Abstract
The case involved a 73-year-old man who had been on anticoagulation therapy after coronary artery bypass surgery and aortic valve replacement for ischemic cardiomyopathy. He presented to our emergency clinic because of persisting epigastralgia. When he was seen, the blood pressure was as low as 97/62 mmHg, and the palpebral conjunctiva looked pale. Blood analysis showed the low Hb level of 8.5 g/dl. Increases in the biliary enzyme levels and the bilirubin level were noted, and stool examination was positive for occult blood. Biliary hemorrhage was likely. An abdominal CT scan showed findings suggestive of hemorrhage within the gallbladder. MRI revealed findings suggestive of the acute phase of hemorrhage. Accordingly gallbladder hemorrhage was diagnosed and laparoscopic-assisted cholecystectomy was performed. After the operation, increased biliary enzymes and jaundice were normalized with time and no hemorrhagic complications were associated. The patient improved and was discharged from the hospital on the 8th postoperative day.
Gallbladder hemorrhage is a comparatively rare entity and anticoagulation therapy has a risk of causing the disease. Since hemostasis can be easily achieved by surgery and the prognosis is favorable so that early diagnosis is important. When we encounter acute abdomen during anticoagulation therapy, gallbladder hemorrhage must be considered as a differential diagnosis.
