Advertisement

Atypical presentation of gangrenous cholecystitis: A case series

Published:August 17, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.039

      Abstract

      Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis that has been associated with increased morbidity. Patient with GC can present with a wide variety of non-specific clinical, laboratory, and imaging characteristics, making the diagnosis challenging. This disease requires emergent treatment, which is why a quick and reliable diagnosis is essential for the wellbeing of the patient. The authors herein present a case of GC in a patient whose initial complaint was intractable hiccups, and provide a thorough review of the literature of cases of GC with atypical presentations.

      Abbreviations:

      mm Hg (millimeter of mercury), mg/dl (milligrams per deciliter), /cu∙mm (per one cubic millimeter), ×103 (thousand), Afib (atrial fibrillation), ALT (alanine transaminase), AS (aortic stenosis), AST (aspartate transaminase), C (cholecystitis), CA (cancer), CBD (common bile duct), CKD (chronic kidney disease), CRP (C-reactive protein), CT (computed topography), DMII (diabetes mellitus II), ED (emergency department), ERCP (endoscopic retrograde cholangiopancreatography), GC (gangrenous cholecystitis), GERD (gastroesophageal reflux disease), GGT (gamma-glutamyl transferase), HTN (hypertension), ILD (interstitial lung disease), IU/L (international units per liter), N/V (nausea and vomiting), O2 (oxygen), RUQ (right upper quadrant), SGOT (serum glutamic oxaloacetic transaminase), SGPT (serum glutamic pyruvic transaminase), SPS (statistical package for social sciences), T (temperature), WBC (white blood cell)

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Indar A.A.
        • Beckingham I.J.
        Acute cholecystitis.
        BMJ [Br Med J]. 2002; 325: 639-643
        • Sureka B.
        • et al.
        Gangrenous cholecystitis: analysis of imaging findings in histopathologically confirmed cases.
        Indian Journal of Radiology and Imaging. 2018; 28: 49-54
        • Girgin S.
        • et al.
        Factors affecting morbidity and mortality in gangrenous cholecystitis.
        vol. 106. 2006: 545-549
        • Weiss 3rd, C.A.
        • Lakshman T.V.
        • Schwartz R.W.
        Current diagnosis and treatment of cholecystitis.
        Curr Surg. 2002; 59: 51-54
        • Merriam L.T.
        • et al.
        Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy.
        Surgery. 1999; 126 ([discussion 685-6]): 680-685
        • Mentzer Jr., R.M.
        • et al.
        A comparative appraisal of emphysematous cholecystitis.
        Am J Surg. 1975; 129: 10-15
        • Nikfarjam M.
        • et al.
        Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.
        HPB (Oxford). 2011; 13: 551-558
        • Bridges F.
        • et al.
        Clinically diagnosed cholecystitis: a case series.
        Neurol J Surg Case Rep. 2018; 2018 ([pp. rjy031-rjy031])
        • Dhir T.
        • Schiowitz R.
        Old man gallbladder syndrome: gangrenous cholecystitis in the unsuspected patient population.
        Int J Surg Case Rep. 2015; 11: 46-49
        • Parker L.J.
        • Vukov L.F.
        • Wollan P.C.
        Emergency department evaluation of geriatric patients with acute cholecystitis.
        Acad Emerg Med. 1997; 4: 51-55
        • Akın Önder M.K.
        • Ülger Burak Veli
        • Oğuz Abdullah
        • Türkoğlu Ahmet
        • Uslukaya Ömer
        Gangrenous cholecystitis: mortality and risk factors.
        Int Surg. 2015; 100: 254-260
        • Fagan S.P.
        • et al.
        Prognostic factors for the development of gangrenous cholecystitis.
        Am J Surg. 2003; 186: 481-485
        • Halldestam I.
        • et al.
        Development of symptoms and complications in individuals with asymptomatic gallstones.
        Br J Surg. 2004; 91: 734-738
        • Eldar S.
        • et al.
        The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis.
        Am J Surg. 1999; 178: 303-307
        • Hunt D.R.H.
        • Chu F.C.K.
        Gangrenous cholecystitis in the laparoscopic era.
        Aust N Z J Surg. 2000; 70: 428-430
        • Chang F.-Y.
        • Lu C.-L.
        Hiccup: mystery, nature and treatment.
        Journal of Neurogastroenterology and Motility. 2012; 18: 123-130
        • Becker D.E.
        Nausea, vomiting, and hiccups: a review of mechanisms and treatment.
        Anesth Prog. 2010; 57: 150-157
        • Howard R.S.
        Persistent hiccups.
        BMJ. 1992; 305: 1237-1238
        • Kumar A.
        Gag reflex for arrest of hiccups.
        Med Hypotheses. 2005; 65: 1206
        • Contini S.
        • et al.
        Can gangrenous cholecystitis be prevented?: a plea against a “wait and see” attitude.
        J Clin Gastroenterol. 2004; 38: 710-716
        • Schafer M.
        • Krahenbuhl L.
        • Buchler M.W.
        Predictive factors for the type of surgery in acute cholecystitis.
        Am J Surg. 2001; 182: 291-297
        • Bennett G.L.
        • et al.
        CT findings in acute gangrenous cholecystitis.
        AJR Am J Roentgenol. 2002; 178: 275-281
        • Stefanidis D.
        • et al.
        Gangrenous cholecystitis in the decade before and after the introduction of laparoscopic cholecystectomy.
        JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2005; 9: 169-173
        • Stefanidis D.
        • Sirinek K.R.
        • Bingener J.
        Gallbladder perforation: risk factors and outcome.
        J Surg Res. 2006; 131: 204-208
        • Clérigo V.
        • Rocha C.
        • Rodrigues A.
        • Fernandes L.
        • Sargento D.
        • Silva G.
        Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman.
        Case Rep Clin Med. 2014; 3: 503-507
        • Carmenate A.M.U.
        • Muana O.
        • Karakalpakis I.
        • Carmenate E.J.
        • Paik W.
        • Vela A.
        • Dave D.
        • Jaralla I.
        Hiccups can be serious: Gangrenous cholecystitis. Case report.
        J Am Geriatr Soc. 2011; 59 (SUPPL. 1)
        • Crossley E.D.T.
        No stones about it, atypical disease presentation delays diagnosis: A case of missed cholecystitis leading to perforation in an elderly patient.
        J Am Geriatr Soc. 2018; 2018 (Supplement 2): S25-S26