Hemorrhagic cholecystitis in a patient with alcoholic liver disease

Abstract

Hemorrhagic cholecystitis is a rare disease with high morbidity and mortality, especially in patients with cirrhosis. Here, we described a case of perforated hemorrhagic cholecystitis in a patient with alcoholic liver disease. A 47-year-old male with a history of alcoholic abuse was presented to the hospital with severe right upper quadrant abdominal pain. He has never been diagnosed with a specific underlying disease. In the emergency room, the initial hemoglobin level was 11 g/dL, but decreased to 8.4 g/dL after 6 hours. On physical examination, there was a palpable mass with tenderness in the right upper quadrant area. On abdomino-pelvis computed tomography, it showed highly attenuated, homogenous materials in the gallbladder, and a diffuse gallbladder wall thickening with edematous change. We performed laparoscopic cholecystectomy that revealed a gallbladder filled with large blood clots and hemoperitoneum. Although hemorrhagic cholecystitis is a rare entity of acute cholecystitis, it should be considered in high risks patients, such as trauma, malignancy, the use of anticoagulation and higher bleeding tendency in dialysis patient. Therefore, early diagnosis of this potentially fatal complication is important to facilitate urgent surgical management.