Hemorrhagic cholecystitis: report of a case

Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report

BACKGROUND

Patients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy.

CASE PRESENTATION

The patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion.

CONCLUSIONS

A Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.

Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders

INTRODUCTION

Laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs.

METHODS

In this retrospective study of 386 LCs, data were collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann-Whitney U testing, and chi-squared testing (α = 0.05).

RESULTS

This study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study.

CONCLUSIONS

HD is associated with improved surgical outcomes of LCs for GGBs demonstrated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.

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.

Hemorrhagic cholecystitis after coronary angiography

Hemorrhagic cholecystitis is a rare condition with several possible causes. Despite being a difficult diagnosis, it is an important one considering the fatal possibility for the patient. The following is the case of a 68-year-old patient with dual antiplatelet therapy, who underwent coronary angiography and angioplasty in a hypocoagulate setting, developing a hemorrhagic cholecystitis. This article seeks to recognize the importance of this differential diagnosis in hypocoagulated patients with abdominal pain.

Complications of cholecystitis: a comprehensive contemporary imaging review

Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.

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.

A Case of Hemorrhagic Cholecystitis and Hemobilia Under Anticoagulation Therapy

Patient: Male, 70-year-old

Final Diagnosis: Hemobilia • hemorrhagic cholecystitis

Symptoms: Abdominal distension • abdominal pain

Medication: —

Clinical Procedure: —

Specialty: Gastroenterology and Hepatology

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.

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.

Carcinoma of the gallbladder presenting as haemorrhagic cholecystitis

Gallbladder carcinoma has several atypical presentations, but one of the rarest is intraluminal haemorrhage, which occurs in 1% of patients. We report a case of gallbladder cancer diagnosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst.

Hemorrhagic Cholecystitis: A Case of Expedited Diagnosis by Point-of-Care Ultrasound in the Emergency Department

BACKGROUND

Hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is a potentially fatal diagnosis. It may be difficult to detect because the symptoms are similar to more common diagnoses. Point-of-care ultrasound is a useful imaging technique in the emergency setting and is readily available to allow for immediate interpretation and application of the results to guide medical decision making.

CASE REPORT

We report a 76-year-old man with a history of hypertension, hyperlipidemia, diabetes, atrial fibrillation on warfarin, and coronary artery disease presenting with epigastric pain radiating to the back, nausea, and vomiting who was found to have hemorrhagic cholecystitis with gallbladder perforation. Ultrasound of the abdominal right upper quadrant showed a large, hyperechoic, nonshadowing, globular structure visualized within the lumen of the gallbladder extending from the neck through the body. The gallbladder wall was noted to be 0.72 cm with wall edema, focal pericholecystic fluid, and a positive sonographic Murphy sign suggestive of acute cholecystitis. The abnormal appearance of the gallbladder contents was suspected to be blood. Computed tomography angiography was performed and confirmed the diagnosis of acute hemorrhagic cholecystitis with perforation. Blood was noted to track from the cystic duct to the gallbladder lumen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is a unique case of hemorrhagic cholecystitis visualized on bedside ultrasound. This case shows that the use of point-of-care ultrasound by emergency medicine providers can facilitate the rapid recognition and treatment of specific, life-threatening hepatobiliary pathology while excluding alternate diagnoses.

Hemorrhagic cholecystitis causing hemobilia and common bile duct obstruction

Biliary obstruction is a common problem associated with gallbladder pathology. However, hemorrhagic cholecystitis with hemobilia as the cause is quite rare. We present a case of hemorrhagic cholecystitis in the setting of systemic anticoagulation causing common bile duct obstruction which required endoscopic retrograde cholangiopancreatography (ERCP) for ductal clearance followed by laparoscopic cholecystectomy. The triad of right upper quadrant abdominal pain, jaundice and gastrointestinal bleed should prompt consideration of hemobilia in the setting of biliary obstruction.

Literature review and case series of haemorrhagic cholecystitis

A diagnosis of haemorrhagic cholecystitis is difficult to make as it is rare and mimics other common disorders. We present three patients who presented with haemorrhagic cholecystitis, two of whom were on anti-coagulation at presentation. All 3 patients were treated conservatively, 2 with percutaneous cholecystostomy drainage and 1 patient with intravenous antibiotics. There are few guidelines on the management of such a condition.

Hemorrhagic Cholecystitis after Warfarin Use for Deep Vein Thrombosis

Hemorrhagic cholecystitis is an uncommon form of acute cholecystitis which can be rapidly fatal. It may be hard to detect as it frequently presents with symptoms found in other, more common diagnoses. We report the case of a 63 year old man recently started on anticoagulation for deep vein thrombosis who was found to have hemorrhagic cholecystitis.