1/13. Conservative management of intrahepatic perforation of the gallbladder secondary to acalculous cholecystitis. gallbladder (GB) perforation is a rare complication of acute acalculous cholecystitis. This complication mostly manifests as acute free perforation into the peritoneal cavity, subacute pericholecystic abscess, or chronic perforation with cholecystoenteric fistula. Perforation of the GB into the liver is extremely rare, and was reported only in adults, of whom all were treated surgically. The authors present an intrahepatic GB perforation secondary to acute acalculous cholecystitis, and its successful conservative management in a 13-year-old boy. ( info) |
2/13. Acute acalculous cholecystitis induced by mesenteric inflammatory veno-occlusive disease (MIVOD) in systemic lupus erythematosus. A 43-year-old woman with systemic lupus erythematosus (SLE) was treated for lupus pleurisy. During the course of her illness, she abruptly suffered severe right hypochondriac pain and high-grade fever. Abdominal ultrasonography revealed a thickening of the gallbladder wall without cholelithiasis, and she was diagnosed with acute acalculous cholecystitis (AAC). Laparoscopic cholecystostomy was performed. Pathological examination revealed lymphocytic venulitis without arteritis. Antiphospholipid antibodies were not demonstrated during the course of illness. From these findings, the cause of AAC was revealed as a mesenteric inflammatory veno-occlusive disease (MIVOD), which is a novel venopathy mainly affecting the mesenteric vein and/or its branches, causing serious ischemic complications. MIVOD should be considered as a possible cause of AAC. ( info) |
| Acute acalculous cholecystitis is characterized by acute inflammation of the gallbladder in the absence of stones, usually occurring in elderly and critically ill patients with atherosclerosis, recent surgery or trauma, or hemodynamic instability. patients may present with only unexplained fever, leukocytosis, and hyperamylasemia without right upper quadrant tenderness. If untreated, rapid progression to gangrene and perforation occurs. Surgical cholecystectomy and cholecystostomy provide the most definitive treatment although recent studies indicate success with percutaneous or endoscopic cholecystostomy. Cholesterolosis and adenomyomatosis of the gallbladder are usually clinically silent and incidental findings at the time of cholecystectomy. Cholesterolosis is characterized by mucosal villous hyperplasia with excessive accumulation of cholesterol esters within epithelial macrophages. Usually clinically silent, the condition rarely is associated with biliary symptoms or idiopathic pancreatitis and cannot reliably be detected by ultrasonography. Adenomyomatosis describes an acquired, hyperplastic lesion of the gallbladder characterized by excessive proliferation of surface epithelium with invaginations into a thickened muscularis propria. ultrasonography may reveal a thickened gallbladder wall with intramural diverticula. Adenomyomatosis may portend a higher risk of gallbladder malignancy. Most cases of cholesterolosis and adenomyomatosis identified by imaging require no specific treatment. gallbladder polyps include all mucosal projections into the gallbladder lumen and include cholesterol polyps, adenomyomas, inflammatory polyps, adenomas, and other miscellaneous polyps. Most polyps are nonneoplastic and rarely cause symptoms. cholecystectomy is advocated for polyps greater than 10 mm in size because of increased risk of adenomatous or carcinomatous features. ( info) |
| Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management. ( info) |
| BACKGROUND/AIMS: We report the case of a 53-year-old man with fever and severe abdominal pain following an upper respiratory tract infection. methods/RESULTS: The clinical signs, the laboratory markers, and the ultrasound findings were consistent with acute acalculous cholecystitis and he underwent cholecystectomy. Histologically the gallbladder showed vasculitis and the patient developed postoperatively a purpuric rash of the legs with transient ankle arthritis. gastroscopy revealed prepyloric ulcers consistent with vasculitis. The patient was diagnosed as having Henoch-Schonlein purpura. Gastric ulcers as well as arthritis disappeared upon treatment with corticosteroids and proton pump inhibitors. CONCLUSION: Taken together, Henoch-Schonlein purpura can mimic acute cholecystitis and should be considered as a rare differential diagnosis of acute cholecystitis. ( info) |
6/13. Antiphospholipid antibody syndrome (APS) presenting as splenic thrombosis and acute acalculous cholecystitis. antiphospholipid syndrome is an uncommon auto-immune disease presenting with various clinical manifestations that may lead to surgical intervention and sometimes even life-threatening emergencies. This syndrome presents with venous and arterial thrombosis of many organs such as liver, kidney and of the skin etc. Clinical manifestations may mimic hematological disorders and be misdiagnosed in some cases due to the complexity of the symptoms. In the present study, a 65-year-old man with APS syndrome presenting with severe abdominal organ pathologies that required surgical intervention, is reported. ( info) |
| We report a 7-year-old girl who presented with features of acute acalculous cholecystitis. She was found to be positive for plasmodium falciparum. To the best of our knowledge, this is the first report of acalculous cholecystitis caused by P. falciparum in a child. ( info) |
8/13. Outpatient treatment with corticosteroids and antibiotics for acalculous cholecystitis in chronic granulomatous disease. We report the outpatient management of acalculous colecistitis in an 18-y-old male with X-linked chronic granulomatous disease. The patient complained of abdominal pain and the initial ultrasound showed a gallbladder with a thickened wall.CONCLUSION: In chronic granulomatous disease, pain from a thickened gallbladder disappears after oral treatment with glucocorticoids and antibiotics. ( info) |
| Acute acalculous cholecystitis is a very rare complication of typhoid fever, and may be due to multi-drug resistant and virulent forms of Salmonella infection. It is particularly rare in adults. A 21-year-old woman, presenting with fever, vomiting, diarrhoea and abdominal pain, was found to have acute acalculous cholecystitis due to typhoid fever on basis of ultrasonographical findings and a positive Widal's test for salmonella typhi. She was treated with antibiotics and made a full recovery. ( info) |
| A 10-year-old boy with systemic lupus erythematosus (SLE) developed abrupt right upper quadrant pain and vomiting during the course of his active disease. Antiphospholipid antibody was negative and the C3 level was low. Abdominal sonography showed cholecystitis with sludge balls in the gallbladder. He was treated by high-dose prednisolone with ceftriaxone and metronidazole IV for 3 days but due to poor response, cholecystectomy was performed and no stone was identified. Histopathologic examination showed vasculitis in the medium-sized arteries of the gallbladder wall. He was doing well at the 9-month follow-up after the operation. This report describes the first pediatric case of SLE with acalculous cholecystitis caused by vasculitis of the gallbladder. ( info) |