Hemocholecyst is defined as the presence of blood inside the gallbladder lumen. The gallbladder may be filled with blood by retrograde flow in the setting of hemobilia, but primary hemocholecyst represents a rare cause of hemobilia. Spontaneous hemorrhage inside the gallbladder has been reported in literature in patients with renal failure, bleeding diathesis, or critical illness, but it can also occur secondary to gallbladder tumors, cholelithiasis, cholecystitis, trauma, and vascular disorders. We present the case of a 77-year-old male patient with significant comorbidities who presented to our Department with epigastric pain and decreased hematocrit level. The patient was diagnosed with spontaneous primary hemocholecyst and was treated conservatively with success avoiding the unnecessary operative risk. No significant causative factors were identified in this patient apart from chronic low-dose aspirin use. In carefully selected patients with spontaneous hemocholecyst, in whom cholecystectomy is not otherwise indicated, effort should be made to manage the condition nonoperatively.
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