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Hemorrhagic complications of hemodialysis have been recognized and described in many
viscera and anatomic locations. Hemorrhagic acalculous cholecystitis is an uncommon
entity.
Herein is described a 68-year-old man undergoing hemodialysis who was admitted to
our hospital complaining of acute onset of right side abdominal pain. Ultrasonography
(US) revealed an enlarged, irregularly thickened gallbladder filled with heterogeneous
material. With US guidance, the gallbladder was catheterized with a 7-Fr sump drain,
which yielded fresh blood. The patient was explored through a midline laparotomy incision
with a diagnosis of hemorrhagic cholecystitis. The gallbladder was removed, and a
cystic duct cholangiogram revealed numerous filling defects in the common bile duct
(Fig 1).
Fig. 1Intraoperative cholangiogram showing linear filling defects in the common bile duct
(arrows).
No gallstones were seen in the gallbladder or common bile duct. The final pathology
report on the gallbladder noted that the mucosa was ulcerated and replaced by recent
and early organizing hemorrhage.
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