Non-traumatic gallbladder hemorrhage with shock in Asia: A case report

Abstract

Gallbladder hemorrhage, rare due to trauma, iatrogenic factors, or conditions like liver/kidney dysfunction or cancer, presents with symptoms such as right upper abdominal pain and fever. In severe cases, gallbladder blood may enter the gastrointestinal tract, causing melena or hematemesis, necessitating surgical intervention. Delay can lead to life-threatening hemorrhagic shock. Diagnosing in the emergency room is challenging, with delayed recognition risking severe outcomes. Ultrasound is vital for diagnosis. A 64-year-old female presented with three days of epigastric pain and nausea, denying trauma, fever, respiratory or chest symptoms. Unstable vital signs were noted. Blood tests showed no abnormalities; ultrasound revealed a distended gallbladder without stones. Post-cholecystectomy confirmed acute hemorrhagic cholecystitis, highlighting ultrasound’s pivotal role. Gallbladder hematoma, rare with vague symptoms, poses diagnostic challenges linked to trauma, tumors, anticoagulant use, or liver/renal disease. Initial symptoms include right upper quadrant pain, tenderness, nausea, and vomiting, resembling cholecystitis. Persistent bleeding may result in dark or bloody stools. Laboratory tests may reveal abnormalities, but sensitivity is limited. Diagnosis is complex, delayed recognition in the emergency department can lead to severe shock and increased mortality. The literature review emphasizes the association with liver/kidney dysfunction and anticoagulant use, presenting symptoms akin to gallbladder inflammation and occasional gastrointestinal bleeding. Ultrasound is pivotal for diagnosis, showcasing features like uneven echoes and localized wall thickening. Treatment approaches vary, with some cases opting for deferred surgical intervention after conservative treatment. Non-traumatic gallbladder hematoma is linked to risk factors like liver/kidney diseases and chronic anticoagulant use. Gallbladder inflammation and gastrointestinal bleeding symptoms coexist, underscoring ultrasound’s crucial role. This study establishes early detection and diagnosis protocols for emergency room settings.