Non-traumatic gallbladder hemorrhage with shock in Asia；A case report

Abstract

Abstract Background Gallbladder hemorrhage, rared and caused by trauma, iatrogenic factors, or underlying conditions like liver/kidney dysfunction or cancer, presents with symptoms such as right upper abdominal pain and fever. In severe cases, blood from the gallbladder may enter the gastrointestinal tract, causing melena or hematemesis. Blood clots may also cause blockage and inflammation, requiring surgical intervention for effective management. Failure to promptly address this can lead to life-threatening hemorrhagic shock. Diagnosing rare diseases in the emergency room is challenging and crucial. Delayed diagnosis may lead to life-threatening conditions, especially hemorrhagic shock. Ultrasound is vital for diagnosing this disease. Case presentation A 64-year-old female presented with three days of epigastric pain and nausea, denying trauma, fever, respiratory or chest symptoms, but with unstable vital signs. Blood tests showed no abnormalities, while an Ultrasound revealed a distended gallbladder without stones. Following cholecystectomy, the diagnosis confirmed acute hemorrhagic cholecystitis, attributed to chronic cholecystitis. This case highlights the pivotal role of ultrasound in diagnosing hemorrhagic cholecystitis. Conclusion Gallbladder hematoma, a rare condition with vague symptoms, poses diagnostic challenges, often linked to trauma, tumors, anticoagulant use, or liver/renal disease. Common symptoms include right upper quadrant pain, tenderness, nausea, and vomiting, initially resembling cholecystitis. Persistent bleeding may result in dark or bloody stools. While laboratory tests may reveal abnormalities, their sensitivity is limited. Diagnosis is complex, and delayed recognition in the emergency department can lead to severe shock and increased mortality. The literature review emphasizes the association with liver/kidney dysfunction and anticoagulant use, presenting symptoms akin to gallbladder inflammation and occasional gastrointestinal bleeding. Ultrasound is pivotal for diagnosis, showcasing distinctive features like uneven echoes and localized wall thickening. Treatment approaches vary, with some cases opting for deferred surgical intervention after conservative treatment, though surgery remains a common outcome. In summary, non-traumatic gallbladder hematoma is primarily linked to risk factors like liver/kidney diseases and chronic anticoagulant use. Gallbladder inflammation and gastrointestinal bleeding symptoms coexist, underscoring the crucial role of timely ultrasound diagnosis. This study establishes early detection and diagnosis protocols for future reference in emergency room settings.