Spontaneous Haemorrhagic Gallbladder Rupture Causing Shock in a Background of Primary Sclerosing Cholangitis

Haemorrhagic gallbladder (HG) is a very rare complication of acute cholecystitis. Cases are not frequently described in the literature, but frail elderly patients on anticoagulants are the primary group of patients affected. Semi-elective or emergency laparoscopic cholecystectomy is the treatment of choice, while haemorrhagic shock requiring emergency laparotomy is an extremely rare event. Primary sclerosing cholangitis (PSC) is an autoimmune liver disease (AiLD), and its association with bleeding complications remains a clinical observation that lacks robust scientific evidence and comprehensive understanding. Here, we present a case of gallbladder rupture causing haemorrhagic shock in a young patient with a background of cirrhotic PSC. A 29-year-old female with PSC and a history of splenic artery aneurysm previously treated with embolization presented to the emergency department complaining of abdominal pain. A striking feature in the biochemistry results was the high bilirubin level without clinical detection of jaundice. Computed tomography (CT) showed a ruptured gallbladder with active bleeding and haemoperitoneum. Emergency laparotomy was mandated as the patient was becoming progressively haemodynamically unstable. The necrosed gallbladder was resected, and blood was evacuated from the abdominal cavity. The patient recovered well with no postoperative complications observed. HG causing haemodynamic shock is quite a rare complication of acute cholecystitis. This is the first case reported in the literature of internal haemorrhage due to HG in a patient with a background of PSC. This case alerts clinicians dealing with PSC patients who may be susceptible to rare complications of common pathologies. AiLD and their relationship with bleeding events remains unclear and subject of future studies.