Diagnosis and management of acute acalculous cholecystitis in an outpatient: a case report

Authors

  • Maria Dass Scott Arockia Singh Department of General and Laparoscopic Surgery, Badr Al Samaa Hospitals, Salalah
  • Meethala Peedikayil Anish Kumar Department of Internal Medicine, Badr Al Samaa Hospitals, Salalah

DOI:

https://doi.org/10.18203/2349-2902.isj20191906

Keywords:

Acalculous cholecystitis, Gangrenous gall bladder, Outpatient, Hypertension, Gall bladder disease, Laparoscopic subtotal cholecystectomy

Abstract

Acute acalculous cholecystitis (AAC) is defined as acute necrotic inflammation of the gall bladder without stone disease. It commonly occurs in ICU patients associated with major trauma, burns, multiorgan failure patients, post major surgery, end stage malignancies, severe sepsis. Here we present a case of acute acalculous cholecystitis with gangrenous formation in a middle-aged outpatient without any prior illness. He was a hypertensive on medications came with complains of abdominal pain. Clinical examination and ultrasound revealed features suggestive of infective acalculous gall bladder disease. Emergency laparoscopic subtotal cholecystectomy done, discharged in a healthy state on 3rd postoperative day. We present this case to raise awareness among primary care physicians of AAC in patients with acute right hypochondrial pain. Prompt diagnosis and urgent surgical management gives the best outcome in these patients.

References

Savoca PE, Longo WE, Zucker KA, McMillen MM, Modlin IM. The increasing prevalence of acalculous cholecystitis in outpatients. Results of a 7-year study. Ann Surg. 1990;211:4337.

Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol. 2018;24(43):4870-9.

Balmadrid B. Recent advances in management of acalculous cholecystitis. F1000Res. 2018;7.pii: F1000 Faculty Rev-1660.

Ganpathi IS, Diddapur RK, Eugene H, Karim M. Acute acalculous cholecystitis: challenging the myths. HPB (Oxford). 2007;9(2):131-4.

Parithivel VS, Gerst PH, Banerjee S, Parikh V, Albu E. Acute acalculous cholecystitis in young patients without predisposing factors. Am Surg. Am Surg. 1999;65(4):366-8.

Huffman JL, Schneker S. Acute Acalculous Cholecystitis. A Rev Clin Gastroenterol Hepatol. 2010;8(1):15-22.

Hakala T, Nuutinen PJ, Ruokonen ET, Alhava E. Microangiopathy in acute acalculous cholecystitis. Br J Surg. 1997; 84:1249-52.

Mirvis SE, Vainright JR, Nelson AW, Johnston GS, Shorr R, Rodriguez A, et al. The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol. 1986;147:1171–5.

Boland GWL, Slater G, Lu DSK, Eisenberg P, Lee MJ, Mueller PR. Prevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients. AJR Am J Roentgenol. 2000;174:973–7.

Supit C, Supit T, Mazni Y, Basir I. The outcome of laparoscopic subtotal cholecystectomy in difficult cases - A case series. Int J Surg Case Rep. 2017;41:311-4.

Laurila JJ, Ala-Kokko TI, Laurila PA, Saarnio J, Koivukangas V, Syrjälä H, et al. Histopathology of acute acalculous cholecystitis in critically ill patients. Histopathology. 2005;47(5):485-92.

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Published

2019-04-29

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Section

Case Reports