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Classical symptoms of hemobilia are often absent and therefore it is important to consider the prospect of hemorrhagic cholecystitis in patients presenting with biliary symptoms associated with gastrointestinal bleeding, unexplained upper abdominal hemoperitoneum, or imaging findings suggestive of pericholecystic or gallbladder blood products. Once identified, a two-step therapeutic approach is recommended with embolization of the culprit vessel to stop the bleeding and stabilize the patient for subsequent cholecystectomy, which remains the ideal definitive treatment in surgical candidates.






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From the manuscript

Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy

Free full text article: Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy

Abstract
Hemorrhagic cholecystitis is a potentially deadly and difficult to recognize entity. It is associated with cystic artery pseudoaneurysm and is usually seen in the setting of acute calculous cholecystitis. We report two cases of hemorrhagic cholecystitis with arteriographic findings of cystic artery pseudoaneurysms that were successfully embolized using microcoils, facilitating subsequent cholecystectomy. Both cases had unusual presentations of gallbladder rupture with hemoperitoneum, the latter of which was atypical occurring in the absence of gallstones. We believe when hemorrhagic cholecystitis is suspected, a two-step therapeutic approach should be employed with embolization of the bleeding cystic artery followed by cholecystectomy. A comprehensive literature review and discussion of hemorrhagic cholecystitis will be provided.






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Keyword search:

1. Hemorrhagic cholecystitis

2. gallstones

3. cholelithiasis

4. hemoperitoneum

5. cholecystectomy

6. embolotherapy

7. microcoil embolization

8. cystic artery pseudoaneurysm

9. angiography


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