Cholecystitis causing rupture of the cystic artery and massive hemoperitoneum

Abstract

Introduction: Cholecystitis is a common surgical pathology; however, it is uncommonly associated with hemorrhage. Cases of hemoperitoneum secondary to cholecystitis are usually in the context of cystic artery pseudoaneurysms; however, no reports describe rupture of a non-aneurysmal cystic artery. Case Report: We present a case of hemoperitoneum and hemorrhagic shock secondary to cholecystitis, with resultant rupture of a branch of the cystic artery, in the absence of a pseudoaneurysm. The patient was a middle-aged man who presented with severe right upper quadrant pain on a background of biliary colic. Imaging was consistent with cholecystitis, and significant volume free fluid in the right upper quadrant. The patient became shocked and was taken for laparoscopy, with conversion to laparotomy. 1.6 liters of hemoperitoneum was evacuated, and a cholecystectomy was performed. It appeared that a gallbladder perforation has caused rupture of a branch of the cystic artery, with resultant intraperitoneal hemorrhage. No pseudoaneurysm was identified. The patient made a complete recovery. Conclusion: This was a previously unreported, yet life-threatening complication of cholecystitis. This report aims to present a novel case and promote awareness of this dangerous complication.