Hemorrhagic Cholecystitis in an Elderly Patient With Fall Syndrome: A Case Report

Hemorrhagic cholecystitis is a rare, potentially fatal complication of acute cholecystitis that develops with or without gallstones. It tends to be diagnosed late because its clinical presentation overlaps with that of other acute abdominal conditions, and suspicion is often low, as it is first a ruling-out diagnosis due to its low incidence. We present the case of an 81-year-old man with epilepsy, heavy tobacco use, and alcohol consumption, who ambulated with crutches due to a previous left ankle fracture. He was admitted following a ground-level fall caused by a tonic-clonic seizure, sustaining a cranio-parietal contusion and direct trauma to the right hemithorax and flank. He was managed for moderate traumatic brain injury with an initial Glasgow Coma Scale score of 15. On the fifth intrahospital day, he developed moderate to severe, constant right-sided abdominal pain with no apparent reason. Laboratory findings showed elevated liver enzymes, amylase, and lipase. Abdominal ultrasound identified a distended gallbladder (GB) containing 200 mL of hyperdense material without acoustic shadowing and free intraperitoneal fluid consistent with hemoperitoneum. Emergency traditional cholecystectomy revealed approximately 100 mL of hemoperitoneum, a fundal hematoma with adherent omental plastron, and a tensely distended intrahepatic GB measuring 8 × 6 × 5 cm with 5-mm walls and a well-organized intraluminal clot. No gallstones were found, confirming acalculous etiology. The patient recovered without vasopressor support and was discharged on the second day after surgery. This case is, to our knowledge, the first indexed report linking acalculous hemorrhagic cholecystitis to geriatric fall syndrome. A systematic search of PubMed, OpenAIRE, and Google Scholar yielded no previously published cases with this clinical association. Early imaging and prompt surgical intervention were the determining factors in this patient's favorable outcome.