Post-colonoscopy gallbladder hemorrhage in decompensated cirrhosis: an unusual complication

Colonoscopy is generally considered a safe procedure, with extra-colonic complications being exceedingly rare. Gallbladder haemorrhage following colonoscopy has been reported only in isolated cases and remains a poorly recognized entity, particularly in patients with cirrhosis. We present a 52-year-old male with decompensated alcoholic cirrhosis who developed abdominal pain, anemia, and hypotension following an unremarkable colonoscopy. Initial imaging was inconclusive, and the patient was discharged after stabilization. He later re-presented with recurrent bloody ascites requiring multiple transfusions. Angiography identified a cystic artery pseudoaneurysm, which was embolized. However, the patient continued to require transfusions to maintain hemoglobin levels. The patient subsequently underwent open cholecystectomy, which revealed an actively bleeding, partially avulsed gallbladder. This allowed stabilization prior to successful orthotopic liver transplantation. This case highlights the diagnostic challenges of hemorrhagic cholecystitis in cirrhotic patients and underscores the importance of maintaining a high index of suspicion and considering early surgical intervention when noninvasive management fails.