately 10–15% of adults have cholelithiasis, but most patients do not develop symptoms. Acute cholecystitis occurs in about 10% of symptomatic patients. Among the recognized complications of acute cholecystitis, the haemorrhagic form occurs uncommonly. Underlying risk factors include a bleeding diathesis or treatment with anticoagulants, aneurysm rupture of colecystic artery and trauma. It is often associated with cholelithiasis. The presenting feature is right upper quadrant pain, which is a dominant feature and may mimic non-haemorrhagic acute cholecystitis. Haemorrhagic cholecystitis is diagnosed by radiographic imaging. The first-choice exam is ultrasonography. However, ultrasound does not appear to be ideal for differentiating between acute and haemorrhagic cholecystitis. Computed tomography (CT) scan is the gold standard in the diagnosis of haemorrhagic cholecystitis. MRI may show breakdown products of blood and can be used to estimate the age of the haemorrhage. Surgical resection or embolization of a cystic artery pseudoaneurysm should be considered the treatment of choice, due to the high risk of fatality associated with this condition. We describe a case of haemorrhagic cholecystitis in an 80-year-old male with secondary haemophilia and cholelithiasis who presented to our department of radiology with right upper quadrant pain.