Acute Hemorrhagic Cholecystitis

Acute hemorrhagic cholecystitis is a severe and uncommon variant of acute cholecystitis characterized by intramural hemorrhage within the gallbladder wall. This bleeding can lead to necrosis, perforation, and ultimately, peritonitis. The pathogenesis is multifactorial, often involving a combination of inflammation, ischemia, and pre-existing gallbladder disease such as cholelithiasis. Vascular compromise, either from direct injury or microvascular thrombosis due to the inflammatory process, plays a significant role. Clinically, it presents with symptoms similar to acute cholecystitis – right upper quadrant pain, fever, nausea, and vomiting – but often with more pronounced systemic signs like tachycardia and leukocytosis. Imaging modalities like ultrasound and CT scans are crucial for diagnosis, often revealing gallbladder wall thickening, pericholecystic fluid, and potentially, evidence of intramural hematoma. The presence of gas within the gallbladder wall (emphysematous cholecystitis) can further complicate the picture. Management typically involves emergent surgical intervention, usually cholecystectomy, to remove the affected gallbladder and prevent further complications. Post-operative care focuses on managing potential sequelae like sepsis and wound infections. Early recognition and prompt surgical management are critical for improved patient outcomes in acute hemorrhagic cholecystitis.