Gallbladder hemorrhage in a patient on apixaban: A rare cause of acute abdominal pain

Spontaneous gallbladder hemorrhage (SGBH) is a rare but serious complication of anticoagulation therapy. We report the case of a 61-year-old woman with renal impairment and multiple comorbidities, including cardiovascular disease and prior thromboembolic events, who presented with acute epigastric pain while on apixaban. Imaging revealed a nonenhancing hyperdense lesion within the gallbladder, consistent with intraluminal hemorrhage. Her hospital course was complicated by melena and a significant drop in hemoglobin, which required blood transfusion. Anticoagulation was transitioned to therapeutic low molecular weight heparin, and the patient was managed conservatively with close monitoring. A delayed cholecystectomy was planned to allow stabilization and resolution of inflammation. The patient later returned, and a cholecystectomy was successfully performed without complications. This case highlights the importance of considering gallbladder hemorrhage in anticoagulated patients with abdominal pain, especially those with impaired renal function.