Hemorrhagic cholecystitis: the forgotten differential diagnosis

Hemorrhagic cholecystitis, a rare complication of acute cholecystitis, poses diagnostic challenges due to its varied clinical presentation and relative infrequency. This case involves a 59-year-old male with untreated diabetes and obesity, who presented with nonspecific abdominal pain. Initial results were inconclusive, leading to a delayed diagnosis. The patient presented again with worsening symptoms, now including melena, prompting a repeat contrast-enhanced computed tomography (CT) scan that revealed a collapsed gallbladder and signs of intra-abdominal bleeding. Urgent exploratory laparoscopy exposed a gangrenous, perforated gallbladder with active bleeding. He required intensive care postoperatively and recovered without complications. Teaching points include the importance of considering hemorrhagic cholecystitis as a possible diagnosis in patients presenting with upper gastrointestinal bleeding. The case emphasizes the role of imaging, particularly contrast-enhanced CT scans, in diagnosis. Surgical intervention remains the gold standard, highlighting the significance of timely management.