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

Kwok, Allan M. F.; Chern, Tien Yew; Winn, Robert

doi:10.1136/bcr-2018-226870

Cited by 7 publications

(13 citation statements)

References 12 publications

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“…Few studies have previously reported on free rupture of the gallbladder with massive intraabdominal bleeding. 4,7,8 The reported cases focus primarily on increased risk of bleeding in patients with patients on anticoagulants or those who have bleeding diathesis.…”

Section: Discussionmentioning

confidence: 99%

“…This is similar for other cases where patients were taking anticoagulants and presented with hemorrhagic cholecystitis. 4,[9][10][11] The patient later presented with substernal and subxiphoid pain that was worked up extensively given his cardiac history. This was likely related to early onset of acute on chronic cholecystitis, which was delayed in diagnosing.…”

Section: Discussionmentioning

confidence: 99%

“…In severe cases, patients may present with hemoperitoneum and in life-threatening hemorrhagic shock. 4 There are a number of mechanisms that may contribute to this complication, including trauma, underlying bleeding diathesis, and antiplatelet or anticoagulant use. Although ultrasound is the mainstay in biliary pathology, its use may be limited in hemorrhagic cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

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Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhag

et al. 2020

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Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhag

et al. 2020

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“…All three patients were transitioning from warfarin to rivaroxaban when they experienced a spontaneous vitreous hemorrhage [36]. Hemoperitoneum from atraumatic splenic rupture and in the setting of acute cholecystitis in patients taking DOACs has been reported [37,38].…”

Section: Epidemiologymentioning

confidence: 99%

“…Bleeding complications from direct oral anticoagulant use[10,20,[22][23][24][25][26][27][30][31][32][33][34][35][37][38][39]42].…”

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confidence: 99%

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Gunasekaran

Rajasurya²,

Devasahayam

et al. 2020

JCM

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Anticoagulation carries a tremendous therapeutic advantage in reducing morbidity and mortality with venous thromboembolism and atrial fibrillation. For over six decades, traditional anticoagulants like low molecular weight heparin and vitamin K antagonists like warfarin have been used to achieve therapeutic anticoagulation. In the past decade, multiple new direct oral anticoagulants have emerged and been approved for clinical use. Since their introduction, direct oral anticoagulants have changed the landscape of anticoagulants. With increasing indications and use in various patients, they have become the mainstay of treatment in venous thromboembolic diseases. The safety profile of direct oral anticoagulants is better or at least similar to warfarin, but several recent reports are focusing on spontaneous hemorrhages with direct oral anticoagulants. This narrative review aims to summarize the incidence of spontaneous hemorrhage in patients treated with direct oral anticoagulants and also offers practical management strategies for clinicians when patients receiving direct oral anticoagulants present with bleeding complications.

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Rivaroxaban

2018

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

Cited by 7 publications

References 12 publications

Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhag

Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhag

A Review of the Incidence Diagnosis and Treatment of Spontaneous Hemorrhage in Patients Treated with Direct Oral Anticoagulants

Rivaroxaban

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