When blood mimics bile: A case of haemorrhagic cholecystitis masquerading as biliary pancreatitis

Background: Cholecystitis and pancreatitis are frequent indications for hospitalization in gastroenterology and hepatology, predominantly due to cholelithiasis. Standard management strategies with imaging and cholecystectomy are common practice. This case report highlights the importance of considering atypical causes in patients presenting with symptoms suggestive of cholecystitis and pancreatitis.

Case Report: A female patient presented repeatedly to the emergency department with atypical ultrasound findings suggestive of cholecystitis with secondary pancreatitis. Following an episode of severe upper gastrointestinal bleeding, a diagnosis of haemobilia with secondary pancreatitis was established.

Discussion: This case illustrates that haemobilia can present with symptoms resembling calculous cholecystitis and biliary pancreatitis. Diagnosis can be challenging, especially in the absence of recent procedures or known malignancy. Quincke’s triad—pain, jaundice, and bleeding—is observed in only a third of cases.

Conclusion: Haemobilia, though rare, is an important differential diagnosis in cases of upper gastrointestinal bleeding and biliary obstruction. A multidisciplinary approach is essential for prompt diagnosis and appropriate treatment.

Keywords: haemobilia, haemorrhagic cholecystitis, gastro-intestinal bleeding, cholelithiasis.