Leukocytosis of Unknown Origin: Gangrenous Cholecystitis

Amara Jyothi Nidimusili,Naseem Eisa,M Chadi Alraies,Abdul Hamid Alraiyes,Khaldoon Shaheen

doi:10.1155/2013/418014

Abstract

There have been case reports where patients admitted with acute cholecystitis, who were managed conservatively, had subsequently developed GC (gangrenous cholecystitis). The current case is unique, since our patient denied any prior episodes of abdominal pain and the only tip off was leukocytosis. A high index of suspicion is essential for the early diagnosis and treatment of GC. GC has a mortality rate of up to 22% and a complication rate of 16–25%. Complications associated with GC include perforation, which has been reported to occur in as many as 10% of cases of acute cholecystitis. The radiological investigations may not be conclusive. Ultrasonography usually serves as the first-line imaging modality for the evaluation of patients with clinically suspected acute cholecystitis. However, CT can play an important role in the evaluation of these patients if sonography is inconclusive. There is a need for an early (if not urgent) surgical intervention in acute cholecystitis (whether laparoscopic or open surgery) in order to decrease the time elapsed from the start of symptoms to admission and treatment.

Highlights

Gangrenous cholecystitis is one of the most severe forms of gallbladder inflammation, and accounts for minority of all patients with acute cholecystitis
A 66-year-old obese man with history of diabetes mellitus and hypertension was admitted to the hospital for atypical left-sided chest pain of several hours duration worsened by movement and relieved with nitroglycerin
Gangrenous cholecystitis (GC) is an ominous progression of acute cholecystitis in which infection, inflammation, edema, bile stasis, and ischemia lead to gallbladder necrosis and perforation

Summary

Introduction

Gangrenous cholecystitis is one of the most severe forms of gallbladder inflammation, and accounts for minority of all patients with acute cholecystitis. It is the result of marked distension of the gallbladder causing increased tension in the gallbladder wall. Associated inflammation leads to ischemic necrosis of the wall. We have an atypical and unique presentation of a patient with painless gangrenous cholecystitis

The Case

Discussion

Findings

Conclusion