Perforated Acalculous Hemorrhagic Cholecystitis without Hemoperitoneum in a Dialysis Patient: A Case Report and Literature Review - Abstract
Hemorrhagic cholecystitis is a rare and fatal diagnosis with an incidence of 3.5% that requires immediate intervention. It is commonly underdiagnosed as it mimics other more common diseases. We describe a case of an older woman on hemodialysis diagnosed with perforated acalculous hemorrhagic cholecystitis without hemoperitoneum. The patient presented with non-specific gastrointestinal symptoms associated with increased inflammatory markers and liver transaminases. MRI showed a heterogeneous collection in the right infra hepatic region with central hyperdensity suggestive of hemorrhagic cholecystitis. Her past medical history was pertinent for atrial fibrillation and adrenal insufficiency, with the use of anticoagulation and steroids, respectively. The patient was started on intravenous antibiotics and underwent urgent cholecystectomy with findings of micro perforation in the gallbladder. Pathology samples revealed evidence of acalculous cholecystitis and necrosis. Unfortunately, the disease’s course was complicated by multiorgan failure, and the patient passed away