BACKGROUND Edoxaban is an orally administered anticoagulant treatment that is used in patients with cerebral infarction, venous thrombosis, or other conditions, with a reported incidence of gastrointestinal hemorrhage at approximately 1%. We encountered the rare case of a patient who developed a gallbladder hemorrhage after the administration of edoxaban. CASE PRESENTATION An 86-year-old Japanese woman visited our gastrointestinal department due to the chief complaint of melena lasting for a week. Her medical history included hypertension and embolic cerebral infarction, and she was taking orally administered carvedilol (5 mg/day) and edoxaban (30 mg/day). Her palpebral conjunctiva was pale during a physical examination, indicating the possibility of anemia. Her blood test results confirmed severe anemia with red blood cells at 1.7 × 106/μL and hemoglobin at 4.7 g/dL. An upper gastrointestinal endoscopy revealed bile and fresh blood on the duodenal bulb and in more distal regions; hemobilia was suspected. A computed tomography scan on the ninth hospitalization day confirmed the hemobilia with a gallbladder fundus high-density signal. She was discharged on the 30th day of hospitalization with only fluid therapy and no progression of anemia. Moreover, she underwent a laparoscopic cholecystectomy 1 month after discharge, but the pathologist did not identify false aneurysms or neoplastic lesions. She has not been shown to develop anemia for 5 months after surgery. CONCLUSIONS Our case suggests that gallbladder hemorrhage needs to be considered a possible complication for patients on direct oral anticoagulants.

中文翻译：

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口服依多沙班治疗期间胆囊出血：一例报告。

背景技术依多沙班是口服给药的抗凝治疗剂，用于患有脑梗塞，静脉血栓形成或其他疾病的患者，据报道胃肠道出血的发生率约为1％。我们遇到了罕见的病人，在使用依多沙班后发生胆囊出血。病例介绍一名86岁的日本妇女因黑蜂病的主诉持续了一周而拜访了我们的肠胃科。她的病史包括高血压和栓塞性脑梗塞，她正在口服卡维地洛（5 mg /天）和依多沙班（30 mg /天）。体检时她的睑结膜苍白，表明有贫血的可能。她的血液检查结果证实严重贫血，红细胞为1。7×106 /μL，血红蛋白为4.7 g / dL。上消化道内窥镜检查显示十二指肠球及更远端区域有胆汁和新鲜血液。怀疑有肝胆病。在住院的第9天进行计算机断层扫描，确认胆囊底高密度信号提示了胆道疾病。她在住院的第30天出院，仅接受液体疗法，无贫血进展。此外，她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。上消化道内窥镜检查显示十二指肠球及更远端区域有胆汁和新鲜血液。怀疑有肝胆病。在住院的第9天进行计算机断层扫描，确认胆囊底高密度信号提示了胆道疾病。她在住院的第30天出院，仅接受液体疗法，无贫血进展。此外，她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。上消化道内窥镜检查显示十二指肠球及更远端区域有胆汁和新鲜血液。怀疑有肝胆病。在住院的第9天进行计算机断层扫描，确认胆囊底高密度信号提示了胆道疾病。她在住院的第30天出院，仅接受液体疗法，无贫血进展。此外，她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。在住院的第9天进行计算机断层扫描，确认胆囊底高密度信号提示了胆道疾病。她在住院的第30天出院，仅接受液体疗法，无贫血进展。此外，她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。在住院的第九天进行计算机断层扫描，证实胆道底高密度信号提示了胆道疾病。她在住院的第30天出院，仅接受液体疗法，无贫血进展。此外，她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。她在出院后1个月接受了腹腔镜胆囊切除术，但病理学家并未发现假的动脉瘤或肿瘤性病变。手术后5个月未显示出患贫血。结论我们的病例表明，对于直接口服抗凝剂的患者，胆囊出血应被视为可能的并发症。