# Clarifying the Spectrum of Gallbladder Haemorrhage: A Systematic Review of Haemorrhagic Cholecystitis and Haemorrhagic Gallbladder

## TL;DR

This review clarifies the distinction between haemorrhagic cholecystitis and haemorrhagic gallbladder, highlighting their clinical differences and recommending a severity-based treatment approach.

## Contribution

The paper introduces a stratified management framework for gallbladder haemorrhage based on clinical severity and treatment urgency.

## Key findings

- Most cases (73.8%) were classified as haemorrhagic gallbladder due to haemodynamic instability.
- Overall mortality was 10.8%, with anticoagulation reported in nearly half of the cases.
- Multimodal treatment was most common, followed by urgent open and laparoscopic cholecystectomy.

## Abstract

Haemorrhagic cholecystitis (HC) and haemorrhagic gallbladder (HGB) refer to rare clinical entities characterised by bleeding originating from the gallbladder. These terms are often used interchangeably in literature to describe a spectrum of presentations, ranging from incidental findings to life-threatening haemorrhage and shock. Reported cases are scarce and primarily limited to case reports and small series. Clinical presentation and management vary significantly, from conservative antibiotic therapy to urgent surgical intervention. This systematic review aims to summarise the published clinical experience, clarify terminology use, and propose a stratified management approach based on presentation severity.

A systematic review of the literature was conducted in accordance with PRISMA guidelines, covering publications from January 2019 to May 2025. PubMed, Embase, Medline, and Google Scholar were searched using terms including “haemorrhagic cholecystitis”, “haemorrhagic gallbladder”, and “gallbladder haemorrhage”. Only English-language studies reporting extractable patient-level data were included. Data collected included demographics, background comorbidities, anticoagulation status, presenting symptoms, haemodynamic findings, treatment modality, transfusion requirement, and mortality. Cases were stratified as haemorrhagic cholecystitis (HC) or haemorrhagic gallbladder (HGB) based on clinical severity, haemodynamic compromise, and treatment urgency.

A total of 65 cases from 50 publications were included. The median age was 67 years (range 20-92), with a male predominance (63.1%). Anticoagulation was reported in 47.7% of cases. Typical symptoms such as right upper quadrant pain, fever, or vomiting were observed in 90.8%, while jaundice, gastrointestinal bleeding, and haemorrhagic shock occurred in 15.4%, 29.2%, and 16.9% of patients, respectively. Gallstones were present in 38.5% of cases. Multimodal treatment was the most commonly employed approach (30.8%), followed by urgent open cholecystectomy (26.2%) and urgent laparoscopic cholecystectomy (18.5%). The overall mortality rate was 10.8%. Retrospective stratification classified 73.8% of cases as HGB and 26.2% as HC.

HC and HGB represent a continuum of gallbladder haemorrhage, with HC referring to stable patients managed conservatively or electively, and HGB reserved for those with haemodynamic instability requiring urgent intervention. Greater awareness is warranted in elderly patients on anticoagulation and in younger patients with atypical presentations or underlying systemic disease. A stratified management approach based on clinical severity is recommended.