Hemorrhagic cholecystitis in an elderly patient taking aspirin and cilostazol

Endoscopic Ultrasound-Guided Cholecystoenterostomy for Acute Hemorrhagic Cholecystitis Drainage

Hemorrhagic cholecystitis is a rare entity with few cases reported in the literature. We report a case of a 42-year-old man with cirrhosis who presented to the hospital with abdominal pain in the right upper quadrant radiating to the back. Computed tomography scan showed findings consistent with acute cholecystitis. Owing to decompensated cirrhosis, he was not a good candidate for cholecystectomy. Endoscopic ultrasound-guided cholecystoenterostomy was performed that immediately yielded a large amount of old blood with clots along with some bile consistent with acute hemorrhagic cholecystitis. After the drainage, he had an uneventful hospitalization.

Gallbladder hemorrhage–An uncommon surgical emergency: A case report

BACKGROUND

Gallbladder hemorrhage is a life-threatening disorder. Trauma (accidental or iatrogenic such as a percutaneous biopsy or cholecystectomy surgery), cholelithiasis, biliary tract parasitosis, vasculitis, vascular malformations, autoimmune and neoplastic diseases and coagulopathies have been described as causes of hemorrhage within the lumen of the gallbladder. The use of non-steroidal anti-inflammatory drugs and anticoagulants may represent a risk factor.

CASE SUMMARY

We report the case of a 76-year-old male patient. An urgent contrast computed tomography scan demonstrated relevant distension of the gallbladder filled with hyperdense non-homogeneous content. The gallbladder walls were of regular thickness. Near the anterior wall a focus of suspected active bleeding was observed. Due to the progressive decrease in hemoglobin despite three blood transfusions, this was an indication for urgent surgery.

CONCLUSION

Early diagnosis of this potentially fatal pathology is essential in order to plan a strategy and eventually proceed with urgent surgical treatment.

A Rare Case of Acute Pancreatitis in the Setting of Hemorrhagic Cholecystitis

Hemorrhagic cholecystitis is a rare form of acute cholecystitis with very few cases reported in the literature. We report a novel case of a 79-year-old male who developed hemorrhagic cholecystitis and concomitant acute pancreatitis. The patient presented to the emergency department with a one-day history of severe epigastric pain radiating to his back. The patient was on an anticoagulant therapy for a history of pulmonary embolism. He had an elevated serum lipase and on a right upper quadrant ultrasound, a mildly distended gallbladder without stones was noted. Computed tomography (CT) the following day demonstrated heterogenous material in the gallbladder concerning for blood clots. Laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) was performed that revealed a gallbladder filled with clots. He had an uneventful post-operative recovery.

Emergency Department Diagnosis of Postprocedural Hemorrhagic Cholecystitis Utilizing Point-of-Care Ultrasoun

BACKGROUND

Hemorrhagic cholecystitis is a rare cause of abdominal pain. Most often described in the setting of blunt abdominal trauma, anticoagulation use, coagulopathy (such as cirrhosis or renal failure), and malignancy (biliary angiosarcoma), this rare condition can be difficult to identify unless high on the differential. With point-of-care ultrasound becoming more commonplace in the emergency department (ED), this tool can be successfully used to make a timely diagnosis in the correct clinical context.

CASE REPORT

A 64-year-old man with a past medical history of paroxysmal atrial fibrillation status post ablation on rivaroxaban, myelodysplastic syndrome, nonalcoholic steatohepatitis, gastroesophageal reflux disease, clonal cytopenias of undetermined significance, hypertension, and chronic pain presented to the ED with complaints of right upper quadrant pain in the setting of a recent transjugular liver biopsy. Using point-of-care ultrasound, the patient was diagnosed with hemorrhagic cholecystitis. This is an incredibly rare entity, with 87 documented cases in the literature, only two of which are in the setting of transjugular liver biopsy. The patient was ultimately managed conservatively until he had worsening symptoms, and a laparoscopic cholecystectomy was performed. The patient tolerated the procedure well and recovered. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hemorrhagic cholecystitis is a rare pathology that can be easily recognized during point-of-care ultrasound examination. This allows for rapid diagnosis and surgical consultation to provide the patient with timely definitive management.

Hemorrhagic Cholecystitis: A Rare Cause of Melena

Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality. A 75-year-old woman with multiple comorbidities, who was undergoing dual antiplatelet therapy, presented with symptoms of acute cholecystitis. Two days later, she developed melena and symptoms of obstructive jaundice. Following radiological evaluation, a diagnosis of hemorrhagic cholecystitis was made. The patient was managed conservatively with IV antibiotics and blood transfusion in the initial period (clopidogrel was withheld); an interval cholecystectomy was performed six weeks later. Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases. Management options include early surgery or conservative management at the initial stage, followed by interval cholecystectomy.

Anticoagulant-induced hemorrhagic cholecystitis with hemobilia after deceased donor kidney transplant and literature review

Introduction and importance

Hemobilia and hemorrhagic cholecystitis are uncommon causes of right upper quadrant abdominal pain. The development of intra-gallbladder and biliary bleeding has been primarily associated with abdominal trauma, malignancy, liver transplant, and iatrogenic injury to the biliary tree and vasculature. Spontaneous anticoagulant induced hemorrhagic cholecystitis and hemobilia are incredibly rare events and have only been documented by a handful of case reports.

Case presentation

A 55-year-old male who had recently undergone a deceased-donor kidney transplant was transferred to our academic institution for evaluation of subjective fever, right upper quadrant abdominal and back pain. The patient demonstrated localized tenderness in the right abdomen and was found to have hemorrhagic cholecystitis on imaging. He subsequently underwent urgent cholecystectomy and recovered without any subsequent complications.

Clinical discussion

Hemorrhagic cholecystitis and hemobilia are a rare cause of right-sided or generalized abdominal pain. Diagnosis is made primarily by pathognomonic findings on CT and US imaging. Prompt diagnosis is essential in preventing mortality and/or significant morbidity. The standard treatment consists of urgent/emergent cholecystectomy.

Conclusion

A rare sequelae of anticoagulant use, intra-biliary bleeding must be considered as a differential diagnosis in anticoagulated patients presenting with right upper quadrant abdominal pain.

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Hemorrhagic cholecystitis is uncommon cause of right upper quadrant abdominal pain

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Spontaneous anticoagulant induced hemorrhagic cholecystitis have only been reported by a handful of case reports.

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Patients experiencing intra-gallbladder bleeding often present with symptoms similar to those seen in acute cholecystitis.

Surgical case report-acalculous hemorrhagic cholecystitis

Haemorrhagic cholecystitis is a seldom seen cause of right upper quadrant pain that can result in gallbladder rupture, massive intraperitoneal haemorrhage and death if untreated. Haemorrhagic cholecystitis is usually seen in the presence of cholelithiasis, malignancy, trauma and coagulopathies. Here, we present the unusual case of an elderly man presenting with acalculous haemorrhagic cholecystitis, who was successfully treated with laparoscopic cholecystectomy. We review the radiological and laparoscopic findings of haemorrhagic acalculous cholecystitis. This case highlights the importance of prudent use of radiological imaging to differentiate haemorrhagic cholecystitis from alternate pathology and early surgical intervention to avoid massive intraperitoneal haemorrhage and the high mortality with which it is associated.

Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy

Hemorrhagic cholecystitis is a potentially deadly and difficult to recognize entity. It is associated with cystic artery pseudoaneurysm and is usually seen in the setting of acute calculous cholecystitis. We report two cases of hemorrhagic cholecystitis with arteriographic findings of cystic artery pseudoaneurysms that were successfully embolized using microcoils, facilitating subsequent cholecystectomy. Both cases had unusual presentations of gallbladder rupture with hemoperitoneum, the latter of which was atypical occurring in the absence of gallstones. We believe when hemorrhagic cholecystitis is suspected, a two-step therapeutic approach should be employed with embolization of the bleeding cystic artery followed by cholecystectomy. A comprehensive literature review and discussion of hemorrhagic cholecystitis will be provided.

It's the Bloody Gallbladder! Spontaneous Gallbladder Hemorrhage Following Factor Xa Inhibition

Spontaneous gallbladder hemorrhage (SGBH) is a rare diagnosis related to trauma, malignancy or vascular abnormalities, associated with significant morbidity and mortality. We present a case of SGBH in a 55-year-old patient with right upper quadrant (RUQ) pain following initiation of apixaban for deep vein thrombosis post recent kidney transplant. Multiple imaging studies revealed a distended gallbladder with heterogeneous hyperdense material in the lumen and cystic duct obstruction. Surgery revealed a gallbladder with chronic cholecystitis, hemorrhage and hematoma. This case highlights a rare adverse event of anticoagulation, and SGBH should be considered when acute RUQ pain occurs in this setting.

Atraumatic spontaneous hemorrhagic cholecystitis

Hemorrhagic cholecystitis is a rare subtype of acute cholecystitis. It is considered a medical emergency, with a morbidity rate of 32% to 58% and a mortality rate of 15% to 20%. It presents with an acute onset of intense abdominal or back pain that can be mistaken for other conditions such as thoracic aortic dissection. Diagnosis hinges on a high index of suspicion and confirmatory studies, such as computed tomography scan or ultrasound. Specific risk factors identified in the literature include a history of trauma and anticoagulant use. We present an atypical case of spontaneous hemorrhagic cholecystitis with no antecedent risk factors.

A 51-year-old female presenting with shock due to hemorrhagic cholecystitis

Hemorrhagic cholecystitis is a rare cause of abdominal pain that can have dire consequences. We report a case of hemorrhagic cholecystitis in a 51-year-old female presenting as shock and abdominal pain. The patient was transported to the emergency room. Ultrasound scan revealed hemoperitoneum and cholecystitis features. On computed tomography, mild gallbladder wall thickening and high density materials in the gallbladder suggested acute calculous cholecystitis, bleeding tumor, or hemorrhagic cholecystitis. An urgent cystic arterial embolization and percutaneous transhepatic drainage were done. After initial stablization, laparoscopic cholecystectomy was performed that revealed a necrotic gallbladder filled with large blood clots. It was important for timely management by having an early recognition of this potentially fatal condition.

Hemorrhagic cholecystitis with rare imaging presentation: a case report and a lesson learned from neglected medication history of NSAIDs

Background

Gallbladder carcinogenesis, frequently occurredin chronic cholecystitis patients, requires radical resection. We herein describe a hemorrhagic cholecystitis case that failed to be differentiated from gallbladder cancer preoperatively owing to the neglected medication history of long term oral nonsteroidal anti-inflammatory drugs (NSIADs) intake.

Case presentation

A 57-year-old Chinese female was admitted for right upper quadrant pain with the initial diagnosis of cholecystitis. Radiological studies were unable to exclude the differential diagnosis of suspected gallbladder cancer. During the scheduled radical resection of the suspected lesions, the gross dissection showed an interesting presentation of hemorrhagic cholecystitis, without any pathological evidence of malignancies. Additional postoperative investigation revealed a neglected medication history of long-term NSAIDs use.

Conclusions

This case suggests the importance of preoperative review of medication history and patient education on prescription drug abuse.

Hemorrhagic Cholecystitis in a Patient with Cirrhosis and Rectal Cancer

Hemorrhagic cholecystitis is a rare presentation of acute calculous cholecystitis which presents with abdominal pain, jaundice, and gastrointestinal bleeding. It is a challenging diagnosis to make because it present similar to other common disorders such as calculous cholecystitis. We present a unique case of hemorrhagic cholecystitis in a patient with cirrhosis and rectal cancer. 

A 66-year-old male with a history of rectal cancer, alcohol-induced cirrhosis, esophageal varices, stroke, paroxysmal atrial fibrillation, and hypertension presented to the emergency department with complaints of abdominal pain. Patient’s computed tomography (CT) scan revealed bleeding from the gallbladder with hemoperitoneum and thickening of the ascending colon. The patient underwent emergent surgery for hemorrhagic cholecystitis.

Hemorrhagic cholecystitis is associated with risk factors, including trauma, malignancy, renal failure, cirrhosis, and anticoagulation therapy. Imaging is not always reliable, but ultrasound and CT scan are the preferred options. Treatment options are surgical or nonsurgical approach depending on patient’s hemodynamic stability.

Gallbladder hemorrhage during orally administered edoxaban therapy: a case report

Background

Edoxaban is an orally administered anticoagulant treatment that is used in patients with cerebral infarction, venous thrombosis, or other conditions, with a reported incidence of gastrointestinal hemorrhage at approximately 1%. We encountered the rare case of a patient who developed a gallbladder hemorrhage after the administration of edoxaban.

Case presentation

An 86-year-old Japanese woman visited our gastrointestinal department due to the chief complaint of melena lasting for a week. Her medical history included hypertension and embolic cerebral infarction, and she was taking orally administered carvedilol (5 mg/day) and edoxaban (30 mg/day). Her palpebral conjunctiva was pale during a physical examination, indicating the possibility of anemia. Her blood test results confirmed severe anemia with red blood cells at 1.7 × 10⁶/μL and hemoglobin at 4.7 g/dL. An upper gastrointestinal endoscopy revealed bile and fresh blood on the duodenal bulb and in more distal regions; hemobilia was suspected. A computed tomography scan on the ninth hospitalization day confirmed the hemobilia with a gallbladder fundus high-density signal. She was discharged on the 30th day of hospitalization with only fluid therapy and no progression of anemia. Moreover, she underwent a laparoscopic cholecystectomy 1 month after discharge, but the pathologist did not identify false aneurysms or neoplastic lesions. She has not been shown to develop anemia for 5 months after surgery.

Conclusions

Our case suggests that gallbladder hemorrhage needs to be considered a possible complication for patients on direct oral anticoagulants.

Anticoagulants is a risk factor for spontaneous rupture and hemorrhage of gallbladder: a case report and literature review

Background

The spontaneous rupture of the gallbladder is extremely rare, majority of ruptures occur secondary to traumatic injuries. Here, we report a case of spontaneous rupture of the gallbladder with probably cause of oral anticoagulants.

Case presentation

A 51-year-old woman presented to the emergency room with sudden-onset severe abdominal pain, as well as hypotension and low level of hemoglobin. Abdominal computed tomography (CT) scan showed a 2.5 cm filling defect and discontinuity in the wall of the gallbladder body, and a massive hematocele in the abdominal cavity. Past medical history was significant for hypertension and had been taking daily aspirin for the past three years because of interventional surgery for cerebral aneurysms, but no history of recent abdominal trauma or past episodes of biliary colic. The patient underwent an urgent laparoscopic abdominal exploration and the gallbladder was removed. The pathology just showed chronic cholecystitis and the patient recovered well.

Conclusion

Long-term use of anticoagulants may increase the risk of gallbladder rupture and hemorrhage, which is a lethal condition. Rapid diagnosis and timely surgical intervention are the most important measures to treat the patient.

Hemorrhagic Cholecystitis During Anticoagulant Therapy in a Patient With Systemic Lupus Erythematosus and Antiphospholipid Syndrome Undergoing Elective Laparoscopic Cholecystectomy

Hemorrhagic cholecystitis is a rare cause of abdominal pain that presents in traumatic settings, malignancy, and bleeding diathesis. Herein, we report a case of hemorrhagic cholecystitis during anticoagulant therapy in a patient with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) who underwent a laparoscopic cholecystectomy. A 61-year-old female presented with abdominal pain and melena during hospitalization for SLE. She had a history of SLE and APS before this episode. She was diagnosed with hemorrhagic cholecystitis by ultrasonography; computed tomography (CT); and duodenoscopy. CT revealed a distended gallbladder containing a hypodense material suggestive of blood. The duodenoscopy revealed blood-mixed bile appearing from the papilla. Following conservative treatment, hemostasis was confirmed, and an elective laparoscopic cholecystectomy was performed based on the diagnosis of hemorrhagic cholecystitis. The opening of the gallbladder revealed a large blood clot that gushed out, and multiple gallstones were also observed. The postoperative course was uneventful, and the patient has remained healthy without any complications.

Hemorrhagic cholecystitis: report of a case

Hemorrhagic cholecystitis is an uncommon cause of abdominal pain that can be fatal. We report a case of hemorrhagic cholecystitis in a 75-year-old male taking an anticoagulant. The patient was brought to the hospital with uncontrolled right upper quadrant abdominal pain. On computed tomography, mild gallbladder wall thickening and high density with gallstones in the gallbladder suggested acute calculous cholecystitis or hemorrhagic cholecystitis. An urgent laparoscopic cholecystectomy was performed that revealed a gallbladder filled with large blood clots and two black stones. Patients who develop hemorrhagic complications were often receiving anticoagulation therapy or had pathologic coagulopathy. An early diagnosis of this potentially fatal condition is important to facilitate urgent surgical treatment.