A case of acute hemorrhagic cholecystitis

Abstract

A 42-year-old woman was admitted with melena and right hypochondralgia. On admission, her laboratory data showed mild liver dysfunction and anemia. Emergency panendoscopy revealed no sign of bleeding from the papilla of Vater. Abdominal ultrasonography, plain CT, and MRI showed evidence of cholecystitis with a hematoma in the enlarged gallbladder. Hemorrhagic cholecystitis was diagnosed. After one week of conservative therapy, a laparoscopic cholecystectomy was performed. The examination of the resected specimen showed that the wall of the gallbladder was mildly thickened, and that a hemorrhagic ulcer was present in the neck ; no gallstones were present. On pathology, submucosal hemorrhage and fibrosis in the area of ulceration, with no evidence of neoplastic or arteriosclerotic changes were noted. The final diagnosis was hemorrhage due to acute non-calculous cholecystitis. The patient has been well without any recurrence of bleeding for the last 5 months. Gallbladder hemorrhage should be considered in cases with unexplained bleeding from the gastrointestinal tract.