Asian Journal of Case Reports in Surgery

Aims: To elucidate the potential complications and management strategies for Haemocholecyst (HC), particularly in a patient with concurrent conditions such as end-stage renal failure (ESRF) and COVID-19, and to stress the importance of recognizing and addressing this rare condition promptly to prevent adverse outcomes.

Presentation of Case: A 72-year-old male with a history of ESRF presented with symptoms of reduced effort tolerance, shortness of breath, and was concurrently diagnosed with COVID-19 pneumonia. His clinical examination demonstrated a lack of abdominal tenderness or visible bleeding but exhibited a significant reduction in hemoglobin levels. Multiple transfusions and investigations were conducted, leading to the discovery of HC through a CT angiogram. Despite surgical intervention, the patient unfortunately succumbed postoperatively.

Discussion: HC's etiology can be both primary and secondary. Elevated urea levels in ESRF patients and COVID-19 infections have been hypothesized to contribute to the occurrence of spontaneous gallbladder bleeding, with the latter potentially causing acute acalculous cholecystitis (AAC) via the ACE2 receptor. Given its rarity, HC presents a significant diagnostic challenge, and a diverse diagnostic approach is crucial when the source of bleeding remains unidentified post-endoscopic procedures.

Conclusion: While simple HC may be managed conservatively, complicated cases require invasive interventions, like surgery or embolization. Early detection and intervention are paramount to managing HC effectively, and meticulous evaluation is crucial in cases of obscure gastrointestinal bleeding, contributing to the knowledge and management of this condition.