Abstract
An 85-year-old man was admitted to another hospital for continuous epigastric pain. Acute cholecystitis was suspected, and he was referred to our hospital. He had developed a stroke approximately two months previously and was undergoing anticoagulant therapy. Abdominal CT scan showed gallbladder (GB) hemorrhage and perforation of the GB wall at the anterior side of the GB neck. Based on a diagnosis of hemorrhagic cholecystitis caused by anticoagulant therapy, we performed emergency operation (cholecystectomy). The resected specimen contained a slightly elevated lesion with a central depression at the peritoneal side of the GB fundus ; we had been unable to detect this lesion on preoperative imaging diagnosis or intraoperative findings. On histopathological examination, it was diagnosed as adenocarcinoma, and an exposed artery at the bottom of the central depression in the tumor had ruptured with agglutination of red blood cells. Therefore, we diagnosed this case as hemorrhagic cholecystitis due to the occult GB cancer. Cases of GB perforation caused by hemorrhagic cholecystitis are relatively rare. Furthermore, cases of hemorrhagic cholecystitis caused by GB tumor are extremely rare. We have reported a case of occult GB cancer that caused a rupture, resulting in hemorrhagic cholecystitis.
