Gallbladder haemorrhage is a rare but life-threatening condition. We report a unique case of a 50-year-old female who presented with acute cholecystitis due to massive intracholecystic haemorrhage. A 17-mm pedunculated gallbladder polyp had been identified, but the patient opted for observation. Three weeks later, she presented to the emergency department with a chief complaint of epigastric pain. Computed tomography showed a distended gallbladder filled with hyperdense material, and magnetic resonance imaging confirmed a haematoma. Semi-urgent cholecystectomy was performed on the third hospital day. Pathological examination of the resected specimen revealed that a pyloric gland adenoma, which was positive for MUC6 and MUC5AC, had detached from its mucosal stalk, leading to significant hemorrhage. Although the primary indication for resecting large gallbladder polyps (≥10 mm) is malignancy risk, this case suggests that the risk of acute haemorrhagic complications from tumour detachment should also be recognized as a strong rationale for surgical intervention.
Yokoyama et al. (Wed,) studied this question.