2016 Volume 36 Issue 3 Pages 681-685
A 63-year-old man who had been undergoing hemodialysis for 6 years because of diabetic renal disease was admitted to our hospital with fever and abdominal pain. Computed tomography revealed a gallbladder stone and ascites, and acute cholecystitis was diagnosed. After admission, he went into shock and we performed emergency surgery for septic shock due to gangrenous cholecystitis. Laparoscopy revealed massive intra-abdominal hemorrhage and pulsatile bleeding from the fundus of the gallbladder. We diagnosed hemorrhagic shock, converted to laparotomy, and performed a cholecystectomy. However, bleeding from the gallbladder bed continued, and hemostasis was difficult to achieve because of coagulopathy. We performed perihepatic towel packing, and the patient was moved to the intensive care unit. With improvement in the coagulopathy, we successfully removed the towels from the abdomen seven days after the initial operation. Hemorrhagic cholecystitis with massive intra-abdominal hemorrhage is rare and was successfully treated with a two-stage operation.
