S1738 Hemorrhagic Cholecystitis: A Rare Cause of Brisk Upper Gastrointestinal Bleeding

Abstract

markedly distended, non-tender abdomen, with a positive fluid wave and shifting dullness. Laboratory findings revealed body fluid studies with a SAAG ratio less than 1.1 indicating malignancy, but a high hepatic venous pressure gradient pointing to portal hypertension, with multiple cytology findings negative for malignant cells, however with good synthetic liver function. CT abdomen pelvis upon presentation was unremarkable, and consistent with previous imaging findings of known hepatectomy. After repeated paracentesis and multiple courses of antibiotic therapies for SBP, with recurrent ascites, complicated by hyponatremia with no mental status changes, further management of the case involved interventional radiology placing a Denver shunt to control the ascites. After a couple of months, the patient was followed up and found to have progression of disease with cancer seeding into the peritoneum with omental caking. Discussion: We strongly believe the patient's recurrent ascites of unknown origin was most likely a case of recurrent malignancy in ascitic fluid, masquerading as intrahepatic portal hypertension. We hope that this case report highlights that although in the setting of poorly differentiated gallbladder adenocarcinoma with local metastasis and negative margin resections, malignant ascites can occur and must not be mistaken for portal hypertension given the conflicting SAAG ratio and HPVG.