Hemorrhagic Cholecystitis: A Rare Cause of Presentation with Upper Gastrointestinal Bleeding

Abstract

Haemorrhagic cholecystitis represents a rare cause of upper gastrointestinal bleeding, often not appreciated in the first instance upon presentation. A 73 year old Caucasian female presented with a 48 hour history of vomiting and malaena. No associated abdominal pain, fevers or jaundice and no history of any similar episodes described. She was on prophylactic Rivaroxaban after recent right hip replacement. She presented apyrexial with normal haemodynamic parameters. Abdominal examination was unremarkable including negative Murphy’s sign. Liver function tests were deranged (bilirubin 55 total, 36 conjugated, ALP 696, GGT 383, ALT 1390, AST 2140), Hb 96 and inflammatory markers raised: WCC 13.8, CRP 114. Coagulation profile was elevated INR 1.4, PT 15, APTT 30. CT abdomen confirmed perforated calculous cholecystitis with heterogenous gallbladder content and loss of integrity of gallbladder wall inferiorly. The patient progressed well on conservative management with IV antibiotics. Anticoagulation was recommenced once Hb observed to be stable. She underwent elective laparoscopic cholecystectomy 8 weeks later. The current literature, with a small number of case reports, supports this management.This presentation highlights the importance of thorough initial assessment including indicated imaging to diagnose and treat rare and challenging manifestations such as haemorrhagic cholecystitis.