A rare complication of acute cholecystitis: transhepatic perforation associated with massive intraperitoneal hemorrhage

Nural, Mehmet Selim; Bakan, Sibel; Bayrak, İlkay Koray; Baydın, Ahmet; Danacı, Murat

doi:10.1007/s10140-007-0621-1

Cited by 13 publications

(17 citation statements)

References 6 publications

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“…Bleeding in this setting is thought to arise from one of a number of mechanisms: acute cholecystitis with perforation and subsequent bleeding from the defect in the wall of the gallbladder, spontaneous bleeding into the lumen of the gallbladder with subsequent rupture due to increased intraluminal pressure or transhepatic perforation of the gallbladder 1 6 7. The last of these refers to bleeding from pressure necrosis of the liver due to gallstones which have eroded through the gallbladder wall and into the liver parenchyma 7. Findings on CT scan are diagnostic and include the presence of high-density pericholecystic fluid containing gallstones and active extravasation of intravenous contrast into a gallbladder containing hyperdense fluid 6 8 12.…”

Section: Discussionmentioning

confidence: 99%

Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban

Kwok¹,

Chern

Winn

2018

BMJ Case Reports

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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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Section: Discussionmentioning

confidence: 99%

Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban

Kwok¹,

Chern

Winn

2018

BMJ Case Reports

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“…Another proposed mechanism that could lead to gallbladder bleeding is wall inflammation leading to mucosal ulceration and necrosis [5]. Hemorrhage could also be from the liver bed when transhepatic perforation takes place [6, 7]. …”

Section: Discussionmentioning

confidence: 99%

Acute cholecystitis presenting with massive intra-abdominal haemorrhage

Aljiffry

Almulhim

Jamal

et al. 2014

Journal of Surgical Case Reports

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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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“…Haemorrhagic perforation of the gallbladder occurs in 2%–11% of cases of acute cholecystitis 3. It has a reported mortality of 60% or higher if gangrenous and is postulated to be the result of transmural inflammation leading to necrosis and eventually perforation.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are unlikely to survive this may be more amenable to percutaneous catheter drainage 1 3…”

Section: Discussionmentioning

confidence: 99%

Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy

2012

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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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A rare complication of acute cholecystitis: transhepatic perforation associated with massive intraperitoneal hemorrhage

Cited by 13 publications

References 6 publications

Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban

Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban

Acute cholecystitis presenting with massive intra-abdominal haemorrhage

Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy

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