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AlMoshary M. Hemorrhagic cholecystitis afflicted with glanzmann thrombasthenia patient. J Family Med Prim Care 2024; 13:5395-5398. [PMID: 39723013 PMCID: PMC11668374 DOI: 10.4103/jfmpc.jfmpc_858_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 12/28/2024] Open
Abstract
Hemorrhagic cholecystitis is a rare and potentially life-threatening condition that requires immediate medical attention. If the gallbladder perforates, it can lead to even more severe complications. We present the case of a 27-year-old man with Glanzmann's thrombasthenia, a rare platelets disorder, who visited the emergency department twice before being diagnosed with this condition. Initially, he complained of ear pain, and later, chest pain. Despite a normal ECG and cardiac markers, he was discharged with non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain. However, when he returned with abdominal pain, nausea, and vomiting, an ultrasound revealed signs of cholecystitis. An emergency laparoscopic cholecystectomy was performed, which revealed hemorrhagic cholecystitis.
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Affiliation(s)
- May AlMoshary
- Department of Basic Science College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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2
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Ichikawa-Escamilla E, Solís-Ibarra XG, Lizárraga-López Z, Valenzuela-Hernández R, Flores-Díaz JA. Hemorrhagic Cholecystitis in a Patient Under Anticoagulant and Antiplatelet Therapy: A Case Report. Cureus 2024; 16:e60378. [PMID: 38883025 PMCID: PMC11179736 DOI: 10.7759/cureus.60378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Hemorrhagic cholecystitis is an uncommon presentation of acute cholecystitis. Due to its etiology and unspecific clinical data, it is an entity that represents a diagnostic challenge. We present a case of a 70-year-old male with diabetes type 2, hypertension, and chronic kidney disease with hemodialysis, who attended the emergency department with sudden-onset abdominal pain in the epigastrium. The patient presented no additional symptoms, a normal electrocardiogram, but due to the characteristics of the pain and elevated troponin I, emergency medicine specialists considered an acute coronary syndrome and initiated antiplatelet and anticoagulant therapy. Due to persistent abdominal pain, a decrease in hemoglobin, and the onset of arterial hypotension, a computed tomography (CT) scan was performed, which revealed perforation of the gallbladder, apparent hemorrhagic cholecystitis, and hemoperitoneum. The patient underwent emergent surgery, where CT findings were confirmed. In our case, the suspicion of hemorrhagic cholecystitis arose until the clinical case was advanced, after receiving anticoagulant and antiplatelet therapy, and it was confirmed during surgery and with histopathology. This concludes that hemorrhagic cholecystitis is a rare disease and difficult to diagnose. Therefore, studies should focus on clinical presentation and risk factors (e.g., trauma, malignancy, renal failure, cirrhosis, and anticoagulation therapy) to promote early diagnosis and avoid complications.
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Affiliation(s)
- Eduardo Ichikawa-Escamilla
- Surgery, Hospital General de Zona No 14 con Unidad de Quemados, Instituto Mexicano del Seguro Social, Hermosillo, MEX
| | - Xiomara G Solís-Ibarra
- Surgery, Hospital General de Zona No 14 con Unidad de Quemados, Instituto Mexicano del Seguro Social, Hermosillo, MEX
| | - Zuleyma Lizárraga-López
- Surgery, Hospital General de Zona No 14 con Unidad de Quemados, Instituto Mexicano del Seguro Social, Hermosillo, MEX
| | - Rafael Valenzuela-Hernández
- Surgery, Hospital General de Zona No 14 con Unidad de Quemados, Instituto Mexicano del Seguro Social, Hermosillo, MEX
| | - José A Flores-Díaz
- Surgery, Hospital General de Zona No 14 con Unidad de Quemados, Instituto Mexicano del Seguro Social, Hermosillo, MEX
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3
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Duhancioglu G, Arif-Tiwari H, Natali S, Reynolds C, Lalwani N, Fulcher A. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol (NY) 2024; 49:722-737. [PMID: 38044336 DOI: 10.1007/s00261-023-04107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
Abstract
Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.
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Affiliation(s)
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
| | - Stefano Natali
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Conner Reynolds
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Neeraj Lalwani
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
| | - Ann Fulcher
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
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4
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Yano YI, Iguchi T, Sato S, Iseda N, Sasaki S, Abe Y, Nakayama T, Honboh T, Kato S, Sadanaga N, Matsuura H. Successful laparoscopic cholecystectomy for gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis: a case report. Surg Case Rep 2023; 9:46. [PMID: 36961559 PMCID: PMC10039168 DOI: 10.1186/s40792-023-01628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Patients on long-term dialysis are prone to hemorrhagic complications, particularly uremic bleeding, but gallbladder hemorrhage is rare, even in patients on dialysis. There have been occasional reports of a Dieulafoy lesion being a cause of gastrointestinal hemorrhage, but its occurrence within the gallbladder is quite rare. This report describes a case of gallbladder hemorrhage from a Dieulafoy lesion in a patient on hemodialysis that was diagnosed early and successfully treated by laparoscopic cholecystectomy. CASE PRESENTATION The patient was a 68-year-old woman on long-term hemodialysis with end-stage renal failure who presented with epigastralgia and back pain. There was no history of trauma or oral administration of antiplatelet or anticoagulant agents. There were no signs of an inflammatory reaction or hyperbilirubinemia. Contrast-enhanced computed tomography revealed a slightly hyperdense area in the distended gallbladder and extravasation within the gallbladder lumen but no gallstones. A severe atherosclerotic lesion was also found. She was diagnosed to have gallbladder hemorrhage and emergency laparoscopic cholecystectomy was performed. Although the postoperative course was complicated by drug fever, she was discharged on postoperative day 10 in a satisfactory condition. Histology revealed hemorrhagic ulceration with an exposed blood vessel accompanied by abnormal arteries in the submucosa. Arteriosclerosis with eccentric intimal hyperplasia in a small-sized artery was also seen. The diagnosis was gallbladder hemorrhage from a Dieulafoy lesion. CONCLUSIONS A Dieulafoy lesion should be kept in mind as a cause of gallbladder hemorrhage in a patient with severe arteriosclerosis and a bleeding diathesis, particularly if on dialysis, and treated as early as possible.
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Affiliation(s)
- Yuu-Ichi Yano
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Iguchi
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan.
| | - Shota Sato
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Norifumi Iseda
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Shun Sasaki
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Yasuhiro Abe
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Tomohiro Nakayama
- Department of Radiology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Takuya Honboh
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin Chuo-Ku, Fukuoka, Japan
| | - Noriaki Sadanaga
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Hiroshi Matsuura
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
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Cochran RL, Coe T, Nakrour N, Goiffon RJ. COVID-19 associated spontaneous hemorrhagic cholecystitis. Radiol Case Rep 2023; 18:353-357. [DOI: 10.1016/j.radcr.2022.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022] Open
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Muacevic A, Adler JR, AlOtaibi WS, Alanazi SN, AlKhayyal Y, Mrad B, Abdulla MH, AlHassan N, Bin Traiki T. Hemorrhagic Necrotizing Cholecystitis With Cholecystocolonic Fistula: A Case Report. Cureus 2022; 14:e32187. [PMID: 36620837 PMCID: PMC9810825 DOI: 10.7759/cureus.32187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cholecystocolonic fistula (CCF) and hemorrhagic cholecystitis are rare complications of gallstones that have a wide range of non-specific symptoms and clinical severity. We present a case of a 74-year-old woman on warfarin who presented to the emergency department with a 10-day history of abdominal pain, vomiting, and watery diarrhea. Her abdomen was distended with generalized tenderness and palpable mass in the right lower quadrant. Laboratory tests revealed leukocytosis and an elevated international normalized ratio (INR). After admission and imaging, exploratory laparotomy showed hemorrhagic cholecystitis with CCF in the cecum. There was no pus or stool contamination. A cholecystectomy followed by right hemicolectomy with primary ileocolic anastomosis was performed. The postoperative course was uneventful, and the patient was discharged in stable condition. The presence of hemorrhagic cholecystitis in conjunction with CCF could lead to significant consequences such as hemorrhagic and septic shock in older patients with comorbidities. It is crucial to identify and intervene early before clinical deterioration.
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Valenti MR, Cavallaro A, Di Vita M, Zanghi A, Longo Trischitta G, Cappellani A. Gallbladder hemorrhage-An uncommon surgical emergency: A case report. World J Clin Cases 2022; 10:9734-9742. [PMID: 36186197 PMCID: PMC9516921 DOI: 10.12998/wjcc.v10.i27.9734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gallbladder hemorrhage is a life-threatening disorder. Trauma (accidental or iatrogenic such as a percutaneous biopsy or cholecystectomy surgery), cholelithiasis, biliary tract parasitosis, vasculitis, vascular malformations, autoimmune and neoplastic diseases and coagulopathies have been described as causes of hemorrhage within the lumen of the gallbladder. The use of non-steroidal anti-inflammatory drugs and anticoagulants may represent a risk factor. CASE SUMMARY We report the case of a 76-year-old male patient. An urgent contrast computed tomography scan demonstrated relevant distension of the gallbladder filled with hyperdense non-homogeneous content. The gallbladder walls were of regular thickness. Near the anterior wall a focus of suspected active bleeding was observed. Due to the progressive decrease in hemoglobin despite three blood transfusions, this was an indication for urgent surgery. CONCLUSION Early diagnosis of this potentially fatal pathology is essential in order to plan a strategy and eventually proceed with urgent surgical treatment.
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Affiliation(s)
- Maria Rosaria Valenti
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Andrea Cavallaro
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Maria Di Vita
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Antonio Zanghi
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Giovanni Longo Trischitta
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Alessandro Cappellani
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
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8
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Khan Hotak M, Fadia M, Gananadha S. The Clinical Significance of Hemorrhagic Cholecystitis. JSLS 2022; 26:JSLS.2022.00030. [PMID: 35815329 PMCID: PMC9255261 DOI: 10.4293/jsls.2022.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Hemorrhagic cholecystitis (HC) is a rare complication of acute cholecystitis. HC is difficult to diagnose pre-operatively and previous case reports suggest a strong association with anticoagulation and an increased morbidity. The purpose of the study is to determine the clinical presentation and outcomes of patients with HC in a large cohort of patients. Method A retrospective review of HC patients diagnosed following review of the clinical and pathological database between January 1, 2000 - June 30, 2021 at two hospitals. A search of the histopathology database, patient medical records, laboratory results, and imaging was conducted. Results Thirty-five patients were diagnosed on the histopathology report from approximately 6458 patients who had cholecystectomies. Thirty-one had emergency presentation and four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female and 15 patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients were converted to open and five patients required postoperative endoscopic retrograde cholangiopancreatography. Two patients (5.7%) were on anticoagulation therapy. Twenty-three (65.7%) had ultrasound, 12 patients (34.2%) had computed tomography, three patients (8.5%) had magnetic resonance cholangiopancreatography, and one patient with a pre-operative diagnosis of HC. Conclusion HC is a rare form of acute cholecystitis. Anticoagulation only accounts for a small fraction of these patients. Pre-operative diagnosis of HC is not often made. Patients were treated with cholecystectomies and made a full recovery with no complications. Our study seems to show HC is a histological diagnosis with no clinical consequences for the patients.
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Affiliation(s)
| | - Mitali Fadia
- Department of Anatomical Pathology, Canberra Hospital, Garran, Australia
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9
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Yap CR, Puri R. A Rare Case of Acute Pancreatitis in the Setting of Hemorrhagic Cholecystitis. Cureus 2022; 14:e22546. [PMID: 35345762 PMCID: PMC8956495 DOI: 10.7759/cureus.22546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/20/2022] [Indexed: 11/05/2022] Open
Abstract
Hemorrhagic cholecystitis is a rare form of acute cholecystitis with very few cases reported in the literature. We report a novel case of a 79-year-old male who developed hemorrhagic cholecystitis and concomitant acute pancreatitis. The patient presented to the emergency department with a one-day history of severe epigastric pain radiating to his back. The patient was on an anticoagulant therapy for a history of pulmonary embolism. He had an elevated serum lipase and on a right upper quadrant ultrasound, a mildly distended gallbladder without stones was noted. Computed tomography (CT) the following day demonstrated heterogenous material in the gallbladder concerning for blood clots. Laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) was performed that revealed a gallbladder filled with clots. He had an uneventful post-operative recovery.
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10
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Emergency Department Diagnosis of Postprocedural Hemorrhagic Cholecystitis Utilizing Point-of-Care Ultrasoun. J Emerg Med 2022; 62:e69-e77. [PMID: 35031169 DOI: 10.1016/j.jemermed.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hemorrhagic cholecystitis is a rare cause of abdominal pain. Most often described in the setting of blunt abdominal trauma, anticoagulation use, coagulopathy (such as cirrhosis or renal failure), and malignancy (biliary angiosarcoma), this rare condition can be difficult to identify unless high on the differential. With point-of-care ultrasound becoming more commonplace in the emergency department (ED), this tool can be successfully used to make a timely diagnosis in the correct clinical context. CASE REPORT A 64-year-old man with a past medical history of paroxysmal atrial fibrillation status post ablation on rivaroxaban, myelodysplastic syndrome, nonalcoholic steatohepatitis, gastroesophageal reflux disease, clonal cytopenias of undetermined significance, hypertension, and chronic pain presented to the ED with complaints of right upper quadrant pain in the setting of a recent transjugular liver biopsy. Using point-of-care ultrasound, the patient was diagnosed with hemorrhagic cholecystitis. This is an incredibly rare entity, with 87 documented cases in the literature, only two of which are in the setting of transjugular liver biopsy. The patient was ultimately managed conservatively until he had worsening symptoms, and a laparoscopic cholecystectomy was performed. The patient tolerated the procedure well and recovered. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hemorrhagic cholecystitis is a rare pathology that can be easily recognized during point-of-care ultrasound examination. This allows for rapid diagnosis and surgical consultation to provide the patient with timely definitive management.
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Khan Hotak M, Joseph C. A case of haemorrhagic cholecystitis with no risk factors. J Surg Case Rep 2021; 2021:rjab542. [PMID: 34992766 PMCID: PMC8718369 DOI: 10.1093/jscr/rjab542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
Haemorrhagic cholecystitis (HC) is a rare cause of cholecystitis that can be fatal if management is delayed. HC could present in the setting of trauma, malignancy and bleeding diathesis, such as renal failure, cirrhosis and anticoagulation. Its symptoms are easily confused with acute calculous or acalculous cholecystitis and might include haemobilia or hematemesis as blood drains from the gallbladder into the gastrointestinal tract. Imaging of HC can be misleading unless the possibility of this diagnosis is considered. In this report, we present an interesting case of HC in a patient with none of the above comorbidities and the patient who was not on anticoagulation neither anti platelets. The case includes relevant imaging and a review of the literature on this rare subject.
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Affiliation(s)
| | - Christo Joseph
- General Surgery, Bega Hospital, New South Wales 2550, Australia
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12
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Aldohayan NA, Rashed AA, Aljurayyan R. Hemorrhagic cholecystitis with auto-avulsion. Radiol Case Rep 2021; 16:3739-3743. [PMID: 34630810 PMCID: PMC8493507 DOI: 10.1016/j.radcr.2021.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
Acute cholecystitis is a common condition, with varying presentations and complications, and is frequently treated in the emergency department. This case report illustrates hemorrhagic cholecystitis (HC) as a rare complication of cholecystitis. A 74-year-old woman presented to our emergency department with intermittent abdominal discomfort and continued vomiting after any oral ingestion as well as watery diarrhea. Patient history included mitral valve replacement and a daily dose of warfarin. Emergent cross-sectional abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass that occupied most of the right abdominal cavity. An exploratory laparotomy revealed a necrotizing and hemorrhagic enlarged gallbladder with cholelithiasis. This enlargement appeared adherent and fistulizing into the cecum, without signs of bowel perforation. The postoperative period was uneventful, and the patient recovered well. Owing to its non-specific presentation, imaging studies are essential in establishing a diagnosis for HC. Although CT has not been advocated as a primary imaging examination for acute right upper quadrant pain, it is a valuable tool for assessing HC, along with MRI.
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Affiliation(s)
- Najla Abdullah Aldohayan
- Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, 7805(46), Riyadh 11472, Saudi Arabia
| | - Abdulmohsen Al Rashed
- Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, 7805, Riyadh 11472, Saudi Arabia
| | - Reshid Aljurayyan
- Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, 7805, Riyadh 11472, Saudi Arabia
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13
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Gobishangar S, Shelton J, Jenil AA. Hemorrhagic Cholecystitis: A Rare Cause of Melena. Cureus 2021; 13:e16385. [PMID: 34306900 PMCID: PMC8279100 DOI: 10.7759/cureus.16385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/05/2022] Open
Abstract
Hemorrhagic cholecystitis -- a rare cause of hemobilia and melena -- is an atypical presentation of calculous cholecystitis, associated with significant morbidity and mortality. A 75-year-old woman with multiple comorbidities, who was undergoing dual antiplatelet therapy, presented with symptoms of acute cholecystitis. Two days later, she developed melena and symptoms of obstructive jaundice. Following radiological evaluation, a diagnosis of hemorrhagic cholecystitis was made. The patient was managed conservatively with IV antibiotics and blood transfusion in the initial period (clopidogrel was withheld); an interval cholecystectomy was performed six weeks later. Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, and its diagnosis is challenging as it mimics various other hepatopancreaticobiliary diseases. Management options include early surgery or conservative management at the initial stage, followed by interval cholecystectomy.
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Affiliation(s)
| | - John Shelton
- General Surgery, Teaching Hospital Jaffna, Jaffna, LKA
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14
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Cunha R, Quintanilha R. Hemorrhagic cholecystitis after coronary angiography. J Surg Case Rep 2021; 2021:rjab255. [PMID: 34194726 PMCID: PMC8238398 DOI: 10.1093/jscr/rjab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Abstract
Hemorrhagic cholecystitis is a rare condition with several possible causes. Despite being a difficult diagnosis, it is an important one considering the fatal possibility for the patient. The following is the case of a 68-year-old patient with dual antiplatelet therapy, who underwent coronary angiography and angioplasty in a hypocoagulate setting, developing a hemorrhagic cholecystitis. This article seeks to recognize the importance of this differential diagnosis in hypocoagulated patients with abdominal pain.
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Affiliation(s)
- Roberto Cunha
- Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Rui Quintanilha
- General Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
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15
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Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 2021; 28:1011-1027. [PMID: 34110530 DOI: 10.1007/s10140-021-01944-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.
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16
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Sakharuk I, Martinez P, Laub M, Gani I, Saeed M. Anticoagulant-induced hemorrhagic cholecystitis with hemobilia after deceased donor kidney transplant and literature review. Int J Surg Case Rep 2021; 84:106027. [PMID: 34118559 PMCID: PMC8196047 DOI: 10.1016/j.ijscr.2021.106027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Hemobilia and hemorrhagic cholecystitis are uncommon causes of right upper quadrant abdominal pain. The development of intra-gallbladder and biliary bleeding has been primarily associated with abdominal trauma, malignancy, liver transplant, and iatrogenic injury to the biliary tree and vasculature. Spontaneous anticoagulant induced hemorrhagic cholecystitis and hemobilia are incredibly rare events and have only been documented by a handful of case reports. Case presentation A 55-year-old male who had recently undergone a deceased-donor kidney transplant was transferred to our academic institution for evaluation of subjective fever, right upper quadrant abdominal and back pain. The patient demonstrated localized tenderness in the right abdomen and was found to have hemorrhagic cholecystitis on imaging. He subsequently underwent urgent cholecystectomy and recovered without any subsequent complications. Clinical discussion Hemorrhagic cholecystitis and hemobilia are a rare cause of right-sided or generalized abdominal pain. Diagnosis is made primarily by pathognomonic findings on CT and US imaging. Prompt diagnosis is essential in preventing mortality and/or significant morbidity. The standard treatment consists of urgent/emergent cholecystectomy. Conclusion A rare sequelae of anticoagulant use, intra-biliary bleeding must be considered as a differential diagnosis in anticoagulated patients presenting with right upper quadrant abdominal pain.
Hemorrhagic cholecystitis is uncommon cause of right upper quadrant abdominal pain Spontaneous anticoagulant induced hemorrhagic cholecystitis have only been reported by a handful of case reports. Patients experiencing intra-gallbladder bleeding often present with symptoms similar to those seen in acute cholecystitis.
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Affiliation(s)
- Ilya Sakharuk
- Augusta University, Department of Surgery, United States of America
| | | | - Melissa Laub
- Augusta University, Department of Pharmacy, United States of America
| | - Imran Gani
- Augusta University, Department of Medicine, United States of America
| | - Muhammad Saeed
- Augusta University, Department of Surgery, United States of America.
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Nguyen D, Goodwin JS, Bhowmik N, Boiteau G, Potts J. Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy. J Radiol Case Rep 2021; 15:25-34. [PMID: 33717408 DOI: 10.3941/jrcr.v15i2.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic cholecystitis is a potentially deadly and difficult to recognize entity. It is associated with cystic artery pseudoaneurysm and is usually seen in the setting of acute calculous cholecystitis. We report two cases of hemorrhagic cholecystitis with arteriographic findings of cystic artery pseudoaneurysms that were successfully embolized using microcoils, facilitating subsequent cholecystectomy. Both cases had unusual presentations of gallbladder rupture with hemoperitoneum, the latter of which was atypical occurring in the absence of gallstones. We believe when hemorrhagic cholecystitis is suspected, a two-step therapeutic approach should be employed with embolization of the bleeding cystic artery followed by cholecystectomy. A comprehensive literature review and discussion of hemorrhagic cholecystitis will be provided.
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Affiliation(s)
- Don Nguyen
- Department of Abdominal Imaging & Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - J Scott Goodwin
- Department of Diagnostic Radiology, Duke University Hospital, Durham, USA
| | - Nirjhor Bhowmik
- Department of Vascular & Interventional Radiology, Medical College of Wisconsin, Wauwatosa, USA
| | - Guillaume Boiteau
- Department of Vascular & Interventional Radiology, Allegheny Health Network, Pittsburgh, USA
| | - Jonathan Potts
- Department of Vascular & Interventional Radiology, Allegheny Health Network, Pittsburgh, USA
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18
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Hui CL, Loo ZY. Vascular disorders of the gallbladder and bile ducts: Imaging findings. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:825-836. [PMID: 33639040 DOI: 10.1002/jhbp.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
Vascular disorders of the gallbladder and biliary tree are many and varied. In the acute setting, the clinical presentation of vascular conditions such as hemorrhagic cholecystitis and gangrenous cholecystitis are non-specific and rely on imaging for diagnosis and triaging for emergent surgery. These hemorrhagic and ischemic complications of acute cholecystitis are uncommon but potentially fatal. Hemorrhage into the gallbladder and biliary tree, from other causes, may itself result in acute cholecystitis. Knowledge of vascular anatomy of the gallbladder and biliary tree is essential for surgeons to prevent significant operative bleeding complications, particularly in laparoscopic cholecystectomy. The unique venous drainage of the gallbladder and biliary tree, with their connections to the portal venous system, lends itself to less well-recognised vascular phenomena such as gallbladder varices, portal biliopathy, and gallbladder bed perfusion abnormalities.
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19
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Ramírez Calderón JZ, Martínez Chamorro E, Ibáñez Sanz L, Albillos Merino JC, Borruel Nacenta S. Hemorrhagic cholecystitis: ultrasound and CT imaging findings-a retrospective case review series. Emerg Radiol 2021; 28:613-620. [PMID: 33464440 DOI: 10.1007/s10140-020-01879-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Gallbladder pathology is diverse, and imaging tests are essential tools for its diagnosis. Acute cholecystitis has multiple manifestations or complications, one of which is hemorrhagic cholecystitis (HC). In the current literature, this pathology has been described only in the spectrum of acute cholecystitis complications, case reports, or series with a maximum of 2 to 3 cases. After a retrospective review, we present 11 cases of hemorrhagic cholecystitis and discuss its various causes, clinical presentations, and findings on ultrasound (US) and computed tomography (CT), considering dual-energy CT and magnetic resonance imaging (MRI). METHODS A retrospective review of 6 years (2012-2018) of hemorrhagic cholecystitis cases diagnosed at our hospital was performed. A search engine of medical terms was used and the database of radiological cases in the emergency department of the hospital. After a careful review by two emergency and one abdominal radiologists, 11 patients were identified as hemorrhagic cholecystitis cases according to their clinical, radiological, and surgical records and confirmed with pathology reports. RESULTS Both lithiasis and anticoagulation/antiplatelet therapy were the most common etiologies found (9 patients, 82%). The clinical presentation may be misleading, simulating a usual cholecystitis episode with abdominal pain, nausea, and vomiting, or manifesting with signs of bile duct obstruction, hematemesis, or anemia that may compromise the patient hemodynamically and become fatal. US is useful, but CT is the most complete test for evaluating hemorrhagic cholecystitis and was performed in all the patients. The common findings were inflammatory changes in all patients (100%), hemobilia in 10 patients (91%), hemoperitoneum in 6 patients (55%), intestinal bleeding in 3 patients (27%), and occasionally perihepatic hematomas or signs of active bleeding. CONCLUSION Although a rare entity, hemorrhagic cholecystitis may be present, and management can be delayed if the appropriate imaging modality is not used for diagnosis.
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Affiliation(s)
- Jessie Z Ramírez Calderón
- Department of Radiology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain.
| | - Elena Martínez Chamorro
- Department of Radiology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Laín Ibáñez Sanz
- Department of Radiology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - José C Albillos Merino
- Department of Radiology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Susana Borruel Nacenta
- Department of Radiology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain
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20
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Hasegawa T, Sakuma T, Kinoshita H, Nakagawa Y, Kawachiya T, Hara J, Teraoka H. A Case of Hemorrhagic Cholecystitis and Hemobilia Under Anticoagulation Therapy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927849. [PMID: 33419958 PMCID: PMC7805246 DOI: 10.12659/ajcr.927849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 70-year-old Final Diagnosis: Hemobilia • hemorrhagic cholecystitis Symptoms: Abdominal distension • abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Tsuyoshi Hasegawa
- Department of Surgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Takashi Sakuma
- Department of Surgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | | | - Yasuo Nakagawa
- Department of Surgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Tomohiro Kawachiya
- Department of Gastroenterology, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Junichi Hara
- Department of Gastroenterology, Baba Memorial Hospital, Sakai City, Osaka, Japan
| | - Hitoshi Teraoka
- Department of Surgery, Baba Memorial Hospital, Sakai City, Osaka, Japan
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21
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Yam MK, Sim SW, Tam KY, Li YL. A 51-year-old female presenting with shock due to hemorrhagic cholecystitis. Radiol Case Rep 2020; 15:2547-2549. [PMID: 33082895 PMCID: PMC7553886 DOI: 10.1016/j.radcr.2020.09.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/31/2023] Open
Abstract
Hemorrhagic cholecystitis is a rare cause of abdominal pain that can have dire consequences. We report a case of hemorrhagic cholecystitis in a 51-year-old female presenting as shock and abdominal pain. The patient was transported to the emergency room. Ultrasound scan revealed hemoperitoneum and cholecystitis features. On computed tomography, mild gallbladder wall thickening and high density materials in the gallbladder suggested acute calculous cholecystitis, bleeding tumor, or hemorrhagic cholecystitis. An urgent cystic arterial embolization and percutaneous transhepatic drainage were done. After initial stablization, laparoscopic cholecystectomy was performed that revealed a necrotic gallbladder filled with large blood clots. It was important for timely management by having an early recognition of this potentially fatal condition.
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Affiliation(s)
- Max K.H. Yam
- Diagnostic Radiology Department, North District Hospital, 9 Po Kin Road, Sheungshui, Hong Kong
- Department of Radiology, Alice Ho Miu Ling Nethersole Hospital, 11 Cheun On Road, Taipo, Hong Kong
- Corresponding author.
| | - Shiu Wah Sim
- Diagnostic Radiology Department, North District Hospital, 9 Po Kin Road, Sheungshui, Hong Kong
- Department of Radiology, Alice Ho Miu Ling Nethersole Hospital, 11 Cheun On Road, Taipo, Hong Kong
| | - Ka Ying Tam
- Diagnostic Radiology Department, North District Hospital, 9 Po Kin Road, Sheungshui, Hong Kong
- Department of Radiology, Alice Ho Miu Ling Nethersole Hospital, 11 Cheun On Road, Taipo, Hong Kong
| | - Yan Lin Li
- Depart of Radiology, Queen Mary Hospital, Pok Fu Lam Road, Pok Fu Lam, Hong Kong
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22
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Zhang X, Zhang C, Huang H, Wang J, Zhang Y, Hu Q. Hemorrhagic cholecystitis with rare imaging presentation: a case report and a lesson learned from neglected medication history of NSAIDs. BMC Gastroenterol 2020; 20:172. [PMID: 32503437 PMCID: PMC7275556 DOI: 10.1186/s12876-020-01312-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Gallbladder carcinogenesis, frequently occurredin chronic cholecystitis patients, requires radical resection. We herein describe a hemorrhagic cholecystitis case that failed to be differentiated from gallbladder cancer preoperatively owing to the neglected medication history of long term oral nonsteroidal anti-inflammatory drugs (NSIADs) intake. Case presentation A 57-year-old Chinese female was admitted for right upper quadrant pain with the initial diagnosis of cholecystitis. Radiological studies were unable to exclude the differential diagnosis of suspected gallbladder cancer. During the scheduled radical resection of the suspected lesions, the gross dissection showed an interesting presentation of hemorrhagic cholecystitis, without any pathological evidence of malignancies. Additional postoperative investigation revealed a neglected medication history of long-term NSAIDs use. Conclusions This case suggests the importance of preoperative review of medication history and patient education on prescription drug abuse.
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Affiliation(s)
- Xin Zhang
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Chunjun Zhang
- Department of Surgery, Shengzhou People's Hospital, Shengzhou, 312400, China
| | - Haifeng Huang
- Department of Surgery, Shengzhou People's Hospital, Shengzhou, 312400, China
| | - Junsen Wang
- Department of Pathology, Shengzhou People's Hospital, Shengzhou, 312400, China
| | - Yun Zhang
- Department of Surgery, Shengzhou People's Hospital, Shengzhou, 312400, China.,Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Qida Hu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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23
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Shah R, Klumpp LC, Craig J, Patel P, Jordan J. Hemorrhagic Cholecystitis in a Patient with Cirrhosis and Rectal Cancer. Cureus 2020; 12:e7882. [PMID: 32489736 PMCID: PMC7255552 DOI: 10.7759/cureus.7882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hemorrhagic cholecystitis is a rare presentation of acute calculous cholecystitis which presents with abdominal pain, jaundice, and gastrointestinal bleeding. It is a challenging diagnosis to make because it present similar to other common disorders such as calculous cholecystitis. We present a unique case of hemorrhagic cholecystitis in a patient with cirrhosis and rectal cancer. A 66-year-old male with a history of rectal cancer, alcohol-induced cirrhosis, esophageal varices, stroke, paroxysmal atrial fibrillation, and hypertension presented to the emergency department with complaints of abdominal pain. Patient’s computed tomography (CT) scan revealed bleeding from the gallbladder with hemoperitoneum and thickening of the ascending colon. The patient underwent emergent surgery for hemorrhagic cholecystitis. Hemorrhagic cholecystitis is associated with risk factors, including trauma, malignancy, renal failure, cirrhosis, and anticoagulation therapy. Imaging is not always reliable, but ultrasound and CT scan are the preferred options. Treatment options are surgical or nonsurgical approach depending on patient’s hemodynamic stability.
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Affiliation(s)
- Rony Shah
- Internal Medicine, Citrus Memorial Hospital, Inverness, USA
| | - Linda C Klumpp
- Internal Medicine, Citrus Memorial Hospital, Inverness, USA
| | - James Craig
- Internal Medicine, Citrus Memorial Hospital, Inverness, USA
| | - Parth Patel
- Surgery, Citrus Memorial Hospital, Inverness, USA
| | - Jeffrey Jordan
- Internal Medicine, Citrus Memorial Hospital, Inverness, USA
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24
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Sweeny A, Smith NA, Serfin JA. Hemorrhagic cholecystitis causing hemobilia and common bile duct obstruction. J Surg Case Rep 2019; 2019:rjz081. [PMID: 31001409 PMCID: PMC6463387 DOI: 10.1093/jscr/rjz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 03/02/2019] [Indexed: 02/07/2023] Open
Abstract
Biliary obstruction is a common problem associated with gallbladder pathology. However, hemorrhagic cholecystitis with hemobilia as the cause is quite rare. We present a case of hemorrhagic cholecystitis in the setting of systemic anticoagulation causing common bile duct obstruction which required endoscopic retrograde cholangiopancreatography (ERCP) for ductal clearance followed by laparoscopic cholecystectomy. The triad of right upper quadrant abdominal pain, jaundice and gastrointestinal bleed should prompt consideration of hemobilia in the setting of biliary obstruction.
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Affiliation(s)
- Andrew Sweeny
- General Surgery Residency Program, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
| | - Nathan A Smith
- Acute Care Surgery Service, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
| | - Jennifer A Serfin
- Acute Care Surgery Service, Good Samaritan Regional Medical Center, Corvallis, OR 97330, USA
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25
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Ma Z, Xu B, Wang L, Mao Y, Zhou B, Song Z, Yang T. Anticoagulants is a risk factor for spontaneous rupture and hemorrhage of gallbladder: a case report and literature review. BMC Surg 2019; 19:2. [PMID: 30611267 PMCID: PMC6321697 DOI: 10.1186/s12893-018-0464-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background The spontaneous rupture of the gallbladder is extremely rare, majority of ruptures occur secondary to traumatic injuries. Here, we report a case of spontaneous rupture of the gallbladder with probably cause of oral anticoagulants. Case presentation A 51-year-old woman presented to the emergency room with sudden-onset severe abdominal pain, as well as hypotension and low level of hemoglobin. Abdominal computed tomography (CT) scan showed a 2.5 cm filling defect and discontinuity in the wall of the gallbladder body, and a massive hematocele in the abdominal cavity. Past medical history was significant for hypertension and had been taking daily aspirin for the past three years because of interventional surgery for cerebral aneurysms, but no history of recent abdominal trauma or past episodes of biliary colic. The patient underwent an urgent laparoscopic abdominal exploration and the gallbladder was removed. The pathology just showed chronic cholecystitis and the patient recovered well. Conclusion Long-term use of anticoagulants may increase the risk of gallbladder rupture and hemorrhage, which is a lethal condition. Rapid diagnosis and timely surgical intervention are the most important measures to treat the patient.
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Affiliation(s)
- Zhilong Ma
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Bin Xu
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Long Wang
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yukan Mao
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Bo Zhou
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zhenshun Song
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| | - Tingsong Yang
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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26
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Kwok A, Chern TY, Winn R. Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban. BMJ Case Rep 2018; 2018:bcr-2018-226870. [PMID: 30373899 PMCID: PMC6214373 DOI: 10.1136/bcr-2018-226870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 11/03/2022] Open
Abstract
We present the case of an 80-year old man taking rivaroxaban for atrial fibrillation who sustained massive intra-abdominal bleeding in the setting of acute cholecystitis. CT scan on admission revealed evidence of active bleeding into the gallbladder lumen and gallbladder perforation. Immediate resuscitation was commenced with intravenous fluids, antibiotics and blood products. Despite attempts to correct coagulopathy, the patient's haemodynamic status deteriorated and an emergency laparotomy was performed, with open cholecystectomy, washout and haemostasis. The patient had a largely uneventful recovery and was discharged on day 11 of admission. Patients with coagulopathies, whether pharmacological or due to underlying disease processes, are at very high risk of severe haemorrhagic complications and subsequent morbidity. As such, prompt recognition and operative management of haemorrhagic perforated cholecystitis is of crucial importance.
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Affiliation(s)
- Allan Kwok
- Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia
| | | | - Robert Winn
- Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia
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27
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Ng ZQ, Pradhan S, Cheah K, Wijesuriya R. Haemorrhagic cholecystitis: a rare entity not to be forgotten. BMJ Case Rep 2018; 2018:bcr2018226469. [PMID: 30244228 PMCID: PMC6157553 DOI: 10.1136/bcr-2018-226469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/04/2022] Open
Abstract
Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
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Affiliation(s)
- Zi Qin Ng
- Royal Perth Hospital, Perth, Australia
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Sharin Pradhan
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Kim Cheah
- Australian Clinical Labs, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Ruwan Wijesuriya
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
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28
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Affiliation(s)
- Víctor López
- From the Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena s/n, El Palmar 30120, Murcia, Spain
| | - Felipe Alconchel
- From the Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena s/n, El Palmar 30120, Murcia, Spain
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29
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Yardan T, Baydin A, Genc S, Cokluk C, Acar E, Aydin K. A Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88-year-old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department.
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Affiliation(s)
| | | | | | - C Cokluk
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
| | | | - K Aydin
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
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30
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Rossi UG, Rigamonti P, Cariati M. Acute Right Upper Abdominal Pain With No Trauma History. Gastroenterology 2016; 151:e14-5. [PMID: 27256863 DOI: 10.1053/j.gastro.2016.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/11/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Umberto G Rossi
- Department of Diagnostic Science, Radiology and Interventional Radiology Unit, ASST Santi Paolo e Carlo Hospital, Milano, Italy
| | - Paolo Rigamonti
- Department of Diagnostic Science, Radiology and Interventional Radiology Unit, ASST Santi Paolo e Carlo Hospital, Milano, Italy
| | - Maurizio Cariati
- Department of Diagnostic Science, Radiology and Interventional Radiology Unit, ASST Santi Paolo e Carlo Hospital, Milano, Italy
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32
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Hamada T, Yasunaga H, Nakai Y, Isayama H, Horiguchi H, Fushimi K, Koike K. Severe bleeding after percutaneous transhepatic drainage of the biliary system: effect of antithrombotic agents--analysis of 34 606 cases from a Japanese nationwide administrative database. Radiology 2014; 274:605-13. [PMID: 25203133 DOI: 10.1148/radiol.14140293] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the relationship between antithrombotic agents (antiplatelet agents and anticoagulants) and severe bleeding after percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction, or cholecystostomy for acute cholecystitis. MATERIALS AND METHODS This retrospective study was institutional review board-approved, and patient consent was waived. Between July 2007 and March 2012, 34 606 patients who underwent PTBD (23 375 patients) or cholecystostomy (11 231 patients) were identified in the Diagnosis Procedure Combination database covering 1119 Japanese hospitals. The association between oral administration of antithrombotic agents prior to the procedure and severe bleeding was evaluated, with adjustment for other potential risk factors, such as age, chronic renal failure, liver cirrhosis, and procedure type. Users of antithrombotic agents were categorized as the continuation group, when they took these agents on the procedure day, or as the discontinuation group, when none were taken. Severe bleeding was defined as bleeding which required red blood cell transfusion or transcatheter arterial embolization within 3 days of the procedure. Univariate and multivariate logistic regression models fitted with generalized estimating equations were performed to evaluate the effect of antithrombotic agents on the bleeding complication. RESULTS Overall, 780 of 34 606 patients (2.3%) experienced severe bleeding. In the multivariate model, continuation of antiplatelet agents was significantly associated with severe bleeding versus nonuse (odds ratio [OR], 1.87; 95% confidence interval [CI]: 1.14, 3.05; P = .013), whereas discontinuation of antiplatelet agents showed no association (OR, 0.92; 95% CI: 0.70, 1.20; P = .517). The effect of neither continuation nor discontinuation of anticoagulants on severe bleeding was significant. Other significant risk factors for bleeding included older age, chronic renal failure, liver cirrhosis, academic hospital, and PTBD. CONCLUSION The continuation of antiplatelet agents can increase severe bleeding after percutaneous transhepatic drainage, whereas the effect of continuation of anticoagulants was inconclusive.
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Affiliation(s)
- Tsuyoshi Hamada
- From the Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (T.H., Y.N., H.I., K.K.); Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan (H.Y.); Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan (H.H.); and Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.)
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33
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Revzin MV, Scoutt L, Smitaman E, Israel GM. The gallbladder: uncommon gallbladder conditions and unusual presentations of the common gallbladder pathological processes. ACTA ACUST UNITED AC 2014; 40:385-99. [DOI: 10.1007/s00261-014-0203-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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34
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Aljiffry MM, Almulhim AN, Jamal MH, Hassanain MM. Acute cholecystitis presenting with massive intra-abdominal haemorrhage. J Surg Case Rep 2014; 2014:rju019. [PMID: 24876458 PMCID: PMC3979172 DOI: 10.1093/jscr/rju019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Haemorrhagic cholecystitis is a known rare life-threatening complication of acute cholecystitis. In this case report, we describe clinical presentation and radiological findings of acute cholecystitis presenting with massive intra-abdominal haemorrhage. We present a case of a 57-year-old male presenting to the emergency department with clinical symptoms of acute cholecystitis. Initially, the patient was haemodynamically stable. Gallbladder could not be visualized by ultrasound. Computed tomography with IV contrast showed a large haematoma in the gallbladder fossa, with active extravasation of IV contrast. On angiography the bleeding was localized to a branch of the cystic artery, which was embolized using gelfoam material. The patient was taken to the operating room for an urgent laparotomy and cholecystectomy.
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Affiliation(s)
- Murad M Aljiffry
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amna N Almulhim
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Mazen M Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia Department of Oncology, McGill University, Montreal, Canada
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35
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Hicks N. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding. BMJ Case Rep 2014; 2014:bcr-2013-202437. [PMID: 24443336 DOI: 10.1136/bcr-2013-202437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.
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Affiliation(s)
- Natalie Hicks
- Department of Urology, James Paget University Hosptial, Great Yarmouth, Norfolk, UK
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36
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Patel NB, Oto A, Thomas S. Multidetector CT of Emergent Biliary Pathologic Conditions. Radiographics 2013; 33:1867-88. [DOI: 10.1148/rg.337125038] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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37
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Kwon JN. Hemorrhagic cholecystitis: report of a case. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:120-2. [PMID: 26388920 PMCID: PMC4575003 DOI: 10.14701/kjhbps.2012.16.3.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 12/03/2022]
Abstract
Hemorrhagic cholecystitis is an uncommon cause of abdominal pain that can be fatal. We report a case of hemorrhagic cholecystitis in a 75-year-old male taking an anticoagulant. The patient was brought to the hospital with uncontrolled right upper quadrant abdominal pain. On computed tomography, mild gallbladder wall thickening and high density with gallstones in the gallbladder suggested acute calculous cholecystitis or hemorrhagic cholecystitis. An urgent laparoscopic cholecystectomy was performed that revealed a gallbladder filled with large blood clots and two black stones. Patients who develop hemorrhagic complications were often receiving anticoagulation therapy or had pathologic coagulopathy. An early diagnosis of this potentially fatal condition is important to facilitate urgent surgical treatment.
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Affiliation(s)
- Jung-Nam Kwon
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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38
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Vijendren A, Cattle K, Obichere M. Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy. BMJ Case Rep 2012; 2012:bcr.12.2011.5427. [PMID: 22778467 DOI: 10.1136/bcr.12.2011.5427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An older lady presented 1 week after being discharged from hospital with acute cholecystitis. She suffered a sudden onset lower abdominal pain and was in hypovolaemic shock upon arrival. It was noted that she had been on antiplatelet therapy after suffering a recent myocardial infarction, an immunosuppressor and steroids for rheumatoid arthritis. Her admission bloods revealed a platelet count of 83 with normal clotting factors. After resuscitation, a CT scan confirmed fluid in the abdomen possibly arising from the right subhepatic space. During laparotomy, bleeding was noted from a perforated and ischaemic-looking gallbladder, with an intact cystic artery and duct and no biliary calculi evident. The gallbladder was removed and the patient was transferred to intensive therapy unit. She recovered well within the subsequent 8 days and was discharged. Her histology described 'haemorrhage within the gallbladder wall along with oedema, fibrosis and patchy inflammation and no signs of malignancy or gangrene'.
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Affiliation(s)
- Ananth Vijendren
- Department of General Surgery, Luton and Dunstable NHS Trust, Luton, Bedfordshire, UK.
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39
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Barbon Remis E, Martínez Menéndez A, Alexandre Hurle E, Del Casar Lizcano JM, Díez Santesteban MC. [Laparoscopic treatment of a hemocholecyst]. Cir Esp 2012; 92:293-5. [PMID: 22578684 DOI: 10.1016/j.ciresp.2012.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Esther Barbon Remis
- Servicio de Cirugía General y Aparato Digestivo, Hospital Fundación Hospital de Jove, Gijón, España.
| | | | - Enrique Alexandre Hurle
- Servicio de Cirugía General y Aparato Digestivo, Hospital Fundación Hospital de Jove, Gijón, España
| | | | - M Cruz Díez Santesteban
- Servicio de Cirugía General y Aparato Digestivo, Hospital Fundación Hospital de Jove, Gijón, España
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40
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Ángel JMR, Bermúdez RP, Conde MAA, Sampedro JEQ, Jofré JGP. [Haemo-cholecyst as a complication of anticoagulant and anti-platelet treatment]. Cir Esp 2011; 89:327-9. [PMID: 21419396 DOI: 10.1016/j.ciresp.2010.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/06/2010] [Accepted: 04/19/2010] [Indexed: 02/07/2023]
Affiliation(s)
- José Manuel Ramia Ángel
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, España.
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41
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Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings. ACTA ACUST UNITED AC 2010; 36:565-8. [DOI: 10.1007/s00261-010-9672-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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Heo TY, An YY, Lee JH, Lee SW, Kim YS, Kang SB, Lee DS. [A case of spontaneous hemorrhagic cholecystitis without gallstone]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 56:260-3. [PMID: 20962563 DOI: 10.4166/kjg.2010.56.4.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Hemorrhagic acalculous cholecystitis is an extremely rare but potentially fatal disease if detection is delayed. Its risk factors include critical illness, diabetes, malignant disease, uremia, and bleeding diathesis. This is the first case report in which hemorrhagic acalculous cholecystitis not accompanied by any risk factor. We herein present a case of hemorrhagic acalculous cholecystitis in a previously healthy patient who suffered from acute abdomen.
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Affiliation(s)
- Tae Yun Heo
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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43
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Chen YY, Yi CH, Chen CL, Hsu YH, Huang SC. Hemorrhagic Cholecystitis After Anticoagulation Therapy. Am J Med Sci 2010; 340:338-9. [DOI: 10.1097/maj.0b013e3181e9563e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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44
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Gore RM, Thakrar KH, Newmark GM, Mehta UK, Berlin JW. Gallbladder imaging. Gastroenterol Clin North Am 2010; 39:265-87, ix. [PMID: 20478486 DOI: 10.1016/j.gtc.2010.02.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The treatment of gallbladder disease has been revolutionized by improvements in laparoscopic surgery as well as endoscopic and radiologic interventional techniques. Therapeutic success is dependent on accurate radiologic assessment of gallbladder pathology. This article describes recent technical advances in ultrasonography, multidetector computed tomography, magnetic resonance imaging, positron emission tomography, and scintigraphy, which have significantly improved the accuracy of noninvasive imaging of benign and malignant gallbladder disease. The imaging findings of common gallbladder disorders are presented, and the role of each of the imaging modalities is placed in perspective for optimizing patient management.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, NorthShore University Health System, Evanston, IL 60201, USA.
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45
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Hague J, Brennand D, Raja J, Amin Z. Cystic Artery Pseudoaneurysms in Hemorrhagic Acute Cholecystitis. Cardiovasc Intervent Radiol 2010; 33:1287-90. [DOI: 10.1007/s00270-010-9861-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Noh R, Kim HJ. [A case of hemocholecyst]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:63-5. [PMID: 19696533 DOI: 10.4166/kjg.2009.54.2.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ran Noh
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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47
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Abstract
Hemorrhagic acalculous cholecystitis is a rare but potentially fatal disease. An increased bleeding tendency is present in both acute and chronic renal failure with impaired platelet function. We herein present a case of hemorrhagic acalculous cholecystitis in a hemodialysis patient who suffered from acute abdomen and upper gastrointestinal bleeding. The pathogenesis may have been associated with ischemia and reperfusion injury, eventually leading to necrosis of the gallbladder wall. Abdominal ultrasound can aid in diagnosis. Biliary colic, jaundice, and melena are the typical symptoms of hemorrhagic cholecystitis, particularly in a patient with unexplained gastrointestinal bleeding.
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Affiliation(s)
- Yi-Chun Lai
- Department of Internal Medicine, National Yang-Ming University Hospital, I-Lan, Taipei, Taiwan, ROC
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