The Clinical Significance of Hemorrhagic Cholecystitis.

Background: Hemorrhagic cholecystitis (HC) is a rare complication of acute cholecystitis. HC is difficult to diagnose pre-operatively and previous case reports suggest a strong association with anticoagulation and an increased morbidity. The purpose of the study is to determine the clinical presentation and outcomes of patients with HC in a large cohort of patients. Method: A retrospective review of HC patients diagnosed following review of the clinical and pathological database between January 1, 2000 - June 30, 2021 at two hospitals. A search of the histopathology database, patient medical records, laboratory results, and imaging was conducted. Results: Thirty-five patients were diagnosed on the histopathology report from approximately 6458 patients who had cholecystectomies. Thirty-one had emergency presentation and four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female and 15 patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients were converted to open and five patients required postoperative endoscopic retrograde cholangiopancreatography. Two patients (5.7%) were on anticoagulation therapy. Twenty-three (65.7%) had ultrasound, 12 patients (34.2%) had computed tomography, three patients (8.5%) had magnetic resonance cholangiopancreatography, and one patient with a pre-operative diagnosis of HC. Conclusion: HC is a rare form of acute cholecystitis. Anticoagulation only accounts for a small fraction of these patients. Pre-operative diagnosis of HC is not often made. Patients were treated with cholecystectomies and made a full recovery with no complications. Our study seems to show HC is a histological diagnosis with no clinical consequences for the patients.

A case of haemorrhagic cholecystitis with no risk factors.

Haemorrhagic cholecystitis (HC) is a rare cause of cholecystitis that can be fatal if management is delayed. HC could present in the setting of trauma, malignancy and bleeding diathesis, such as renal failure, cirrhosis and anticoagulation. Its symptoms are easily confused with acute calculous or acalculous cholecystitis and might include haemobilia or hematemesis as blood drains from the gallbladder into the gastrointestinal tract. Imaging of HC can be misleading unless the possibility of this diagnosis is considered. In this report, we present an interesting case of HC in a patient with none of the above comorbidities and the patient who was not on anticoagulation neither anti platelets. The case includes relevant imaging and a review of the literature on this rare subject.

Mixed serous and mucinous retroperitoneal cystadenoma: an extremely rare case.

Mixed serous and mucinous retroperitoneal cyst adenoma is an extremely rare condition as most of the reported cases in the literature are primary retroperitoneal mucinous cystadenomas and primary retroperitoneal serous cystadenomas. They are initially asymptomatic and become symptomatic gradually depending on their size and anatomical extension and location. We report a 49-year-old woman with a history of right-side abdomen pain for a few years. Diagnostic images revealed a large retroperitoneal cystic lesion. A laparoscopic resection was performed without spillage. The patient was discharged without complication postoperatively and no recurrence on follow-up. Surgical excision, either open/or laparoscopic without any spillage, remains the most effective and appropriate treatment for this lesion.