Gallbladder perforation and massive intraperitoneal bleeding secondary to haemorrhagic cholecystitis

A 76-year-old man on apixaban presented with abdominal pain, vomiting, and signs of haemorrhagic shock. Imaging showed large volume haemoperitoneum with active arterial extravasation in the gallbladder fossa. The patient proceeded to emergency laparotomy, where haemorrhage was thought to arise from within a perforated gallbladder. Cholecystectomy was performed and haemostasis was achieved. Histology showed features of subacute on chronic cholecystitis, with some sections suggestive of an underlying arteritis. Haemorrhagic cholecystitis is rare, and gallbladder perforation with massive intraperitoneal haemorrhage is rarer still. This article presents a case report and literature review of this entity.