Abstract
Cholelithiasis can present from a milder form of biliary colic to a more severe and complicated one like empyema gallbladder and a lesser-known variant of gangrenous gallbladder called marbleization of the gallbladder. The clinical signs and symptoms are similar to acute cholecystitis. Diabetes mellitus could have a role in the process of marbleization. Diagnosing marbleization of the gall bladder is not easy preoperatively. Computerized tomography is a better diagnostic modality when compared to laboratory investigations. Urgent cholecystectomy is the only option, and there is no role of conservative treatment. We report a case of a 36-year-old man with newly diagnosed Diabetes Mellitus diagnosed initially as acute cholecystitis and managed conservatively. He did not respond to treatment and hence underwent cholecystectomy and intraoperatively was found to have marbleization of the gall bladder.
Highlights
Cholelithiasis and its related complications are commonly seen in the surgical wards
The various complications that Cholelithiasis can cause are acute cholecystitis, ascending cholangitis, biliary pancreatitis, etc.[1]. It can develop into rare complications such as empyema gall bladder and gangrenous gall bladder that are life-threatening. There is another variant of gangrenous cholecystitis (GC) that many are unaware where coalescing of the bile sludge with necrosis, withered in the outer layer of gall bladder giving an appearance of shiny dark green marblelike appearance
The incidence of GC ranges from 2%to 30% in all patients with acute cholecystitis.[2]
Summary
Cholelithiasis can present from a milder form of biliary colic to a more severe and complicated one like empyema gallbladder and a lesser-known variant of gangrenous gallbladder called marbleization of the gallbladder. The clinical signs and symptoms are similar to acute cholecystitis. Diabetes mellitus could have a role in the process of marbleization. Diagnosing marbleization of the gall bladder is not easy preoperatively. Urgent cholecystectomy is the only option, and there is no role of conservative treatment. We report a case of a 36-year-old man with newly diagnosed Diabetes Mellitus diagnosed initially as acute cholecystitis and managed conservatively. He did not respond to treatment and underwent cholecystectomy and intraoperatively was found to have marbleization of the gall bladder
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