Abstract
A middle-aged man presented 1 day after being discharged from hospital with completing the first course of postoperative chemotherapy. He suffered a sudden persistent high fever and chills. It was noted that he had a history of a total gastrectomy (with D2 lymphadenectomy) 1 month ago. His admission bloods revealed total bilirubin was 142.2umol/L , indirect bilirubin of 107.6umol/L and white cell count of 20.05×109/L. A color doppler ultrasound scan confirmed fluid and gas around liver and hilus lienis while the gallbladder cannot be detected. During Computed Tomography (CT) guided puncture positioning technology and setting a three-channel tube, about 400 ml of foul smell hazel turbid liquid was drained out. He was diagnosed as gallbladder perforation and he was underwent conservative treatment consist of drainage, banning diet, total parenteral nutrition and intravenous antibiotics. Then he recovered well within the subsequent 10 days and was discharged.
Highlights
Perforation of the gallbladder is a rare but life-threatening condition, which usually requires immediate surgical intervention [1, 2]
History of a total gastrectomy with D2 lymphadenectomy 1 months ago and one course of postoperative chemotherapy which consisted of Oxaliplatin and S-1(Oxaliplatin 150mg ivdrip d1, S-1 po 40mg bid Day1-14) because of gastric cancer
Acute acalculous cholecystitis is defied as acute cholecystitis without detection of any gallstones
Summary
Perforation of the gallbladder is a rare but life-threatening condition, which usually requires immediate surgical intervention [1, 2]. History of a total gastrectomy with D2 lymphadenectomy 1 months ago and one course of postoperative chemotherapy which consisted of Oxaliplatin and S-1(Oxaliplatin 150mg ivdrip d1, S-1 po 40mg bid Day1-14) because of gastric cancer He has no liver or biliary disease history. Baseline investigations revealed a aspertate aminotransferase of 97U/L, and the total bilirubin was 142.2umol/ L, indirect bilirubin of 107.6umol/L, white cell count of 20.05×109/L His hepatitis virus examination was negative and renal function, Electrolyte was normal. Outcome and follow-up His temperature dropped to 37 degrees,and the jaundice was significantly improved by the first day of conservative treatment His drainage quantity and liver function tests were noted to be persistently elevated (Table 1). Review normal every 4 weeks and he had begun the second course of chemotherapy which consisted of oxaliplatin and fluorouracil (oxaliplatin 150mg ivdrip day1, 5-fluorouracil (5-FU) 500mg iv day1, 5-FU 2500mg civ day 2–3)
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