Hemorrhagic Cholecystitis Presenting with Intraperitoneal Bleeding Managed by Damage Control Surgery: A Case Report

Abstract

A 56-year-old man with a history of liver cirrhosis presented with acute chest and back pain. Abdominal contrast-enhanced computed tomography revealed a large volume of hemorrhagic ascites in Morison’s pouch, an impacted gallstone in the gallbladder neck, and hyperdense content within the gallbladder. Based on the findings, we considered the diagnosis of hemorrhagic cholecystitis with intraperitoneal bleeding. Emergency laparotomy confirmed gallbladder perforation with ongoing hemorrhage. Following cholecystectomy, because of the ongoing bleeding from the gallbladder bed and abdominal wall, we undertook damage control surgery with gauze packing to stabilize the patient and manage the hemorrhage. A second-look surgery confirmed complete hemostasis, and the patient was successfully discharged on postoperative day 21 without complications. Hemorrhagic cholecystitis is rare. Early surgical intervention in combination with damage control surgery may be crucial for achieving a life-saving outcome.