A Case of Hemorrhagic Cholecystitis with Gallstone during Anticoagulant Therapy after Aortic Valve Replacement

Shusuke Haruta, Masaji Hashimoto, Toshiro Iizuka*, Masato Matsuzaki, Shuichiro Matoba, Tsuyoshi Yokoyama, Harushi Udagawa, Toshihito Sawada and Goro Watanabe

Department of Gastroenterological Surgery and Department of Gastroenterology^*, Toranomon Hospital

Hemorrhagic cholecystitis is rare. We report a case of it occurring during anticoagulant therapy. A stone incarcerated in the cystic duct made it difficult to diagnose hemorrhaging into the gallbladder and showed a fluid-fluid level in the gallbladder. The 69-year-old woman with upper abdominal pain, although anemia and liver dysfunction were detected at admission, abdominal ultrasonography showed only small stone in the gallbladder. MRI and repeated abdominal ultrasonography showed a fluid-fluid level in the gallbladder, leading to the diagnosis of hemorrhagic cholecystitis with an incarcerated stone in the cystic duct necessitating cholecystectomy. Only 6 cases of hemorrhagic cholecystitis during anticoagulant therapy have been reported in Japan. In our case, hemorrhage was suspected to have been caused by passing of a stone into the common bile duct. The prognosis of hemorrhagic cholecystitis is improving with progress in imaging diagnosis.

Key words
hemorrhagic cholecystitis, anticoagulant therapy

Reprint requests
Shusuke Haruta Department of Surgery, Toranomon Hospital
2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470 JAPAN

Accepted
June 30, 2004

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