Hemoperitoneum from Hemorrhagic Perforated Cholecystitis in a Patient with Acquired Deficiency of Factor VIII

A laparoscopic approach was deemed unfeasible because of the active bleeding and the high likelihood of encountering adhesions resulting from the previous surgery. [...]it was decided to perform a right subcostal laparotomy, despite a median laparotomy, to avoid the adhesions that could be present in the midline; few minutes before skin incision, the patient was administered with eptacog-alfa 7 mg followed by 7 mg after two hours, and after three and six hours. Hemorrhagic cholecystitis undoubtedly represents a challenge in terms of diagnosis and treatment. [...]our specific case here presented an exceptionally complex scenario in terms of treatment, given the even higher risk attached to surgery in a hemorrhagic patient affected by a coagulation disorder. [...]hemorrhagic cholecystitis represents a rare and serious clinical condition associated with high morbidity and mortality rates, which presents itself in the form of acute abdominal pain or, in the most serious cases, hemorrhagic shock.