Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2020.232
Autopsy and Case Reports
Clinical Case Report

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

Zachary Pickell; Krishnan Raghavendran; Maria Westerhoff; Aaron M. Williams

Downloads: 3
Views: 1390

Abstract

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.

Keywords

Cholecystitis, Acute, Gastrointestinal Hemorrhage, General Surgery, Biliary Tract Surgical Procedures

References

1 Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E. Diagnosis and treatment of gallbladder perforation. World J Gastroenterol. 2006;12(48):7832-6. http://dx.doi.org/10.3748/wjg.v12.i48.7832. PMid:17203529.

2 Stefanidis D, Sirinek KR, Bingener J. Gallbladder perforation: risk factors and outcome. J Surg Res. 2006;131(2):204-8. http://dx.doi.org/10.1016/j.jss.2005.11.580. PMid:16412466.

3 Bedirli A, Sakrak O, Sozuer EM, Kerek M, Guler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology. 2001;48(41):1275-8. PMid:11677945.

4 Kwok A, Chern TY, Winn R. Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban. BMJ Case Rep. 2018;2018:bcr2018226870. http://dx.doi.org/10.1136/bcr-2018-226870. PMid:30373899.

5 Tavernaraki K, Sykara A, Tavernaraki E, Chondros D, Lolis ED. Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings. Abdom Imaging. 2011;36(5):565-8. http://dx.doi.org/10.1007/s00261-010-9672-y. PMid:21161216.

6 Menakuru SR, Kaman L, Behera A, Singh R, Katariya RN. Current management of gall bladder perforations. ANZ J Surg. 2004;74(10):843-6. http://dx.doi.org/10.1111/j.1445-1433.2004.03186.x. PMid:15456428.

7 Mechera R, Graf L, Oertli D, Viehl CT. Gallbladder perforation and massive intra-abdominal haemorrhage complicating acute cholecystitis in a patient with haemophilia A. BMJ Case Reports. 2015;2015(1):bcr2014205971-b. http://dx.doi.org/10.1136/bcr-2014-205971.

8 Alvi A, Ajmal S, Saleem T. Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report. Cases Journal. 2009;2:166. http://dx.doi.org/10.1186/1757-1626-2-166.

9 Kinnear N, Hennessey DB, Thomas R. Haemorrhagic cholecystitis in a newly anticoagulated patient. BMJ Case Rep. 2017;2017:bcr-2016-214617. http://dx.doi.org/10.1136/bcr-2016-214617. PMid:28404563.

10 Vijendren A, Cattle K, Obichere M. Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy. BMJ Case Rep. 2012;2012:bcr1220115427. http://dx.doi.org/10.1136/bcr.12.2011.5427. PMid:22778467.

11 Ng ZQ, Pradhan S, Cheah K, Wijesuriya R. Haemorrhagic cholecystitis: a rare entity not to be forgotten. BMJ Case Rep. 2018;2018:bcr2018226469. http://dx.doi.org/10.1136/bcr-2018-226469. PMid:30244228.

12 Köhler G, Koch OO, Antoniou SA, et al. Relevance of surgery after embolization of gastrointestinal and abdominal hemorrhage. World J Surg. 2014;38(9):2258-66. http://dx.doi.org/10.1007/s00268-014-2570-7. PMid:24728537.

13 Berry R, Han J, Girotra M, Tabibian JH. Hemobilia: perspective and role of the advanced endoscopist. Gastroenterol Res Pract. 2018;2018:3670739. http://dx.doi.org/10.1155/2018/3670739. PMid:30116262.

14 Navuluri R. Hemobilia. Semin Intervent Radiol. 2016;33(4):324-31. http://dx.doi.org/10.1055/s-0036-1592321. PMid:27904252.

15 Lo Nigro C, Geraci G, Sciuto A, Li Volsi F, Sciume C, Modica G. Bile leaks after videolaparoscopic cholecystectomy: duct of Luschka. Endoscopic treatment in a single centre and brief literature review on current management. Ann Ital Chir. 2012;83(4):303-12. PMid:23012722.

16 Tzovaras G, Peyser P, Wilson T, Padbury R, Toouli J. Minimally invasive management of bile leak after laparoscopic cholecystectomy. HPB (Oxford). 2001;3(2):165-8. http://dx.doi.org/10.1080/136518201317077189. PMid:18332919.

17 Zhornitskiy A, Berry R, Han JY, Tabibian JH. Hemobilia: historical overview, clinical update, and current practices. Liver Int. 2019;39(8):1378-88. http://dx.doi.org/10.1111/liv.14111. PMid:30932305.
 


Submitted date:
08/19/2020

Accepted date:
09/08/2020

Publication date:
01/28/2021

601319970e88250841045c65 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections