Case Of Acalculous Cholecystitis Research Articles

A case of acalculous cholecystitis or Brucella-induced acute cholecystitis?

Brucella spp. is a microorganism that can cause febrile, systemic infection, especially in endemic areas. Although it causes a multisystemic involvement and creates various clinical symptoms, osteoarticular symptoms are the most common. However, Brucella spp. is known to be a great mimic and can cause rare, atypical presentations. In this case report, we aimed to present a 67-year-old Turkish female patient diagnosed with stony cholecystitis due to Brucella spp. Although rare, brucellosis can be encountered as a cause of acute cholecyst. Although there are changes in the epidemiology of brucellosis, it is useful to keep in mind brucellosis in the differential diagnosis of many diseases, in endemic areas, especially in rural areas.

S1545 Acute Acalculous Cholecystitis Leading to the Diagnosis of Systemic Lupus Erythematosus

Introduction: Acute acalculous cholecystitis (AAC) involves inflammation of the gallbladder without the presence of gallstones, and is commonly seen in ill hospitalized patients. We present a case of acalculous cholecystitis as the initial presentation of systemic lupus erythematosus (SLE). Case Description/Methods: A 34-year-old woman presented with two weeks of fever, epigastric pain with nausea, and a 10-pound weight loss. Review of systems was positive for dry eyes, dry mouth, and myalgias. Past medical history was notable for miscarriage. Complete blood count was notable for thrombocytopenia, normocytic anemia, and neutropenia (with absolute neutrophil count of 660 10*3/uL). Comprehensive metabolic panel was notable for an elevated protein gap and slightly abnormal AST 161 IU/L and ALT 61 IU/L. CT abdomen demonstrated gallbladder wall thickening, with no evidence of cholelithiasis. RUQ ultrasound confirmed the absence of gallstones. HIDA scan showed non-visualization of the gallbladder consistent with cystic duct obstruction. Erythrocyte sedimentation rate was elevated at 56 mm/hr and ferritin was greater than 4000 ng/ml. Further testing revealed positive testing for ANA, double-stranded DNA, anti-ro, and lupus anticoagulant. Given the predominant autoimmune symptoms, she was started on prednisone 60 mg for newly diagnosed lupus with improvement of her symptoms. After discharge she was started on plaquenil and azathioprine, and steroids were tapered. Repeat testing confirmed persistent antibodies for antiphospholipid syndrome. She was lost to follow up 6 months after discharge. Discussion: GI manifestations of lupus can be vast, and include oral ulcers, mesenteric vasculitis, intestinal pseudo-obstruction, protein losing enteropathy, lupus associated pancreatitis, and serositis. Hepatobiliary manifestations include primary sclerosing cholangitis and autoimmune cholecystitis. The pathogenesis of AAC in SLE typically involves vasculitis, serositis, or thrombosis, and gallbladder histology often shows vasculitis of small vessel arteries and venules. Treatment typically involves percutaneous cholecystostomy tube placement or cholecystectomy; however, there have been case reports of successful treatment of AAC in SLE with high dose corticosteroids, often in combination with antibiotics or other immunosuppressants. Our case demonstrates the importance of considering underlying autoimmune conditions in patients presenting with gastrointestinal symptoms.

86 Acalculous Cholecystitis: Changing Trends From 2004 to 2014

INTRODUCTION: Acute acalculous cholecystitis (AAC) which accounts for 10% cases of cholecystitis is associated with high morbidity and mortality rates. The management options for AAC range from surgical removal of the gall bladder to emergent drainage either by percutaneous means or endoscopically. Data about the in-hospital outcomes of AAC is sparse. METHODS: The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. We analyzed the National Inpatient Sample Database (NIS) for all patients in which acute acalculous cholecystitis (ICD-9 codes: 575.0, 575.1) was the principal discharge diagnosis from 2004 to 2014. We further looked at procedure codes Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Percutaneous transhepatic cholangiography (PTC), open and laparoscopic cholecystectomy. The outcome variables were in hospital mortality, length of stay and total hospital charge. Univariate and multivariate analysis was performed adjusted for multiple confounder. RESULTS: In 2014 there were 35865 hospital admissions with the principal diagnosis AAC which increased significantly from 23485 in 2004 (P < 0.001). The mean length of stay for acute cholecystitis decreased by 21.6% between 2004 and 2014 (i.e., from 5.1 days to 4.0 days; (P < 0.05). During the same time period, however, mean hospital charges have increased by 190.5% from US$24 514 per patient in 2004 to US$46847 per patient in 2014 (P < 0.001). There were no cases of EUS guided drainage in 2004 while in 2014 there were 485 cases. A significantly higher proportion of patients received PTC, ERCP and laparoscopic cholecystectomy in 2014 compared to 2004 (P = 0.001). The in-hospital mortality declined from 1.4% in 2004 to 0.9% in 2014. Factors associated with in-hospital mortality were Diabetes mellitus (OR = 1.76, P = 0.004), presence of Chronic kidney disease (OR = 2.36, P = 0.003), hematologic malignancy (OR = 4.5, P < 0.001) and metastatic cancer (OR = 14.56, P < 0.0001). CONCLUSION: The number of cases of acalculous cholecystitis has shown a gradual increase from 2004 to 2014. However there has been a gradual reduction in mortality and length of stay in these patients. While it is associated with increased utilization of ERCP and EUS, causality cannot definitively be established.

Acalculous cholecystitis occurring in the context of Plasmodium malariae infection: a case report

IntroductionAcalculous cholecystitis has been shown to occur in the context of malarial infection with Plasmodium vivax and Plasmodium falciparum and requires prompt diagnosis and treatment to prevent complications. To the best of our knowledge this is the first reported case of the disease occurring in a patient infected with Plasmodium malariae.Case presentationWe report the first case of acalculous cholecystitis associated with Plasmodium malariae in a 59-year-old male Nepalese ex-Gurkha soldier. He presented with fever and vomiting and later developed right upper quadrant pain. Abdominal ultrasound and computed tomography scans confirmed acalculous cholecystitis for which he was treated medically with chloroquine, gentamicin and metronidazole. He made a full recovery.ConclusionsPhysicians should be aware that in addition to Plasmodium vivax and Plasmodium falciparum infections, acalculous cholecystitis can occur in the context of Plasmodium malariae infection. Mechanisms for this are discussed but further studies are needed to establish the etiology of this association.

An unusual case of acalculous cholecystitis heralding presentation of acute mesenteric ischaemia with typical radiological findings

INTRODUCTIONAcalculous cholecystitis accounts for 10–15% of cases of cholecystitis. It is often associated with critical illness and has a high morbidity and mortality. PRESENTATION OF CASEWe report an unusual case of an elderly lady who presented with acalculous cholecystitis as the herald event for subsequent fatal intestinal ischaemia. She demonstrated classical radiological features of pneumatosis coli and hepatic porto-venous gas (HPVG). DISCUSSIONThe pathogenesis of acalculous cholecystitis remains uncertain but theories including biliary stasis, sepsis and ischaemia have been proposed. The gallbladder is particularly vulnerable to ischaemia which may precipitate the inflammatory process. In this case, we propose that acute acalculous cholecystitis was triggered by ischaemia and was a herald sign of the ischaemia that would later affect the entire gastrointestinal tract. We suggest that the gallbladder's tenuous blood supply made it more vulnerable to the ischaemia that the rest of the bowel subsequently suffered from. CONCLUSIONIntramural and hepatic porto-venous gas are classical, though rarely seen, CT findings in acute intestinal ischaemia. In these situations HPVG is often associated with poor outcome. In this case the acute acalculous cholecystitis may have been a herald sign of mesenteric ischaemia.

Acute acalculus cholecystitis and hepatitis caused by Brucella melitensis

Acute cholecystitis is a very rare presentation of brucellosis. A case of acalculous cholecystitis caused by Brucella melitensis is reported with a review of previously reported cases.

Acalculous cholecystitis in a patient with Plasmodium falciparum infection after a trip to the Dominican Republic

Acalculous cholecystitis has been associated with several infectious agents, but its relation with Plasmodium falciparum infection has not been clearly defined. This is the first case of acalculous cholecystitis produced by Plasmodium falciparum infection that is directly documented and should be included among the differential diagnoses of acalculous cholecystitis.

Campylobacter cholecystitis

There are 13 cases of campylobacter cholecystitis reported so far in the medical literature. Among them, only 4 patients had diarrhea. We report another case of acalculous cholecystitis in a setting of campylobacter enteritis. The case report is followed by a literature review regarding this rare condition.

Major complications of ultrasound‐guided percutaneous radiofrequency ablations for liver malignancies: Single center experience

Despite radiofrequency ablation (RFA) for malignant liver nodular lesions having promising therapeutic effects, the trade-off between the risks and benefits must be acceptable. This study analyzed the major complications of ultrasound (US)-guided percutaneous RFA procedures encountered at a single center, by a single physician. A total of 104 patients (total 183 tumors) underwent 172 US-guided percutaneous RFA sessions between May 2003 and March 2006. The definition of major complications was according to the standardized Society of Interventional Radiology grading system (classification C-E). Eighty-six patients had hepatocellular carcinoma (HCC) and 18 patients had hepatic metastatic tumors. Nine major complications occurred from 172 RFA sessions (9/172, incidence of 5.2% per session); namely, two cases of transient liver function impairment, two cases of infection (liver abscess and septicemia), two cases of tumor seeding along the ablated track, one case of colon perforation, one case of acalculous cholecystitis and, lastly, a case of hemocholecyst. We further analyzed the possible risk factors precipitating these complications, and found that only tumor size (Pearson's correlation coefficient, 0.324; P < 0.05) and baseline liver function reserve (compensated 0%, 0/148 vs decompensated 8.3%, 2/24; P = 0.019) were significant factors for the complication of transient liver function impairment. Radiofrequency ablation for liver malignancy is a safe procedure with acceptable incidence of complications. Decompensated baseline liver function reserve and large tumor size are precipitating factors for transient liver function impairment after RFA and warrant a close follow up.

Acalculous and Clostridial Cholecystitis in a Pig

A 21-month-old domestic Hanford pig (Sus scrofa domestica) in a 1-year study for experimental myocardial infarction was euthanized at the end of the study. One week earlier, the animal had symptoms and elevated clinical chemistry results suggestive of hepatobiliary disease, which resolved after medical therapy. At necropsy, the gallbladder was markedly enlarged, discolored, and had a thickened wall. Within the gallbladder, there was abundant friable green-brown material. A culture of the gallbladder luminal material yielded Clostridium perfringens type A. Histopathology of the gallbladder demonstrated multifocal areas of necrosis of varying depths, admixed with an inflammatory infiltrate that was also observed on the serosa and within the associated adipose tissue. Luminal material was composed of cellular debris and bile sludge admixed with numerous bacterial rods. Smooth-muscle hypertrophy of numerous small arterioles with narrowed lumina was observed in the gallbladder. A diagnosis of acalculous cholecystitis presumably because of ischemia of the gallbladder with secondary clostridial infection was made. To the authors' knowledge, this is the first reported case of acalculous cholecystitis with evidence of vascular compromise in a pig, as well as cholecystitis secondarily attributed to Clostridium perfringens type A.

Acalculous cholecystitis: Ascariasis as an unusual cause

Migration of roundworms into the biliary tree is a well-known complication of Ascaris lumbricoides infestation of the intestine. Massive infestation of the hepato-biliary tract is uncommon but can lead to complications if not treated. Here, we report two cases of acalculous cholecystitis caused by ascariasis.

ACALCULOUS CHOLECYSTITIS IN PATIENTS WITH ACUTE LEUKAEMIA

SUMMARY Cases of acalculous cholecystitis in patients with acute leukaemia are rare. Manifestations of the primary disease often mask the acute cholecystitis symptoms. A high index of suspicion and ultrasonographic examination in leukaemic patients with abdominal pain and unexplained fever may allow earlier diagnosis, before the development of complications. We report two cases of acute acalculous cholecystitis during the course of acute leukaemia.

Morphine cholescintigraphy in the evaluation of hospitalized patients with suspected acute cholecystitis.

The authors determined if the diagnosis of acute cholecystitis can be accurately made or reliably eliminated by the use of morphine-augmented radionuclide cholescintigraphy (morphine cholescintigraphy [MC]) in hospitalized patients in whom the diagnosis is in doubt. SUMMARY/BACKGROUND DATA: Diagnosis of acute cholecystitis, calculous or acalculous, may be difficult in patients hospitalized for abdominal pain or other illnesses. Clinical signs often are obscure, and routine imaging studies are nonspecific or associated with a high incidence of false-positive tests. The authors report the use of MC in the evaluation of 163 hospitalized patients for acute cholecystitis over an 8-year period. All patients suspected to have acute cholecystitis initially had standard cholescintigraphy performed, which showed nonvisualization of the gallbladder, and then were given morphine sulfate (0.05-0.1 mg/kg, intravenously). Patients were divided into the following three groups: I--acute abdominal pain (N = 53); II--hospitalized for associated illness (N = 49); and III--critically ill (N = 61). Overall, MC confirmed the diagnosis of acute cholecystitis in 75 patients (46%), including 23 cases of acalculous cholecystitis. Visualization of the gallbladder occurred within 60 minutes of intravenous administration of morphine sulfate in all patients. Cystic duct obstruction and, presumably, the diagnosis of acute cholecystitis was excluded in 79 patients, including 38 who were critically ill. There were eight false-positive and one false-negative studies. Morphine cholescintigraphy had a sensitivity of 99%, a specificity of 91%, a positive predictive value of 0.9, a negative predictive value of 0.99, and an overall accuracy of 94%. In hospitalized patients with nonvisualization of the gallbladder after standard cholescintigraphy, MC is highly accurate, especially in predicting the absence of acute cholecystitis in patients with known risk factors.

Cytomegaloviral and Cryptosporidial Cholecystitis in Two Patients with AIDS

We report two cases of acalculous cholecystitis due to infection with cytomegalovirus (CMV) and cryptosporidium. Both involved homosexual men who presented with right upper quadrant pain and elevations of serum alkaline phosphatase and bilirubin. Cholecystectomy specimens showed a thickened gallbladder wall and ulcerated mucosa. There were no stones. CMV inclusion bodies were found in granulation tissue at the base of ulcers and intact mucosa surrounding ulcers. Cryptosporidia were aligned along the luminal surface of intact mucosal epithelial cells. Both organisms have a patchy distribution; hence the diagnosis requires a high degree of suspicion. The prognosis is poor. Following cholecystectomy, both patients pursued a downhill course with development of pancreatitis and cholangitis. Both patients are now dead.

Paediatric acalculous cholecystitis

Three cases of acalculous cholecystitis were found in a review of gall bladder disease over a 34-year period. Each case is presented and the literature is reviewed.

Non calculous cholecystitis: an 8 year review of cases treated by elective cholecystectomy.

From a total of 248 cases of cholecystectomy, 36 were found to be without stones. These cases of acalculous cholecystitis have been reviewed with regard to signs, symptoms and radiological investigations. The complications of operative treatment have been documented and the etiology of the condition discussed. As a result of favourable outcome of operative treatment in these patients, it is suggested that surgery should be considered even in the absence of positive radiological findings at an earlier date.

Acute acalculous cholecystitis. Complication of other illnesses in childhood.

Seventy-four cases of acalculous cholecystitis in infants and children (seven personal cases and 67 from the literature) were analyzed. In 45 cases the cholecystitis appeared as a complication of another illness. The primary illnesses in our patients were leptospirosis (four cases), diarrhea (two cases), and third-degree burns (one case). All seven children were critically ill. Abdominal pain and an abdominal mass were present in all. Fever was present in six of the seven patients, jaundice in four. Tube cholecystostomies were done in all cases. After recovery from their illness, the five surviving patients had normal bilary tracts when studied by cholangiography via the tube. Acute acalculous cholecystitis in infancey and childhood as a complication of injury or illness should be treated as an undrained abcess.

Acalculous cholecystitis in burned patients

Ten cases of acalculous cholecystitis in burned patients are reviewed. The disorder appears to be associated with overwhelming bacterial invasion or other postburn complications leading to dehydration or necessitating surgery. Recommendations regarding prophylaxis and therapy are made.

Acalculous cholecystitis

Twelve cases of acalculous cholecystitis are reviewed and the pathologic condition discussed. Preoperative diagnosis is difficult to make. The increased morbidity associated with cholecystectomy in patients with acalculous disease makes mandatory a search for associated diseases, a classification of which is offered.