Hemorrhagic Cholecystitis: A Rare Cause of Melena

Sreekanthan Gobishangar,John Shelton,Anton A Jenil

doi:10.7759/cureus.16385

Sreekanthan Gobishangar, John Shelton + Show 1 more

Open Access

https://doi.org/10.7759/cureus.16385

Copy DOI

Journal: Cureus	Publication Date: Jul 14, 2021
Citations: 1	License type: cc-by

Affiliation: Jaffna Teaching Hospital, University of Jaffna

Abstract

Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality. A 75-year-old woman with multiple comorbidities, who was undergoing dual antiplatelet therapy, presented with symptoms of acute cholecystitis. Two days later, she developed melena and symptoms of obstructive jaundice. Following radiological evaluation, a diagnosis of hemorrhagic cholecystitis was made. The patient was managed conservatively with IV antibiotics and blood transfusion in the initial period (clopidogrel was withheld); an interval cholecystectomy was performed six weeks later. Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases. Management options include early surgery or conservative management at the initial stage, followed by interval cholecystectomy.

Highlights

Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality
Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases
Hemorrhagic cholecystitis is a rare cause of hemobilia and melena [1]

Summary

Introduction

Hemorrhagic cholecystitis is a rare cause of hemobilia and melena [1]. It is associated with significant morbidity and mortality due to delay in its diagnosis. There were no palpable masses in the abdomen One day later, she developed yellowish discoloration of the sclera and melena. Non-contrast and IV contrast CT of the abdomen and pelvis showed a heterogeneous material, with a density almost equal to that of blood, filling the entire distended gall bladder, with no significant contrast enhancement in the arterial/venous phases (Figure 2). We arranged a multidisciplinary meeting with her physician and cardiologist and decided to continue conservative management unless her condition deteriorated She responded well to antibiotics, and the melena resolved spontaneously on day 5 of admission.

Discussion

Conclusions

Findings

Disclosures

Sandblom P