A Case of Hemorrhagic Cholecystitis That Developed During Antithrombotic Therapy in a Patient Who Had Undergone Open Heart Surgery: A Case Report

Abstract

A 78-year-old woman who presented with angina pectoris and was diagnosed as having aortic valve stenosis underwent aortic valve replacement and coronary artery bypass grafting. Postoperatively, she was started on antiplatelet and anticoagulant drug therapy (100 mg aspirin ＋ 2 mg warfarin). On the 17th postoperative day, the patient complained of upper abdominal pain and black stools. An abdominal contrast-enhanced CT revealed an enlarged and tense gallbladder, with a high-density area inside; based on the findings, we diagnosed the patient as having hemorrhagic cholecystitis and performed an emergency cholecystectomy. The gallbladder was enlarged and discolored. As the patient was receiving anticoagulant therapy, it was difficult to stop the bleeding. A blood clot was found inside the resected gallbladder. The patient’s postoperative course was favorable, and she was discharged on the 13th postoperative day. Hemorrhagic cholecystitis developing during anticoagulant therapy is rare, and there are few case reports, especially of cases developing after open heart surgery. In patients receiving anticoagulant therapy who present with upper abdominal pain or tarry stools, hemorrhagic cystitis should also be considered, besides gastrointestinal bleeding, in the differential diagnosis.