Haemorrhagic cholecystitis treated with endovascular embolization

Abstract

Haemorrhagic cholecystitis is a rare complication of acute cholecystitis. Traditionally, treatment has been with emergency cholecystectomy. Endovascular management of haemorrhage allows the patient to be optimized for surgery at a later date. Our case presents a 52-year-old woman with haemorrhagic cholecystitis who underwent endovascular coil embolization of the cystic artery in interventional radiology. Further complications later ensued including a haematoma in the gallbladder fossa and a bile leak into the peritoneal cavity. As a result, the patient had an endoscopic retrograde cholangiopancreatography (ERCP) with placement of a covered stent into the extrahepatic bile ducts. The patient later developed abscess formation in the gallbladder fossa, which was managed with a percutaneous pigtail drain. Following clinical and radiological improvement, the patient was discharged with the gallbladder fossa drain and biliary stent in situ to await elective cholecystectomy. Endovascular embolization is a useful alternative, in the acute setting, to emergency surgical cholecystectomy.