Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhag

Abstract

Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.

Haemorrhagic cholecystitis in a young patient, complicated by gallbladder perforation and choledocholithiasis

“…Gallbladder perforation is seen in approximately 2–15% of cases of cholecystitis and carries a mortality rate of up to 42% 6. Gallbladder perforation secondary to haemorrhagic cholecystitis is very rare; we identified only 19 cases in the literature 2 4 6–22…”

“…Currently, there are no guidelines for managing this condition. The pathophysiology is thought to be due to gallbladder wall erosion and infarction in the context of cholecystitis, which subsequently leads to haemorrhage into the gallbladder lumen or into the peritoneal cavity 2…”

“…Haemorrhagic cholecystitis can present with a range of signs and symptoms. Patients may present with acute right upper quadrant pain, fever, nausea and vomiting 2. Jaundice may occur due to the presence of blood within the biliary tree, known as haemobilia, which can also lead to haematemesis and melaena, although the incidence is not reported in the literature 5.…”

“…Other signs and symptoms may include abdominal distension, tenderness and peritonitis, depending on the severity of the condition and whether complications have occurred. Laboratory studies may reveal raised inflammatory markers, elevated liver enzymes and coagulation abnormalities 2. In severe cases, patients may present with signs of shock, such as hypotension and tachycardia.…”

Endoscopic Ultrasound-Guided Cholecystoenterostomy for Acute Hemorrhagic Cholecystitis Drainage

“…1 This condition has been associated with trauma, anticoagulation use, biliary neoplasm and parasite infection, renal failure, and cirrhosis. [2][3][4] Diagnosis can be performed using abdominal ultrasound, computed tomography, or magnetic resonance imaging. Cholecystectomy is recommended as to avoid GB perforation; 5 however, it may not be appropriate in patients with comorbidities and high risk of complications.…”