{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:05:44Z","timestamp":1790024744599,"version":"4.0.1"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,9,29]]},"abstract":"<jats:p>We present the case of an 80-year old man taking rivaroxaban for atrial fibrillation who sustained massive intra-abdominal bleeding in the setting of acute cholecystitis. CT scan on admission revealed evidence of active bleeding into the gallbladder lumen and gallbladder perforation. Immediate resuscitation was commenced with intravenous fluids, antibiotics and blood products. Despite attempts to correct coagulopathy, the patient\u2019s haemodynamic status deteriorated and an emergency laparotomy was performed, with open cholecystectomy, washout and haemostasis. The patient had a largely uneventful recovery and was discharged on day 11 of admission. Patients with coagulopathies, whether pharmacological or due to underlying disease processes, are at very high risk of severe haemorrhagic complications and subsequent morbidity. As such, prompt recognition and operative management of haemorrhagic perforated cholecystitis is of crucial importance.<\/jats:p>","DOI":"10.1136\/bcr-2018-226870","type":"journal-article","created":{"date-parts":[[2018,10,29]],"date-time":"2018-10-29T01:05:20Z","timestamp":1540775120000},"page":"bcr-2018-226870","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Acute cholecystitis and gallbladder perforation leading to massive haemoperitoneum in a patient taking rivaroxaban"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-6236","authenticated-orcid":false,"given":"Allan","family":"Kwok","sequence":"first","affiliation":[{"name":"Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8320-0101","authenticated-orcid":false,"given":"Tien Yew","family":"Chern","sequence":"additional","affiliation":[{"name":"St George Hospital, Kogarah, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Winn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wollongong Hospital, South Coast Mail Centre, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,10,28]]},"reference":[{"key":"2025082805083688000_2018.oct27_1.bcr-2018-226870.1","doi-asserted-by":"crossref","unstructured":"Mechera R , Graf K , Oertli D , et al . 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Spontaneous acalcuilous gallbladder perforation. BMJ Case Rep. Published online 2014;7.","DOI":"10.1136\/bcr-2014-206002"},{"key":"2025082805083688000_2018.oct27_1.bcr-2018-226870.11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s12664-016-0723-3","article-title":"\u201cHole sign\u201d of the gallbladder","volume":"36","author":"Indiran","year":"2017","journal-title":"Indian Journal of Gastroenterology"},{"key":"2025082805083688000_2018.oct27_1.bcr-2018-226870.12","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-007-9358-2"},{"key":"2025082805083688000_2018.oct27_1.bcr-2018-226870.13","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181e9563e"},{"key":"2025082805083688000_2018.oct27_1.bcr-2018-226870.14","doi-asserted-by":"crossref","unstructured":"Vijendren A , Cattle K , Obichere M . Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy. 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