Open AccessAcute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban
Author(s) -
Allan M. F. Kwok,
Tien Yew Chern,
Robert Winn
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-226870
Subject(s) - medicine , gallbladder , cholecystitis , rivaroxaban , cholecystectomy , laparotomy , surgery , coagulopathy , perforation , resuscitation , thrombus , atrial fibrillation , warfarin , materials science , punching , metallurgy
We present the case of an 80-year old man taking rivaroxaban for atrial fibrillation who sustained massive intra-abdominal bleeding in the setting of acute cholecystitis. CT scan on admission revealed evidence of active bleeding into the gallbladder lumen and gallbladder perforation. Immediate resuscitation was commenced with intravenous fluids, antibiotics and blood products. Despite attempts to correct coagulopathy, the patient's haemodynamic status deteriorated and an emergency laparotomy was performed, with open cholecystectomy, washout and haemostasis. The patient had a largely uneventful recovery and was discharged on day 11 of admission. Patients with coagulopathies, whether pharmacological or due to underlying disease processes, are at very high risk of severe haemorrhagic complications and subsequent morbidity. As such, prompt recognition and operative management of haemorrhagic perforated cholecystitis is of crucial importance.