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The Clinical Significance of Hemorrhagic Cholecystitis
Mirwais Khan Hotak1, Mitali Fadia2, Sivakumar Gananadha3
1Department of Surgery, Calvary and Canberra Hospital, Bruce, Australia.
Insights
Hemorrhagic cholecystitis (HC) is a rare condition. This study found HC is primarily a histological diagnosis, with most patients recovering fully after cholecystectomy, regardless of anticoagulation status.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Hepatobiliary Surgery
Background:
- Hemorrhagic cholecystitis (HC) is an uncommon complication of acute cholecystitis.
- Pre-operative diagnosis of HC is challenging, and it is often associated with anticoagulation and increased morbidity.
- Understanding the clinical presentation and outcomes of HC is crucial for patient management.
Purpose of the Study:
- To determine the clinical presentation and outcomes of patients diagnosed with hemorrhagic cholecystitis (HC).
- To evaluate the association of anticoagulation with HC in a large patient cohort.
- To assess the diagnostic challenges and treatment efficacy for HC.
Main Methods:
- Retrospective review of patients diagnosed with HC between January 1, 2000, and June 30, 2021.
- Analysis of clinical, pathological, laboratory, and imaging data from a histopathology database and patient medical records.
- Inclusion of approximately 6458 cholecystectomy patients, with 35 diagnosed with HC.
Main Results:
- Thirty-five cases of HC were identified, representing a rare complication of acute cholecystitis.
- Only a small fraction of patients (5.7%) were on anticoagulation therapy.
- Most patients underwent cholecystectomy with full recovery and no reported complications; pre-operative diagnosis was rare.
Conclusions:
- Hemorrhagic cholecystitis (HC) is predominantly a histological diagnosis.
- Anticoagulation is not a significant factor in most HC cases.
- Patients with HC typically have favorable outcomes following cholecystectomy, with no significant clinical consequences observed.
Background:
Hemorrhagic cholecystitis (HC) is a rare complication of acute cholecystitis. HC is difficult to diagnose pre-operatively and previous case reports suggest a strong association with anticoagulation and an increased morbidity. The purpose of the study is to determine the clinical presentation and outcomes of patients with HC in a large cohort of patients.
Method:
A retrospective review of HC patients diagnosed following review of the clinical and pathological database between January 1, 2000 - June 30, 2021 at two hospitals. A search of the histopathology database, patient medical records, laboratory results, and imaging was conducted.
Results:
Thirty-five patients were diagnosed on the histopathology report from approximately 6458 patients who had cholecystectomies. Thirty-one had emergency presentation and four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female and 15 patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients were converted to open and five patients required postoperative endoscopic retrograde cholangiopancreatography. Two patients (5.7%) were on anticoagulation therapy. Twenty-three (65.7%) had ultrasound, 12 patients (34.2%) had computed tomography, three patients (8.5%) had magnetic resonance cholangiopancreatography, and one patient with a pre-operative diagnosis of HC.
Conclusion:
HC is a rare form of acute cholecystitis. Anticoagulation only accounts for a small fraction of these patients. Pre-operative diagnosis of HC is not often made. Patients were treated with cholecystectomies and made a full recovery with no complications. Our study seems to show HC is a histological diagnosis with no clinical consequences for the patients.
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