Letter| Volume 132, ISSUE 5, P903, November 2002

Hemorrhagic acalculous cholecystitis associated with hemodialysis

      Hemorrhagic complications of hemodialysis have been recognized and described in many viscera and anatomic locations. Hemorrhagic acalculous cholecystitis is an uncommon entity.
      • Johnson LB
      The importance of early diagnosis of acute acalculous cholecystitis.
      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).
      Figure thumbnail gr1
      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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