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.