Anticoagulant-induced hemorrhagic cholecystitis with hemobilia after deceased donor kidney transplant and literature review

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.

A Case of Hemorrhagic Cholecystitis in a Patient on Apixaban After COVID-19 Infection

“…In our patient case, hemorrhagic cholecystitis occurred within 1 month after apixaban initiation. Other case reports showed a wide range of such occurrence, ranging from 24 hours [ 1 ], 27 days following initiation after cardiac surgery [ 8 ], and up to 6 weeks [ 7 ]. In the prior case reports, clinical presentations also varied, with some patients presenting with fever and pain radiating to the back, which was not observed in our patient.…”

“…Hemorrhagic cholecystitis is a rare cause of abdominal pain, which can result from malignancy, bleeding, or trauma [ 1 ]. The incidence of hemorrhagic cholecystitis is estimated at 3.5% of all reported cholecystitis cases, with mortality rates of 15–20% [ 2 ].…”

“…The presentation, which includes right upper-quadrant pain, nausea, and vomiting, can overlap with other disease states, thereby rendering the diagnosis challenging. Early diagnosis and management can reduce mortality and improve the clinical outcomes [ 1 , 3 ]. We present an unusual case of hemorrhagic cholecystitis after recent initiation of the direct oral anticoagulant (DOAC) apixaban, as well as steroid treatment of SARS-CoV-2 (COVID-19) pneumonia in the setting of suspected pancreatic cancer.…”