A Case of Hemorrhagic Cholecystitis with Perforation and Intraperitoneal Bleeding During Anticoagulant Therapy

Abstract

A 59-year-old man who was receiving direct oral anticoagulant (DOAC) therapy for portal vein thrombosis complicating alcoholic liver cirrhosis admitted to a hospital with sudden onset of upper abdominal pain, nausea and syncope. As abdominal computed tomography (CT) showed hemorrhage of the gallbladder with intraperitoneal bleeding, the patient was shifted to our hospital. After admission, the patient went into a shock state and developed abdominal distension；abdominal physical examination revealed muscle guarding in the upper abdomen. With rapid fluid infusion and catecholamine administration, the patient recovered from the shock. Enhanced abdominal CT revealed a gallbladder stone, extravasation from the wall of the gallbladder and perforation, and emergency surgery was performed. The fundus of the gallbladder was perforated, with hemorrhage from the perforation. Partial cholecystectomy was performed. We made the final diagnosis in this case of hemorrhage associated with cholecystitis due to gallbladder stone, in a patient with alcoholic liver cirrhosis receiving DOAC therapy.