A Case of Hemorrhagic Cholecystitis during Anticoagulant Therapy after Cerebral Infarction

Abstract

A 68-year-old woman was admitted to our hospital with cerebral infarction. Anticoagulant therapy was initiated following thrombolytic therapy. Although the patient initially responded well to treatment, she suddenly developed abdominal pain after eating. Laboratory data indicated inflammation as well as severe and rapid liver dysfunction. Therefore, we made a diagnosis of acute hemorrhagic cholecystitis with hemobilia. Firstly endoscopic therapy was undergone for hemobilia and obstruction of bile duct with liver dysfunction during anticoagulant therapy. However, it was very difficult to perform the endoscopic therapy. Hence, we suspected perforation of the bile duct and duodenum and performed an emergency laparotomy. A region of the perforation could not be clearly observed; therefore, we finally chose cholecystectomy and placed a drainage tube in the bile duct for intraperitoneal drainage. The patient's postoperative course was uneventful. We emphasize that early diagnosis of hemorrhagic cholecystitis is very important and therapy should be initiated without delay.