Cases Of Acute Acalculous Cholecystitis Research Articles

ACUTE ACALCULOUS CHOLECYSTITIS RELATED TO HEPATITIS A VIRUS: REPORT OF 3 CASES.

Hepatitis A virus commonly affects children in developing countries. Usually, it presents as an asymptomatic infection or a self-limited acute hepatitis. We report 3 rare pediatric cases of acute acalculous cholecystitis associated with to hepatitis A virus. Conservative treatment was successful, with complete clinical, analytical and imaging remission.

Acute Acalculous Cholecystitis Associated with Abscesses-An Unknown Dual Pathology.

(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/-16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis.

Acute acalculous cholecystitis: an unusual presentation of vitamin B12 deficiency

Paediatric cases of acute acalculous cholecystitis (AAC) are due to infectious diseases or immune mediated disorders. Hereby, we present a case of 6 months old infant who presented with excessive crying with irritability and tenderness over right hypochondrium region with a palpable liver. Investigations revealed AAC and anaemia. In the work-up of anaemia, vitamin B12 deficiency was diagnosed and after giving treatment with vitamin B12, anaemia resolved as well as AAC. Through this case report we intent to emphasize the possibility of vitamin B12 deficiency presenting as AAC.

A Case of Systemic Lupus Erythematosus Initially Presented with Acute Acalculous Cholecystitis

SLE is an autoimmune disease with multiorgan involvement and a wide range of clinical manifestations, and inflammation of gallbladder also can be represented. There were a few cases of acute acalculous cholecystitis (AAC) in previous reports. Most of them tended to already know about underlying SLE when detected AAC at that time. It may be difficult to detect AAC caused by SLE not due to biliary stone if physician is not conscious of undiagnosed lupus. We introduce a 70-year old female patient, who is diagnosed with AAC. Her symptoms were satisfied the ACR classification criteria for SLE, and was diagnosed with SLE, simultaneously. After a high dose steroid pulse therapy, followed by cyclophosphamide, her symptoms have improved rapidly. In order to better diagnose and treat the disease, we need to be aware of AAC as a potential manifestation of SLE.

Colecistite aguda alitiásica na criança

Introduction: Acute acalculous cholecystitis is rare in pediatric age. It usually is associated with severe pathology, and is rare in healthy children.Case report: We describe two cases of acute acalculous cholecystitis, with distinct etiologies, diagnosed in two healthy children.Discussion: We also discuss the pathophysiology, clinical features and management of acute acalculous cholecystitis, enhancing the ultrasound contribution to its diagnosis.

Acute Acalculous Cholecystitis after Gastrointestinal Surgery

Acute acalculous cholecystitis has been identified as a rare but potentially devastating entity after trauma, and burns, as well as in critically ill patients, and in the postoperative period. Gastrointestinal surgery is most frequently implicated in postoperative acute acalculous cholecystitis, especially after gastric and colorectal procedures. Review of the English literature identified 28 articles reporting 76 cases of acute acalculous cholecystitis after gastrointestinal operations, which included a case from Tulane University Medical Center of a 64-year-old man who developed postoperative acute acalculous cholecystitis after elective left hemicolectomy. A total of 52.4 per cent of the patients developed gangrenous acute acalculous cholecystitis, with a mortality rate of 21.1 per cent, much higher than that reported in postoperative calculous cholecystitis. This emphasizes the need for a high level of suspicion and early detection in the postoperative period to avoid devastating consequences.

Malaria Caused by Plasmodium vivax Complicated by Acalculous Cholecystitis

We report the first adult cases of acute acalculous cholecystitis (AAC) exclusively caused by infections with Plasmodium vivax. We reviewed the previous cases of AAC occurring during malaria, compared and contrasted the variables of previously reported cases with the cases reported here, examined the pathogenic link between malaria and AAC, and considered the diagnostic pitfalls and treatment implications as they applied to clinical outcomes in patients with this serious and potentially underrecognized illness.

Two reports of acute neonatal acalculous cholecystitis (necrotizing cholecystitis) in a 2-week-old premature infant and a term neonate

We present 2 cases of acute acalculous cholecystitis, an extremely rare entity in newborns. A number of risk factors have been identified, such as inspissated bile, prematurity, sepsis, dehydration, total parenteral nutrition, medications, and Escherichia coli lipopolysaccharide endotoxin. In our cases, gallbladder bile had positive bacterial cultures for E coli. We present the cases of a premature infant and a term neonate who developed acute acalculous cholecystitis: one with several risk factors and the second with a very atypical presentation.

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.

ACUTE ACALCULOUS CHOLECYSTlTlS

Ten cases of acute acalculous cholecystitis, presenting to one university affiliated institution, are described. These patients were predominantly older males with either overt vascular disease or a predisposition to vascular disease and were without the usual precipitating factors described for acalculous cholescystitis. Ultrasonography was helpful in making the diagnosis and early laparotomy revealed gangrenous cholecystitis in all patients, three of whom had perforated gall-bladders. Although there was no mortality, morbidity was high, and patients stayed in hospital a mean of 10.5 days. A vascular aetiology seems likely and early surgery is recommended to avoid the high mortality reported in the literature. It seems that this form of acalculous cholecystitis is different to that seen in other clinical settings.

Acute acalculous cholecystitis in childhood

Three cases of acute acalculous cholecystitis in children are presented with comments on the diagnosis and treatment. Cholecystectomy was the operation of choice, and was done as an emergency in one patient. Recovery was uneventful in all cases.

Acalculous cholecystitis in association with major burns

Three cases of acute acalculous cholecystitis are presented, from a retrospective study of approximately 380 consecutive patients admitted to a regional adult burn centre. Two patients were male, one female. The mean body surface area (BSA) burn was 41 per cent, with a mean full thickness injury of 36·7 per cent. All patients survived but had markedly prolonged hospital stays. All patients demonstrated predisposing factors associated with acalculous cholecystitis: extensive burn area, multiple transfusions, bacteraemia, total parenteral nutrition (TPN), narcotic analgesics. and positive pressure ventilation. One patient required only conservative treatment. The other patients required surgical cholecystectomy. Cholecystostomy may have a role in critically ill patients.

Acute acalculous cholecystitis: sensitivity in detection using technetium-99m iminodiacetic acid cholescintigraphy.

Forty-one proved cases of acute acalculous cholecystitis imaged with technetium-99m iminodiacetic acid (IDA) cholescintigraphy were retrospectively analyzed. After the exclusion of one indeterminate scan (showing poor initial hepatic uptake and excretion), the study yielded a 92.5% (37 of 40) sensitivity for the detection of cystic or common bile duct obstruction. Each of the three patients with false-negative scintigrams had other abnormal scintigraphic findings suggestive of biliary tract disease. Of the 20 patients (48.8%) with focal or diffuse gangrenous cholecystitis or perforation, seven (35%) exhibited either free peritoneal spill or increased pericholecystic activity to indicate the presence of advanced disease.

Acute acalculous cholecystitis in the critically ill patient

Nine cases of acute acalculous cholecystitis were diagnosed in the surgical intensive care unit at Hartford Hospital during a 2 year period after abdominal, cardiovascular, and traumatic surgery. A tender mass in the right upper quadrant was suggestive but not diagnostic of the condition. Hyperamylasemia was seen in all patients. Ultrasonography is the most useful diagnostic tool; serial studies reveal progressive gallbladder dilatation and edema. Tube cholecystostomy was used in five patients and cholecystectomy in four. Cholecystostomy led to resolution of the inflammatory process in all five patients. Cholecystectomy should be reserved for those patients with extensive gallbladder necrosis. Six of the nine patients in the series died, all from multiple systems failure with concomitant sepsis. Hypotension is probably central to the development of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Acute acalculous cholecystitis represents another organ failure in critically ill patients who are experiencing progressive failure of multiple organ systems. An aggressive approach to the manifestations of organ failure, including acalculous cholecystitis, must be employed.