Kinjo Rintaro, Uemura Masao, Ihashi Takafumi, Yamanaga Shigeyoshi, Yokomizo Hiroshi
Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, JPN.
Cureus. 2025 Aug 3;17(8):e89306. doi: 10.7759/cureus.89306. eCollection 2025 Aug.
Hemorrhagic cholecystitis (HC) is a rare but life-threatening condition. While anticoagulant therapy is a known risk factor, the coronavirus disease 2019 (COVID-19) has recently emerged as another trigger. We experienced a severe case of perforated HC complicated by hemoperitoneum in a patient presenting both risk factors. An 87-year-old male patient on apixaban therapy was admitted to a referral hospital seven days before COVID-19, where treatment with antiviral medication and steroids was initiated. Five days before transfer, the patient developed abdominal pain with elevated levels of inflammatory markers. On the day of presentation, the patient experienced sudden right upper abdominal pain and was transferred to our hospital following plain computed tomography (CT), which revealed gallbladder enlargement and suspected hemoperitoneum. Upon arrival, the patient exhibited diffuse abdominal tenderness. Contrast-enhanced CT revealed extravasation from the cystic artery and hematomas around the gallbladder, confirming the diagnosis of HC with hemoperitoneum. Emergency laparoscopic cholecystectomy was performed after administration of recombinant Factor Xa (used to reverse anticoagulation). Intraoperatively, hemorrhagic ascites were observed, with the gallbladder appearing tense, gangrenous, and perforated. A histopathological examination confirmed acute cholecystitis with necrosis and perforation. The postoperative course was uneventful, and apixaban therapy was restarted on postoperative day 1. The patient was discharged to a rehabilitation facility on postoperative day 13. Emergency laparoscopic cholecystectomy was lifesaving in this patient with HC and hemoperitoneum.
出血性胆囊炎（HC）是一种罕见但危及生命的疾病。虽然抗凝治疗是已知的危险因素，但2019冠状病毒病（COVID-19）最近已成为另一个触发因素。我们遇到了一例严重的HC穿孔并伴有血腹的病例，该患者同时存在这两个危险因素。一名正在接受阿哌沙班治疗的87岁男性患者在感染COVID-19的七天前被转诊至一家医院，在那里开始使用抗病毒药物和类固醇进行治疗。在转院的五天前，患者出现腹痛，炎症标志物水平升高。在就诊当天，患者突然出现右上腹疼痛，在进行普通计算机断层扫描（CT）后被转至我院，CT显示胆囊增大并疑似血腹。到达我院时，患者表现出弥漫性腹部压痛。增强CT显示胆囊动脉有造影剂外渗以及胆囊周围有血肿，确诊为HC合并血腹。在给予重组凝血因子Xa（用于逆转抗凝作用）后进行了急诊腹腔镜胆囊切除术。术中观察到出血性腹水，胆囊表现为紧张、坏疽和穿孔。组织病理学检查证实为急性胆囊炎伴坏死和穿孔。术后过程顺利，术后第1天重新开始阿哌沙班治疗。患者于术后第13天出院至康复机构。急诊腹腔镜胆囊切除术挽救了这名患有HC和血腹的患者的生命。
