Asymptomatic Gangrenous Cholecystitis Discovered During Elective Laparoscopic Cholecystectomy

Abstract

Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis. It is associated with significant morbidity and mortality. A male with type 2 diabetes mellitus had been treated for acute cholecystitis and discharged home. The patient was admitted electively for a laparoscopic cholecystectomy 6 weeks post discharge at which time he was entirely asymptomatic. Intra-operatively the gallbladder was found to be necrotic but it was removed laparoscopically and without complication. Acute cholecystitis is the most common complication of cholelithiasis occurring in approximately 1-2% of asymptomatic patients annually; however, in approximately 2-29.6% of patients, the disease processes to GC. GC is associated with a significant morbidity and mortality; however, in spite of its grave prognosis, its diagnosis can be elusive both clinically and biochemically. Many factors have been implicated in the formation of GC, including diabetes mellitus, age ? 51 years, male sex, leucocytosis (WCC > 15 10⁹) and a high CRP. Complications associated with GC include perforation, which has been reported to occur in up to 10% of cases of acute cholecystitis. When managing a patient with acute cholecystitis, a high index of suspicion is essential for the possibility of GC, especially in a diabetic and elderly patient even if the patient appears to be improving clinically and in the presence of normalizing laboratory investigations. There is a need to consider early or emergency cholecystectomy in these patients due to the high risk of gangrenous transformation with possibility of gallbladder perforation and a resultant increased morbidity and mortality.




J Med Cases. 2014;5(11):576-578
doi: https://doi.org/10.14740/jmc1530w