Acute cholecystitis with intraluminal gallbladder bleeding: Case report and literature review

Background: Hemorrhagic cholecystitis is an infrequent complication of acute cholecystitis associated with high mortality rate. Recognition of this acute abdominal condition is often challenging. Authors present a case of acute intraluminal gallbladder bleeding with a consequential gallbladder wall perforation and hematoperitoneum requiring emergency surgery in a patient on anticoagulant therapy. Case Presentation: An 80-year old woman with atrial fibrillation on warfarin was presented to abdominal surgeon due to acute abdominal pain with hemodynamic instability and active intraluminal gallbladder bleeding on CT-scan. An emergency laparotomy with cholecystectomy was performed. Despite intensive treatment patient died on the third postoperative day. Conclusions: Hemorrhagic cholecystitis is a potentially life-threatening condition. Patients on anticoagulant therapy with clinical signs of acute cholecystitis are more prone to develop bleeding into the gallbladder. Contrast-enhanced CT of the abdomen is the diagnostic modality of choice and cholecystectomy definitive therapy in patients with hemorrhagic cholecystitis.