Abstract
A 49-year-old man who had taken warfarin after open-heart surgery, which was performed twice for aortitis, presented with right upper abdominal pain, was diagnosed with acute cholecystitis, and visited our hospital. A computed tomography (CT) detected calculi and a hematoma in the gall bladder, and fluid accumulation around the gall bladder. He developed hemorrhagic shock after admission, but improved under intensive care. An enhanced CT scan did not detect obvious arterial hemorrhage; he recovered from hemorrhagic shock, and underwent a laparotomy for severe cholecystitis 5 days after admission. The patient's gall bladder was perforated with a puriform hematoma around it; a cholecystectomy was performed. He was discharged on postoperative day 15 without complications. Histopathological analysis revealed desquamated and ulcerative mucosal membrane of the gall bladder without malignancy. We believe the pressure of the hematoma in the gall bladder caused the perforation.
