Hemorrhagic cholecystitis with auto-avulsion

Acute cholecystitis is a common condition, with varying presentations and complications, and is frequently treated in the emergency department. This case report illustrates hemorrhagic cholecystitis (HC) as a rare complication of cholecystitis. A 74-year-old woman presented to our emergency department with intermittent abdominal discomfort and continued vomiting after any oral ingestion as well as watery diarrhea. Patient history included mitral valve replacement and a daily dose of warfarin. Emergent cross-sectional abdominopelvic computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass that occupied most of the right abdominal cavity. An exploratory laparotomy revealed a necrotizing and hemorrhagic enlarged gallbladder with cholelithiasis. This enlargement appeared adherent and fistulizing into the cecum, without signs of bowel perforation. The postoperative period was uneventful, and the patient recovered well. Owing to its non-specific presentation, imaging studies are essential in establishing a diagnosis for HC. Although CT has not been advocated as a primary imaging examination for acute right upper quadrant pain, it is a valuable tool for assessing HC, along with MRI.