Abstract
A 40-year-old woman with sudden onset of abdominal pain was transported to our emergency room. Abdominal computed tomography (CT) scan showed a thickened gallbladder wall and high-density contents in the gallbladder; hence, a diagnosis of cholecystitis was made following gallbladder hemorrhage. Marked elevation of the levels of hepatobiliary enzymes was observed, and we performed endoscopic nasobiliary drainage. We further performed percutaneous transhepatic gallbladder drainage because the inflammatory response worsened gradually. After the degree of inflammation decreased, the patient underwent laparoscopic cholecystectomy. The gallbladder wall was found to be diffusely thickened, with marked thickening of the wall of the gallbladder fundus. The origin of the hemorrhage could not be determined macroscopically. Histopathological analysis showed Rokitansky Aschoff sinuses (RASs) in the gallbladder, and 1 RAS was filled with blood. We concluded that the acute cholecystitis and biliary hemorrhage were triggered by gallbladder hemorrhage resulting from the RAS.
