eP309 Hemorrhagic cholecystitis; A Case Report

Introduction Haemorrhagic cholecystitis is a rare presentation with RUQ pain and additional features of hematemesis, Malena or haemobilia. Its pathogenesis is still unclear and sometimes an underlying pseudoaneurysm of the cystic artery can be identified as the source of bleeding with active blush on the CT scan. Other risk factors for HC are anticoagulants, gallbladder malignancies, clotting disorders, history of blunt abdominal trauma, renal and liver diseases. Although ultrasound is the mainstay of investigations to look for biliary pathologies and cholecystitis, its use is limited in HC and computerized tomography should be used to make a diagnosis. Management starts with resuscitation and correcting coagulopathy if any, followed by laparoscopic cholecystectomy as earliest. In cases where haemorrhage is localized in the gallbladder or if patient is unfit for surgery, then interventional radiology might be helpful to perform a cholecystostomy. Case Here we present a case of an 82-year-old male with a history of heart failure, ischemic heart disease, diabetes, gallstones, and alcoholic liver disease presented with acute abdominal pain, fever, and vomiting. He was diagnosed with haemorrhagic cholecystitis, he was deemed unfit for surgery and treated conservatively. After ERCP for haemobilia, his condition improved, and he was discharged with follow-up. Conclusion Haemorrhagic cholecystitis is a rare condition characterized by haemorrhage in the gallbladder lumen. This behaves like calculous cholecystitis presenting with right upper quadrant pain. Mostly it is associated with a pseudoaneurysm of the cystic artery with rare cases without any identifiable cause. Diagnosis needs careful investigations to improve treatment outcomes.