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Neitzel E, Laskus J, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med 2024:8850666241259421. [PMID: 38839258 DOI: 10.1177/08850666241259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Julia Laskus
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Radiology and Department of Student Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Khan U, Aarebrot A, Mo S, Landa S, Rösler C, Sodha OK, Bjørneklett R, Dizdar V. Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain: A Case Report from the Emergency Department. J Emerg Med 2024; 66:e365-e368. [PMID: 38423863 DOI: 10.1016/j.jemermed.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/27/2023] [Accepted: 10/01/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. CASE REPORT This case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously.
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Affiliation(s)
- Umael Khan
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Anders Aarebrot
- Deparment of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Solveig Mo
- Department of Surgery, Haraldsplass Hospital, Bergen, Norway
| | - Signe Landa
- Department of Radiology, Haukeland University Hospital, Bergen
| | - Cornelia Rösler
- Department of Radiology, Haukeland University Hospital, Bergen
| | - Ole Kamal Sodha
- Department of Emergency Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rune Bjørneklett
- Department of Emergency Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vernesa Dizdar
- Department of Emergency Medicine, Haukeland University Hospital, Bergen, Norway
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Manglik S, Pal C, Basu U, Kapoor L, Narayan P, Dubey SK. Feasibility and Safety of Concomitant Laparoscopic Cholecystectomy With Open-Heart Surgery: A Systematic Review and Our Early Clinical Experience. Cureus 2024; 16:e52844. [PMID: 38406031 PMCID: PMC10884984 DOI: 10.7759/cureus.52844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Significant valvular or coronary artery disease may co-exist in patients presenting with symptomatic cholelithiasis. Isolated laparoscopic cholecystectomy in these cases is often associated with cardiac complications. Addressing the cardiac condition first may result in flaring up of cholecystitis during postoperative recovery and is associated with adverse outcomes. Open-heart surgery followed by laparoscopic cholecystectomy during a single operative setting is an option in these situations. The aim of our study is to review the published articles for this strategy and to share our initial experience with two such patients. PubMed, OVID Medline, and Cochrane library database were used, and we searched these databases using Medical Subject Headings (MeSH) terms and keywords from the inception date until August 1, 2023, and did not restrict our search to any language, study type, sample size, or publication date. All the publications reporting concomitant laparoscopic cholecystectomy and open-heart surgery were identified and a systematic review was carried out. Our first case underwent coronary artery bypass grafting and laparoscopic cholecystectomy. The second patient underwent a double valve replacement and laparoscopic cholecystectomy. Both the patients made an uneventful recovery, and are alive and doing well. Concomitant open-heart surgery and laparoscopic cholecystectomy in certain situations may be necessary and can be performed safely.
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Affiliation(s)
- Shresth Manglik
- Department of General Surgery and Minimally Invasive Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
| | - Camelia Pal
- Department of General Surgery and Minimally Invasive Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
| | - Urmila Basu
- Department of General Surgery and Minimally Invasive Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
| | - Lalit Kapoor
- Department of Cardiothoracic and Vascular Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
| | - Pradeep Narayan
- Department of Cardiothoracic and Vascular Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
| | - Sanjay K Dubey
- Department of General Surgery and Minimally Invasive Surgery, Narayana Hospital - Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, IND
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Kim SH, Lim MG, Han JS, Ahn CH, Jung TD. Rare or Overlooked Cases of Acute Acalculous Cholecystitis in Young Patients with Central Nervous System Lesion. Healthcare (Basel) 2023; 11:healthcare11101378. [PMID: 37239669 DOI: 10.3390/healthcare11101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
This case series presents two cases of acute acalculous cholecystitis (AAC)-a rare condition-in young women with central nervous system (CNS) lesions. Both patients had significant neurologic deficits and no well-known risk factors or presence of comorbidities (such as diabetes or a history of cardiovascular or cerebrovascular disease). Early diagnosis is important in cases of AAC owing to its high mortality rate; however, due to neurological deficits in our cases, accurate medical and physical examinations were limited, thereby leading to a delay in the diagnosis. The first case was of a 33-year-old woman with multiple fractures and hypovolemic shock due to a traumatic accident; she was diagnosed with hypoxic brain injury. The second case was of a 32-year-old woman with bipolar disorder and early-onset cerebellar ataxia who developed symptoms of impaired cognition and psychosis; she was later diagnosed with autoimmune encephalopathy. In the first case, the duration between symptom onset and diagnosis was 1 day, but in the second case, it was 4 days from diagnosis based on the occurrence of high fever. We emphasize that if a young woman presents with high fever, the possibility of AAC should be considered, particularly if a CNS lesion is present because it may pose difficulty in the evaluation of typical symptoms of AAC. Careful attention is thus required in such cases.
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Affiliation(s)
- Seong-Hun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Min-Gyu Lim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Jun-Sang Han
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
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Öcal S, Eren Durmuş M, Yalçın İŞ, Alparslan AŞ, Çekin AH, Durmuş E. ACUTE ACALCULOUS CHOLECYSTITIS TRIGGERED BY AN ACUTE FLARE-UP IN VIRAL HEPATITIS B INFECTION: A CASE REPORT. Gastroenterol Nurs 2023; 46:67-70. [PMID: 36706144 DOI: 10.1097/sga.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Serkan Öcal
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Merve Eren Durmuş
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - İbrahim Şenel Yalçın
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Ahmet Şükrü Alparslan
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Ayhan Hilmi Çekin
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Emin Durmuş
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
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Dargham TB, Moumneh MB, Atallah C, Zaghal A. A scoping review on acute gastrointestinal surgical complications in immunocompromised pediatric patients. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management.
Main body
This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions.
Conclusion
Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.
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Acute acalculous cholecystitis in hospitalized patients in intensive care unit: study of 5 cases. Heliyon 2022; 8:e11524. [DOI: 10.1016/j.heliyon.2022.e11524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/10/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
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Muacevic A, Adler JR, Combs E. Rare But Fatal: Hemophagocytic Lymphohistiocytosis (HLH) With Acute Acalculous Cholecystitis. Cureus 2022; 14:e31737. [PMID: 36569679 PMCID: PMC9769779 DOI: 10.7759/cureus.31737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Acalculous cholecystitis is an acute inflammatory disease of the gall bladder with high morbidity and mortality rate. It can be seen in trauma, burns, sepsis, total parenteral nutrition, prolonged fasting, and autoimmune diseases. However, there are very few reports of acalculous cholecystitis with macrophage activation syndrome (MAS) and hemophagocytic lymphohistiocytosis (HLH) in patients with underlying rheumatic/autoimmune disorders. Here we report a 23-year-old male with a past medical history of granulomatosis with polyangiitis who presented with fever, weight loss, and pancytopenia. A comprehensive infectious evaluation was done including bacterial cultures and viral and fungal serologies. Repeat abdominal imaging obtained later due to developing abdominal pain raised concerns for acute acalculous cholecystitis. Despite aggressive management of sepsis, the patient continued to decline clinically. HLH was suspected when the patient was found to meet the clinical criteria with fever, splenomegaly, cytopenia, hypertriglyceridemia, elevated liver function tests, hypofibrinogenemia, and ferritin of 22K ng/mL, absent NK cell activity, and elevated soluble CD25 receptor levels. Bone marrow biopsy did not reveal hemophagocytosis. Intravenous methylprednisolone was started and the patient showed remarkable clinical improvement with a decrease in all inflammatory markers and did not require any surgical intervention. On the review of the literature, we were able to identify four female patients with underlying adult-onset Still's disease and Kikuchi disease who presented with HLH along with acalculous cholecystitis likely triggered by flare. Our male patient presented with HLH and acute acalculous cholecystitis. He had a history of granulomatosis polyangiitis (GPA) that remained in remission. Hypersecretion of pro-inflammatory cytokines and cytotoxic cells in HLH promotes ischemia of the gall bladder wall. Early initiation of immunosuppressive therapy under careful observation can prevent surgical intervention and mortality in these patients.
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Suleman M, Sadiq A, Amsi P, Lodhia J. Gallbladder perforation: An uncommon cause of peritonitis in a child. Int J Surg Case Rep 2022; 100:107765. [PMID: 36302315 PMCID: PMC9614562 DOI: 10.1016/j.ijscr.2022.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance Gallbladder perforations are infrequently encountered in the pediatric group but can be a cause of peritonitis with significant morbidity and mortality if not diagnosed and managed promptly. Case presentation We present a case of a 10-year-old female who presented with peritonitis due to a perforated gallbladder diagnosed by CT-scan. She was managed surgically successfully. Clinical discussion Gallbladder perforation due to cholecystitis is usually seen in the elderly population but is uncommon among the pediatric population. Mortality rate can be as high as 26 % hence early diagnosis is vital. Management is mostly surgical as seen in the index case. Conclusion Clinicians should keep gallbladder perforation in mind as a differential diagnosis of acute abdomen in children although uncommon. Gallbladder perforation is uncommon to the pediatric population. If encountered in children, causes significant morbidity and mortality Clinicians should keep it as a differential diagnosis of peritonitis with a high index of suspicion. Prompt management through surgery yields favourable outcome.
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Affiliation(s)
- Mujaheed Suleman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Radiology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Patrick Amsi
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Pathology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania.
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Saragò M, Fiore D, De Rosa S, Amaddeo A, Pulitanò L, Bozzarello C, Iannello AM, Sammarco G, Indolfi C, Rizzuto A. Acute acalculous cholecystitis and cardiovascular disease, which came first? After two hundred years still the classic chicken and eggs debate: A review of literature. Ann Med Surg (Lond) 2022; 78:103668. [PMID: 35734727 PMCID: PMC9206910 DOI: 10.1016/j.amsu.2022.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
The existence of a close association between disease of the biliary tract and disease of the heart is known from the mists of time. Acute acalculous cholecystitis (AAC) can be defined as an acute necro inflammatory disease of the gallbladder in the absence of cholelithiasis. AAC is a challenging diagnosis. The atypical clinical onset associated to a paucity and similarity of symptoms and to laboratory data mimicking cardiovascular disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC has commonly a fulminant course compared to calculous cholecystitis and it is often associated with gangrene, perforation and empyema as well as considerable morbidity and mortality (up 50%). Early diagnosis is crucial to a prompt treatment in order to avoid complications and to increase survivability. Even today, although scientific evidence dating two hundred years has shown a close association between AAC and CVD, due to the lack of RCT, there is still a lot of confusion regarding the relationship and consequently the clinical management AAC and CVD. In addition, emergency physicians are not always familiar with transient ECG changes with AAC. The aim of this review was to provide evidence regarding epidemiology, pathophysiology, clinical presentation and treatment of the complex association between AAC and CVD. Our main findings indicate that AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA (Acute myocardial infarction) could be related to a misdiagnosed AAC. US – Ultrasonography-plays a key role in the early diagnosis and also in the follow up of AAC. Cholecystostomy and cholecystectomy as unique or sequential represent the two prevailing treatment options for AAC. AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA could be related to a misdiagnosed AAC. Cholecystectomy is an only definitive treatment for AAC. The first report on this theme after 20 years.
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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:1886-1895. [DOI: 10.1007/s00268-022-06566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Park YS, Yoon H, Kang SY, Jo IJ, Woo S, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG. Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis. Diagnostics (Basel) 2022; 12:diagnostics12030721. [PMID: 35328274 PMCID: PMC8946906 DOI: 10.3390/diagnostics12030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the diagnostic value of gallbladder width measurement with computed tomography (CT) in patients with acute cholecystitis. This retrospective case−control study was conducted between March 2016 and March 2020 at a tertiary emergency department. Of 310 patients, 254 patients with acute cholecystitis confirmed by surgery were compared with 254 patients diagnosed with other diseases (controls). In the acute cholecystitis group, the number of older patients with underlying illnesses was much higher (64% of men). Upon CT, the median (interquartile range [IQR]) gallbladder width was significantly longer in patients with acute cholecystitis (2.26 [1.82−2.78] cm vs. 3.73 [3.32−4.16] cm, p < 0.001). The optimal cut-off value of gallbladder width for differentiating acute cholecystitis was 3.12 cm, showing a sensitivity of 88% and specificity of 86%. In a multivariable analysis using a logistic regression model for diagnosing acute cholecystitis with CT findings (gallbladder width, length, stone, wall thickening, and pericholecystic fluid), a gallbladder width of ≥3.12 cm was significantly meaningful, even when adjusting for other variables (odds ratio 37.9; p < 0.001). Therefore, an increase in gallbladder width (≥3.12 cm) measured with CT can be a simple and sensitive diagnostic sign of acute cholecystitis, supporting the underlying pathophysiology of bile outflow obstruction.
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Affiliation(s)
- Yong Suk Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
- Correspondence:
| | - Soo Yeon Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sookyoung Woo
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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15
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Takeda E, Shikino K. Eosinophilic granulomatosis polyangiitis associated with acute acalculous cholecystitis. BMJ Case Rep 2021; 14:14/7/e243536. [PMID: 34253525 DOI: 10.1136/bcr-2021-243536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Eriko Takeda
- Generai Medicine, Chiba University Hospital, Chiba, Japan.,General Medicine, Sanmu Medical Center, Sanmu, Chiba, Japan
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16
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BONINSEGNA SARA, STORATO SILVIA, RICCARDI NICCOLÒ, SOPRANA MARCO, OLIBONI EUGENIO, TAMAROZZI FRANCESCA, BOCUS PAOLO, MARTINI MARIANO, FLOREANI ANNAROSA. Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult patient: a case report and a literature review of a neglected clinical presentation. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E237-E242. [PMID: 34322642 PMCID: PMC8283645 DOI: 10.15167/2421-4248/jpmh2021.62.1.1859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022]
Abstract
Primary Epstein-Barr virus (EBV) infection may present with self-limiting abdominal involvement, characterized by hepatitis with mild elevation of aminotransferases, splenomegaly, and rarely with acute acalculous cholecystitis (AAC). Usually, treatment of EBV related AAC is symptomatic, without the need for surgery. Here, we describe a severe case of AAC occurring as the first manifestation of infectious mononucleosis in a young adult woman, receiving treatment with interleukin 6 receptor (IL-6r) inhibitor for rheumatoid arthritis (RA); moreover, we have performed a review of the literature on EBV-related AAC.
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Affiliation(s)
- SARA BONINSEGNA
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - SILVIA STORATO
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - NICCOLÒ RICCARDI
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Correspondence: Niccolò Riccardi, Infectious and Tropical Medicine Specialist, IRCCS Sacro Cuore Don Calabria Hospital - E-mail:
| | - MARCO SOPRANA
- Division of General Medicine, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - EUGENIO OLIBONI
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - FRANCESCA TAMAROZZI
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - PAOLO BOCUS
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - MARIANO MARTINI
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - ANNAROSA FLOREANI
- University of Padova, Italy - IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Glucagon-Like Peptide 2 Inhibits Postprandial Gallbladder Emptying in Man: A Randomized, Double-Blinded, Crossover Study. Clin Transl Gastroenterol 2021; 11:e00257. [PMID: 33512799 PMCID: PMC7710225 DOI: 10.14309/ctg.0000000000000257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION: A recent study in mice points to the gut-derived hormone glucagon-like peptide 2 (GLP-2) as an important regulator of gallbladder motility inducing gallbladder relaxation and refilling. In this study, we evaluated the effect of exogenous GLP-2 on postprandial gallbladder motility in healthy men. METHODS: In a randomized, double-blinded, placebo-controlled, crossover study, we evaluated the effect of 4-hour intravenous infusions of high-dose GLP-2 (10 pmol × kg−1 × min−1), low-dose GLP-2 (1 pmol × kg−1 × min−1), and placebo (saline) on postprandial gallbladder motility. A 300-kcal liquid-mixed meal (added 1.5 g of acetaminophen for indirect measurement of gastric emptying) was served 30 minutes after start of intravenous infusions. Gallbladder volume was assessed by ultrasonography. RESULTS: Fifteen healthy men, age 24.3 (22.4–26.1) years (mean [95% confidence interval]) and body mass index 22.5 (21.7–23.4) kg × m−2, were included. Basal plasma GLP-2 concentration was 14 (11–17) pmol/L. During low-dose and high-dose GLP-2 infusions, steady-state postprandial plasma GLP-2 concentrations amounted to 201 (188–214) and 2,658 (2,443–2,873) pmol/L, respectively, compared with maximum postprandial plasma GLP-2 concentration of 34 (25–44) pmol/L during placebo. Gallbladder emptying (assessed as baseline-subtracted area under the curve for gallbladder volume) was reduced by low-dose GLP-2 (−0.8 [0.7–1.9] L × min, P < 0.0001) and nearly abolished by high-dose GLP-2 (1.3 [−1.7 to 0.01] L × min, P = 0.029) compared to placebo (−2.0 [−2.8 to −1.1] L × min). Compared to placebo, gastric emptying was reduced by high-dose GLP-2 (P = 0.0060 and 0.019), whereas low-dose GLP-2 did not affect gastric emptying (P = 0.13 and 0.85). DISCUSSION: Exogenous GLP-2 exerts a dose-dependent inhibitory effect on postprandial gallbladder emptying in healthy men.
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18
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Requarth J. All the World Is a Nail: Why Are Surgeons Resistant to Learn How to Place Cholecystostomy Drains in Seriously Ill Patients With Acute Acalculous Cholecystitis? Am Surg 2020; 86:1462-1466. [PMID: 33213199 DOI: 10.1177/0003134820965954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgeons routinely provide palliative care, but often the technical procedure needed for the palliative intervention is beyond our training and comfort zone. This case is an example of surgical palliative care that utilizes image-guided techniques to provide optimal care. A frail elderly patient with multiple comorbidities who had been hospitalized for other diseases was diagnosed with acute acalculous cholecystitis. General surgery and gastroenterology were initially consulted, and the patient was referred to interventional radiology for a percutaneous cholecystostomy. The procedure was technically successful, and the patient's clinical status improved. A few days later, a follow-up cholecystogram showed a decompressed gallbladder, patent cystic duct, a common bile duct free of stones, and dilute contrast in the duodenum. After 2 weeks, the fistula tract was interrogated and found to be intact. The cholecystostomy tube was removed without incident. This case is presented as a call to action for surgeons to learn the skills required to place percutaneous cholecystostomies themselves and to add it to their surgical armamentarium.
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19
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Walsh K, Goutos I, Dheansa B. Acute Acalculous Cholecystitis in Burns: A Review. J Burn Care Res 2020; 39:724-728. [PMID: 29931066 DOI: 10.1093/jbcr/irx055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute acalculous cholecystitis (AAC) is an acute inflammatory disorder of the gallbladder, which can complicate the recovery of burn patients. No formal literature review has been performed about this uncommon but potentially fatal complication in burn care. A Pubmed search from 1950 to 2015 was performed using MESH terms: "acalculous cholecystitis," "burns or thermal injuries or thermal damage," and "cholecystitis or gallbladder inflammation." The articles were analyzed and data collected individually on the incidence, presenting symptoms or signs, risk factors, investigations, and treatment modalities used. An International Burns Injury Database (IBID) search was additionally performed to identify the incidence of AAC in burn patients between 2005 and 2015 in the United Kingdom. Nineteen articles were identified which described 90 cases of AAC and thermal injuries. The incidence of AAC in burns ranges between 0.4 and 3.5%, typically affecting males (82.4%) with a mean age of 35 (range 13-89), and 97.8% of burns were >30% total body surface area (range: 22-80%). The majority of patients had established known risk factors for acquiring AAC, including blood transfusion (56.6% of patients), sepsis (52.2%), mechanical ventilation (45.5%), prolonged fasting or total parenteral nutrition administration (44.4%), and use of narcotic medication (10%). The IBID search identified one case of AAC among 145,227 burn injuries during 2005 to 2015 in the United Kingdom. AAC is a rare life-threatening condition that is associated with large thermal burns. Improvements in burns critical care have probably improved the management of known risk factors and reduced the incidence of this condition over recent decades.
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Affiliation(s)
- Karl Walsh
- Plastic Surgery Registrar, Royal Preston Hospital, Preston, Lancashire, UK
| | - Ioannis Goutos
- Consultant Burns and Plastic Surgeon, Blizard Institue, Queen Mary University, Whitechapel, London
| | - Baljit Dheansa
- Consultant Burns and Plastic Surgeon, East Grinstead, UK
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20
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Abstract
Although cholecystectomy is generally recommended for acute acalculous cholecystitis (AAC) treatment, non-surgical management can be considered in patients at a high risk for surgery. This study compared outcomes of surgical and non-surgical management and analyzed the long-term outcomes of AAC patients managed non-surgically.We retrospectively analyzed 89 patients diagnosed with AAC between January 1, 2007 and April 30, 2014. These patients were divided into 2 groups: non-surgical (n = 41) and surgical (n = 48). Non-surgical management methods were percutaneous cholecystostomy (PC, n = 14) and antibiotics only (n = 27). The non-surgical group was followed up for >3 years after treatment.The mean age was slightly higher in the non-surgical group than in the surgical group without significant difference. The prevalence of cerebrovascular accident in the non-surgical group was significantly higher than that in the surgical group (26.8% vs 8.3%, P = .020). Mean hospital stay was not statistically different between two groups. The surgical group had a significantly higher incidence of posttreatment complications than the non-surgical group (18.8% vs 2.4%, P = .015). During the mean follow-up of 5.7 years, AAC recurred in 4 (9.8%) patients in the non-surgical group. Three patients underwent cholecystectomy, 1 was treated with antibiotics, and no recurrence-related death occurred. The recurrence rate of AAC was not different between PC and antibiotics only groups (14.3% vs 7.4%, P = .596).Recurrence was observed in 9.8% of AAC patients treated non-surgically and the outcome in the non-surgical group was not inferior to that in the surgical group.
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21
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Bachta KER, Allen JP, Cheung BH, Chiu CH, Hauser AR. Systemic infection facilitates transmission of Pseudomonas aeruginosa in mice. Nat Commun 2020; 11:543. [PMID: 31992714 PMCID: PMC6987207 DOI: 10.1038/s41467-020-14363-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
Health care-associated infections such as Pseudomonas aeruginosa bacteremia pose a major clinical risk for hospitalized patients. However, these systemic infections are presumed to be a "dead-end" for P. aeruginosa and to have no impact on transmission. Here, we use a mouse infection model to show that P. aeruginosa can spread from the bloodstream to the gallbladder, where it replicates to extremely high numbers. Bacteria in the gallbladder can then seed the intestines and feces, leading to transmission to uninfected cage-mate mice. Our work shows that the gallbladder is crucial for spread of P. aeruginosa from the bloodstream to the feces during bacteremia, a process that promotes transmission in this experimental system. Further research is needed to test to what extent these findings are relevant to infections in patients.
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Affiliation(s)
- Kelly E R Bachta
- Department of Microbiology-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Jonathan P Allen
- Department of Microbiology-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Bettina H Cheung
- Department of Microbiology-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alan R Hauser
- Department of Microbiology-Immunology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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22
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Teopoulos Lamprianidis K, Easom N, Patch E, Thomas S. Acute Epstein-Barr infection presenting as cholecystitis with ascites. BMJ Case Rep 2020; 13:13/1/e232562. [PMID: 31919065 DOI: 10.1136/bcr-2019-232562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A young female patient presented with features of ascites and cholecystitis. She was subsequently diagnosed with an acute Epstein-Barr virus infection. This is a rare presentation of a common infection. The patient was managed conservatively and the illness resolved within 6 weeks.
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Affiliation(s)
| | - Nicholas Easom
- Infectious Diseases, Whipps Cross University Hospital NHS Trust, London, UK
| | - Emma Patch
- Acute Medicine, Whipps Cross University Hospital NHS Trust, London, UK
| | - Sherine Thomas
- Infectious Diseases, Whipps Cross University Hospital NHS Trust, London, UK
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23
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Mazur-Melewska K, Derwich A, Mania A, Kemnitz P, Służewski W, Figlerowicz M. Epstein-Barr virus infection with acute acalculous cholecystitis in previously healthy children. Int J Clin Pract 2019; 73:1-6. [PMID: 31243873 DOI: 10.1111/ijcp.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 06/02/2019] [Accepted: 06/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein-Barr virus (EBV) infection, but it is an atypical clinical presentation. AIM The aim of our study was to analyse AAC occurrence in children with primary symptomatic EBV infection who had been admitted to the hospital. METHODS We retrospectively evaluated the medical documentation of 181 children with EBV infection who were diagnosed based on the presence of viral capsid antigen IgM antibodies. All EBV-positive patients underwent transabdominal ultrasonography of the liver in the supine and right anterior oblique positions. Fifteen children who presented with AAC symptoms, including abdominal pain and a positive Murphy's sign, were analysed as a subsample and re-evaluated after 2-3 months. RESULTS The incidence of AAC in children hospitalised with infectious mononucleosis (IM) was estimated at 8.3%. Analysis of the laboratory results confirmed that the C-reactive protein (CRP) concentration was the only parameter which was higher in children who presented with AAC symptoms. The mean number of leucocytes and monocytes and liver enzyme activities were not significantly higher. The radiological findings of AAC were evident: increased GB wall thickness, non-shadowing echogenic sludge and pericholecystic fluid collection. CONCLUSION AAC during primary EBV infection appears to be a more common pathology than previously suspected. Its relatively mild nature and the lack of laboratory abnormalities mean that ultrasonographic examination is required for diagnosis. This might explain why the prevalence in children is underestimated.
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Affiliation(s)
- Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Aleksandra Derwich
- Student Research Circle at the Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Paweł Kemnitz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Wojciech Służewski
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
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A Rare Case of Systemic Adult Burkitt Lymphoma Presenting as Acute Acalculous Cholecystitis. ACG Case Rep J 2019; 6:e00048. [PMID: 31616732 PMCID: PMC6658046 DOI: 10.14309/crj.0000000000000048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is an uncommon presentation of cholecystitis accounting for 10% of cases. AAC is caused by a localized ischemic event in the gallbladder usually in critically ill patients. Several cases of localized or systemic lymphoma have been described in the literature as causes of AAC. We present a patient with a rare case of AAC due to undiagnosed systemic Burkitt lymphoma. Pathology of the gallbladder revealed Burkitt lymphoma with analysis of his cerebral spinal fluid confirming Stage IV disease. This case report reviews acute acalculous cholecystitis, lymphomas of the gallbladder and extrahepatic duct, and adult Burkitt lymphoma.
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25
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Infectious mononucleosis - not always a benign condition: a case report of infectious mononucleosis-associated acute acalculous cholecystitis. CAN J EMERG MED 2018; 21:154-156. [PMID: 29490709 DOI: 10.1017/cem.2018.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Infectious mononucleosis is typically a self-limited viral infection of adolescence and early adulthood that resolves in a period of weeks, causing no major sequelae. We describe a case of a healthy 18-year-old female diagnosed with infectious mononucleosis who also presented with right upper quadrant abdominal pain, moderate transaminitis, and cholestatic biochemistry. An ultrasound revealed acute acalculous cholecystitis, generally a condition seen in the context of critical illness. Further investigating emergency department patients with infectious mononucleosis is often not indicated, but may be important for those who present atypically.
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26
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Noh SY, Gwon DI, Ko GY, Yoon HK, Sung KB. Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients. Eur Radiol 2017; 28:1449-1455. [PMID: 29116391 DOI: 10.1007/s00330-017-5112-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC). METHODS The study population comprised 271 patients (mean age, 72 years; range, 22-97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated. RESULTS Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4-365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively. CONCLUSIONS The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients. KEY POINTS • Many patients with AAC are too ill to undergo cholecystectomy. • PC in AAC patients shows low complication and recurrence rate. • PC solely can be a definitive treatment option in the majority of AAC patients.
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Affiliation(s)
- Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic Ro, 43-Gil, Songpa-gu, Seoul, 05505, Korea
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Davies P, Aoyagi Y. Leptospirosis presenting as acute acalculous cholecystitis. Clin Case Rep 2017; 5:1775-1779. [PMID: 29152269 PMCID: PMC5676275 DOI: 10.1002/ccr3.1173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022] Open
Abstract
Leptospirosis is the commonest zoonotic infection worldwide but is vastly underreported and extremely heterogeneous in its presentation. Acalculous cholecystitis is an under recognized presentation of acute leptospirosis. In the appropriate clinical context, with a clear exposure history, recognition of this association presents a unifying diagnosis and limits unnecessary surgical interventions.
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Affiliation(s)
- Peter Davies
- Medical Department Whangarei Base Hospital Whangarei New Zealand
| | - Yuki Aoyagi
- Medical Department Whangarei Base Hospital Whangarei New Zealand
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Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults-Case Report and Review of the Literature. Case Rep Infect Dis 2017; 2017:5790102. [PMID: 28194287 PMCID: PMC5282411 DOI: 10.1155/2017/5790102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/29/2016] [Indexed: 12/15/2022] Open
Abstract
Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.
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Hashimoto M, Koide K, Arita M, Kawaguchi K, Tokunaga M, Mikuriya Y, Iwamoto T. Acute acalculous cholecystitis due to breast cancer metastasis to the cystic duct. Surg Case Rep 2016; 2:111. [PMID: 27730536 PMCID: PMC5059227 DOI: 10.1186/s40792-016-0239-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/05/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is a relatively rare disorder of the gallbladder. Breast cancer recurrence more than 10 years after curative surgery is also infrequent. CASE PRESENTATION Here, we report a case of a 59-year-old woman who presented with right flank pain. Her medical history included a lumpectomy for cancer of the left breast 12 years prior. Laboratory tests showed a severe inflammatory reaction and mild liver function abnormalities. Ultrasonography and computed tomography revealed an enlarged gallbladder and inflammation of the surrounding tissues; however, no gallstone was present. She was diagnosed with AAC. We performed an emergency laparoscopic cholecystectomy, and histopathological examination revealed a poorly differentiated adenocarcinoma in the cystic duct. Both metastatic and primary tumor cells were positive for estrogen and progesterone receptors on immunohistochemistry. The final pathological diagnosis was acute cholecystitis due to breast cancer metastasis to the cystic duct. CONCLUSION Although AAC secondary to metastatic breast cancer is rare, it should be included in the differential diagnosis for abdominal pain in patients with a previous history of breast cancer.
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Affiliation(s)
- Masakazu Hashimoto
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
| | - Kei Koide
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Michinori Arita
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Koji Kawaguchi
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Masakazu Tokunaga
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Yoshihiro Mikuriya
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Toshiyuki Iwamoto
- Department of Pathology, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
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Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case. Case Rep Pediatr 2016; 2016:9130673. [PMID: 27200203 PMCID: PMC4855020 DOI: 10.1155/2016/9130673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022] Open
Abstract
A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.
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Hill PA, Harris RD. Clinical Importance and Natural History of Biliary Sludge in Outpatients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:605-610. [PMID: 26903661 DOI: 10.7863/ultra.15.05026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Gallbladder sludge is a common diagnosis on routine abdominal sonography, yet its clinical importance is uncertain, especially in outpatients. To determine its natural history and potential future complications in this setting, we reviewed the imaging and clinical histories of nonhospitalized patients with a diagnosis of sludge on sonography. METHODS We conducted a retrospective search of our institutional radiology information system for all sonographic reports using the key words "biliary sludge without gallstones" over a 3-year period. For each of the 104 patients with isolated biliary sludge on initial sonography, we reviewed the electronic medical records and all imaging for the development of pancreaticobiliary complications. RESULTS We found an overall prevalence of biliary sludge in outpatients of 1.8%. Of the 104 patients reviewed with a mean follow up of 630 days (21 months), 25 developed a pancreaticobiliary complication, including cholelithiasis, cholecystitis, choledocholithiasis, and pancreatitis. The most frequent complication was cholecystitis, with a total of 14 diagnoses (12 chronic acalculous and 2 acute with gallstones). An additional 6 patients developed gallstones without cholecystitis features; 4 patients developed pancreatitis; and 1 developed choledocholithiasis. Biliary sludge remained quiescent or resolved in 76% of patients. CONCLUSIONS Biliary sludge always represents a pathologic process, but its clinical implications among outpatients have not been previously investigated. Our ambulatory population developed pancreaticobiliary complications at similar rates as prior mixed-patient setting studies. Regardless of the patient setting, biliary sludge is likely of more clinical importance than previously regarded.
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Affiliation(s)
- Paul Armstrong Hill
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA.
| | - Robert D Harris
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA
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Abstract
Acute acalculous cholecystitis (AAC) is a severe disease seen in critically ill patients, including those with autoimmune diseases. We herein report the case of a 41-year-old female who developed macrophage activation syndrome (MAS) accompanied by a recurrence of Kikuchi disease. Abdominal imaging revealed marked thickening of the gallbladder wall and pericholecystic fluid, typically found in AAC. Treatment with intravenous pulse methylprednisolone induced in a significant improvement in the gallbladder wall, resulting in no need for surgical intervention. We should consider that patients with MAS may therefore sometimes develop AAC and that early immunosuppressive therapy can be effective in AAC cases associated with rheumatic or autoimmune diseases.
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Affiliation(s)
- Yukimi Otsuka
- Division of Rheumatology, Fukuoka Red Cross Hospital, Japan
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Branco L, Vieira M, Couto C, Coelho MD, Laranjeira C. Acute Acalculous Cholecystitis by Epstein-Barr Virus Infection: A Rare Association. Infect Dis Rep 2015; 7:6184. [PMID: 26753086 PMCID: PMC4693334 DOI: 10.4081/idr.2015.6184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/18/2015] [Accepted: 10/20/2015] [Indexed: 12/17/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare complication of Epstein Barr virus (EBV) infection, with only a few cases reported among pediatric population. This clinical condition is frequently associated with a favorable outcome and, usually, a surgical intervention is not required. We report a 16-year-old girl who presented with AAC following primary EBV infection. The diagnosis of AAC was documented by clinical and ultrasonographic examination, whereas EBV infection was confirmed serologically. A conservative treatment was performed, with a careful monitoring and serial ultrasonographic examinations, which led to the clinical improvement of the patient. Pediatricians should be aware of the possible association between EBV and AAC, in order to offer the patients an appropriate management strategy.
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Affiliation(s)
- Liliana Branco
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Maria Vieira
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Cristiana Couto
- Department of Pediatrics, Portuguese Oncology Institute , Porto, Portugal
| | - Maria D Coelho
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Carla Laranjeira
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
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Kim JB, Mun YS, Kwon OS, Lee MK, Park JS, Jang JH. Acute Acalculous Cholecystitis in Severe Trauma Patients: A Single Center Experience. JOURNAL OF ACUTE CARE SURGERY 2015. [DOI: 10.17479/jacs.2015.5.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jong Beom Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Yun Su Mun
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Oh Sang Kwon
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
- Trauma Center, Eulji University Hospital, Daejeon, Korea
| | - Joo Seung Park
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Je Ho Jang
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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35
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Tana M, Tana C, Cocco G, Iannetti G, Romano M, Schiavone C. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion. J Ultrasound 2015; 18:317-20. [PMID: 26550069 DOI: 10.1007/s40477-015-0176-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/22/2015] [Indexed: 12/20/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.
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Affiliation(s)
- Marco Tana
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy ; Internal Medicine Unit, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Claudio Tana
- Internal Medicine Unit, Guastalla Hospital, Ausl Reggio Emilia, Italy
| | - Giulio Cocco
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Iannetti
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | | | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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Yi DY, Kim JY, Yang HR. Ultrasonographic Gallbladder Abnormality of Primary Epstein-Barr Virus Infection in Children and Its Influence on Clinical Outcome. Medicine (Baltimore) 2015; 94:e1120. [PMID: 26166109 PMCID: PMC4504559 DOI: 10.1097/md.0000000000001120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The incidence of pediatric acute inflammatory gallbladder (GB) disease without gallstone such as acute acalculous cholecystitis has increased with the development of improved diagnostic modalities. Although Epstein-Barr virus (EBV) infection is common in general population, only few cases of GB diseases caused by EBV infection have been reported. This study analyzed ultrasonographic characteristics of primary EBV infection in children and evaluated the influence of EBV-associated GB disease on clinical course and outcome of EBV infection.Between March 2004 and January 2013, 94 of 287 pediatric patients with EBV infection underwent abdominal ultrasonography (USG); clinical features, laboratory data, and USG findings were collected and analyzed retrospectively.Of 94 children, ultrasonographic thick GB wall was observed in 24 (25.3%). Platelet counts were lower in the thickened GB wall group than in the normal GB wall thickness group (P = 0.004). Direct bilirubin, alanine aminotransferase, and γ-glutamyl transferase levels were higher in the thickened GB wall group (P = 0.000, P = 0.041, and P = 0.001, respectively). The duration of hospitalization was longer in patients with thickened GB wall (P = 0.043).Radiologic findings of acute acalculous inflammatory GB disease such as thickened GB wall caused by primary EBV infection are more common than previously reported. Consideration of EBV infection in the differential diagnosis of children suspected with acute acalculous GB diseases may avoid unnecessary surgical intervention.
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Affiliation(s)
- Dae Yong Yi
- From Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea (DYY, HRY); Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea (DYY); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea (JYK); and Seoul National University College of Medicine, Seoul, Republic of Korea (HRY)
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Shah S, Schroeder S. A rare case of primary EBV infection causing acute acalculous cholecystitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited. Surg Today 2015; 46:309-12. [PMID: 25904560 DOI: 10.1007/s00595-015-1173-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/03/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE To compare the safety of emergent laparoscopic cholecystectomy for acute acalculous cholecystitis (AAC) with surgery for acute calculous cholecystitis (ACC). METHODS We retrospectively reviewed the perioperative records of 111 patients who underwent emergent laparoscopic cholecystectomy for acute cholecystitis under the care of the Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, between January 2010 and April 2014. Patients were divided into the AAC group (27 patients) and the ACC group (84 patients), and their perioperative outcomes were compared. RESULTS Patients in the AAC group had significantly higher disease severity and American Society of Anesthesiologists physical status scores (p = 0.001 and 0.037, respectively), lower blood hemoglobin and albumin concentrations (p = 0.0005 and 0.017, respectively), and lower hematocrit and platelet count (p < 0.0001 and 0.040, respectively) than those in the ACC group. When we compared perioperative outcomes, we also found that patients in the AAC group were more likely to have received a blood transfusion (p = 0.002) and to have required conversion to open surgery (p = 0.008). There were no significant differences in morbidity, mortality or length of hospital stay. CONCLUSIONS Early laparoscopic cholecystectomy is safe in acute acalculous as well as acute calculous cholecystitis.
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Acalculous Acute Cholecystitis in Previously Healthy Children: General Overview and Analysis of Pediatric Infectious Cases. Int J Hepatol 2015; 2015:459608. [PMID: 26640715 PMCID: PMC4658411 DOI: 10.1155/2015/459608] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder, which does not appear to be associated with the presence of gallstones. AAC is estimated to represent more than 50% of cases of acute cholecystitis in the pediatric population. Although this pathology was initially described in critically ill patients, actually most pediatric cases have been observed during several infectious diseases. Particularly, here we reviewed pediatric infectious acute acalculous cholecystitis and analyzed the pathophysiological and clinical aspects of bacterial and viral forms.
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40
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A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi. Case Rep Med 2014; 2014:758583. [PMID: 25161668 PMCID: PMC4137699 DOI: 10.1155/2014/758583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 06/23/2014] [Indexed: 01/25/2023] Open
Abstract
Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases.
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Gagneux-Brunon A, Suy F, Pouvaret A, Pillet S, Tarantino E, Bouchet D, Fresard A, Cazorla C, Guglielminotti C, Lucht F, Botelho-Nevers E. Acute acalculous cholecystitis, a rare complication of Epstein-Barr virus primary infection: report of two cases and review. J Clin Virol 2014; 61:173-5. [PMID: 25049206 DOI: 10.1016/j.jcv.2014.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 12/29/2022]
Abstract
We described two cases of acalculous cholecystitis (AAC), due to EBV primary infection in two young Caucasian women and we reviewed other reported cases. In contrast with AAC of other etiologies, antibiotics and surgery are not useful in the management of AAC secondary to EBV.
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Affiliation(s)
- Amandine Gagneux-Brunon
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France.
| | - Florence Suy
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Anne Pouvaret
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sylvie Pillet
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France; Laboratoire de bactériologie et Virologie, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Enrico Tarantino
- Department of General Surgery, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Dorothée Bouchet
- Department of Radiology, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Anne Fresard
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Céline Cazorla
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Guglielminotti
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Lucht
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
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Kim A, Yang HR, Moon JS, Chang JY, Ko JS. Epstein-barr virus infection with acute acalculous cholecystitis. Pediatr Gastroenterol Hepatol Nutr 2014; 17:57-60. [PMID: 24749090 PMCID: PMC3990785 DOI: 10.5223/pghn.2014.17.1.57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 12/22/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder in the absence of demonstrated stones. AAC is frequently associated with severe systemic inflammation. However, the exact etiology and pathogenesis of AAC still remain unclear. Acute infection with Epstein Barr virus (EBV) in childhood is usually aymptomatic, whereas it often presents as typical infectious mononucleosis symptoms such as fever, cervical lymphadenopathy, and hepatosplenomegaly. AAC may occur during the course of acute EBV infection, which is rarely encountered in the pediatric population. AAC complicating the course of a primary EBV infection is usually associated with a favorable outcome. Most of the patients recover without any surgical treatment. Therefore, the detection of EBV in AAC would be important for prediction of better prognosis. We describe the case of a 10-year-old child who presented with AAC during the course of primary EBV infection, the first in Korea, and review the relevant literature.
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Affiliation(s)
- Ahlee Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. ; Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Yi DY, Kim JY, Choi EY, Choi JY, Yang HR. Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children. BMC Pediatr 2014; 14:51. [PMID: 24548331 PMCID: PMC3938642 DOI: 10.1186/1471-2431-14-51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/13/2014] [Indexed: 12/20/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication. In some patients, an association has been noted between elevated liver enzymes or an abnormal gallbladder (GB) and hepatobiliary involvement in KD. In this study, we aimed to evaluate clinical, laboratory, and ultrasonographic (USG) risk factors of hepatobiliary involvement for the intravenous immunoglobulin (IVIG) resistance and the development of CAA in children with KD. Methods From March 2004 through January 2013, clinical features, laboratory data, echocardiographic findings, and USG findings were retrospectively reviewed regarding the response to IVIG treatment and coronary artery complications in 67 children with KD. Acute acalculous cholecystitis (AAC) was diagnosed based on USG criteria. Results Among all factors, only the prothrombin time international normalized ratio was significantly different between the IVIG-response and IVIG-resistance groups (p = 0.024). CAA was statistically more frequent in the AAC group (n = 24) than in the non-AAC group (n = 43) (23.3% vs. 58.3%, p = 0.019). Among the laboratory factors, segmented neutrophil percentage, total bilirubin level, and C-reactive protein were significant in children with CAA (p = 0.014, p = 0.009, and p = 0.010). Abnormal GB findings on USG were significantly more frequent in children with CAA than in those without CAA (p = 0.007; OR = 4.620; 95% confidence interval [CI]: 1.574–13.558). GB distension on USG was the only significant risk factor for CAA (p = 0.001; OR = 7.288; 95% CI: 2.243–23.681) by using multiple logistic regression analysis. Conclusion For children in the acute phase of KD, USG findings of the GB, especially GB distension, may be an important risk factor for CAA as a complication.
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Affiliation(s)
| | | | | | | | - Hye Ran Yang
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Abstract
Acute acalculous cholecystitis (AAC) represents a severe disease in critically ill patients. The pathogenesis of acute necroinflammatory gallbladder disease is multifactorial and intensive care unit (ICU) patients show multiple risk factors. In addition AAC is difficult to diagnose because of the vague physical and non-specific technical findings. Only the combination of clinical and technical findings including the challenging physical examination of critically ill patients, laboratory results and ultrasound or computed tomography (CT) scan, will lead to the diagnosis. The condition of AAC has a rapid progress to gallbladder necrosis, gangrene and perforation and these complications are reflected in the high morbidity and mortality rates, therefore, therapy should be promptly initiated. If there are no clinical contraindications for an operative approach cholecystectomy is the definitive treatment and both open and laparoscopic procedures have been used. In unstable, critically ill patients percutaneous cholecystostomy should be immediately performed. In addition, transpapillary endoscopic drainage is also possible if there are contraindications for percutaneous cholecystostomy. Patients who fail to improve or deteriorate following interventional drainage should be reconsidered for cholecystectomy. Due to the fact that more than 90 % of patients treated with percutaneous cholecystostomy showed no recurrence of symptoms during a period of more than 1 year, it is still unclear if percutaneous cholecystostomy is the definitive treatment of AAC for unstable patients or if delayed cholecystectomy is still necessary.
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Abstract
Patients in the setting of the intensive care unit can develop intra-abdominal complications that may worsen outcome. Clinical suspicion of such complications coupled with early diagnosis and treatment may reduce morbidity and mortality associated with these processes. This article addresses the diagnosis and management of some of the common causes of intra-abdominal catastrophes.
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Affiliation(s)
- Joao B Rezende-Neto
- Department of Surgery, St. Michael's Hospital, 30 Bond Street 16CC-044, Toronto, Ontario M5B1W8, Canada
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Higuchi R, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Kimura Y, Okamoto K, Gabata T, Hata J, Gomi H, Supe AN, Jagannath P, Singh H, Kim MH, Hilvano SC, Ker CG, Kim SW. TG13 miscellaneous etiology of cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:97-105. [PMID: 23307005 DOI: 10.1007/s00534-012-0565-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as miscellaneous etiology that has not so far been touched on. (1) Oriental cholangitis is the type of cholangitis that occurs following intrahepatic stones and is frequently referred to as an endemic disease in Southeast Asian regions. The characteristics and diagnosis of oriental cholangitis are also commented on. (2) TG 07 recommended percutaneous transhepatic biliary drainage in patients with cholestasis (many of the patients have obstructive jaundice or acute cholangitis and present clinical signs due to hilar biliary stenosis or obstruction). However, the usefulness of endoscopic naso-biliary drainage has increased along with the spread of endoscopic biliary drainage procedures. (3) As for biliary tract infections in patients who underwent biliary tract surgery, the incidence rate of cholangitis after reconstruction of the biliary tract and liver transplantation is presented. (4) As for primary sclerosing cholangitis, the frequency, age of predilection and the rate of combination of inflammatory enteropathy and biliary tract cancer are presented. (5) In the case of acalculous cholecystitis, the frequency of occurrence, causative factors and complications as well as the frequency of gangrenous cholecystitis, gallbladder perforation and diagnostic accuracy are included in the updated Tokyo Guidelines 2013 (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan ACW, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:35-46. [PMID: 23340953 DOI: 10.1007/s00534-012-0568-9] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
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Harris EF, Younger E, Llewelyn MB. Acalculous cholecystitis occurring in the context of Plasmodium malariae infection: a case report. J Med Case Rep 2013; 7:197. [PMID: 23889828 PMCID: PMC3750288 DOI: 10.1186/1752-1947-7-197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/11/2013] [Indexed: 01/02/2023] Open
Abstract
Introduction Acalculous 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 presentation We 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. Conclusions Physicians 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.
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Affiliation(s)
- Eleanor F Harris
- Department of Infectious Diseases, Department of Medicine, Royal Gwent Hospital, Newport, Wales NP20 2UB, United Kingdom.
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Sanjay P, Mittapalli D, Marioud A, White RD, Ram R, Alijani A. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013; 15:511-6. [PMID: 23750493 PMCID: PMC3692020 DOI: 10.1111/j.1477-2574.2012.00610.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to review a series of consecutive percutaneous cholecystostomies (PC) to analyse the clinical outcomes. METHODS All patients who underwent a PC between 2000 and 2010 were reviewed retrospectively for indications, complications, and short- and long-term outcomes. RESULTS Fifty-three patients underwent a PC with a median age was 74 years (range 14-93). 92.4% (n = 49) of patients were American Society of Anesthesiologists (ASA) III and IV. 82% (43/53) had ultrasound-guided drainage whereas 18% (10/53) had computed tomography (CT)-guided drainage. 71.6% (n = 38) of PC's employed a transhepatic route and 28.4% (n = 15) transabdominal route. 13% (7/53) of patients developed complications including bile leaks (n = 5), haemorrhage (n = 1) and a duodenal fistula (n = 1). All bile leaks were noted with transabdominal access (5 versus 0, P = 0.001). 18/53 of patients underwent a cholecystectomy of 4/18 was done on the index admission. 6/18 cholecystectomies (33%) underwent a laparoscopic cholecystectomy and the remaining required conversion to an open cholecystectomy (67%). 13/53 (22%) patients were readmitted with recurrent cholecystitis during follow-up of which 7 (54%) had a repeated PC. 12/53 patients died on the index admission. The overall 1-year mortality was 37.7% (20/53). CONCLUSIONS Only a small fraction of patients undergoing a PC proceed to a cholecystectomy with a high risk of conversion to an open procedure. A quarter of patients presented with recurrent cholecystitis during follow-up. The mortality rate is high during the index admission from sepsis and within the 1 year of follow-up from other causes.
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Affiliation(s)
| | | | - Aseel Marioud
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Richard D White
- Department of Radiology, Ninewells Hospital and Medical SchoolDundee, UK
| | - Rishi Ram
- HPB Unit, Auckland City HospitalAuckland, New Zealand
| | - Afshin Alijani
- Upper GI & HPB Unit, Ninewells Hospital and Medical SchoolDundee, UK
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50
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Kim KH, Kim JS, Nam SH, Kim KU, Kim WW, Kim YH. Acute acalculous cholecystitis after laparoscopic appendectomy in a young healthy patient: report of a case. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2013; 17:83-5. [PMID: 26155220 PMCID: PMC4304492 DOI: 10.14701/kjhbps.2013.17.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/11/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022]
Abstract
Acute acalculous cholecystitis (AAC) is defined as acute inflammation of the gallbladder in the absence of gallstones. AAC occurs in patients after major surgery and in the presence of serious co-morbidities such as severe trauma, burns, sepsis, prolonged intravenous hyperalimentation and hemodynamic instability. AAC is rare in patients with none of the established risk factors. We present a case of a 38-year-old woman who developed AAC after laparoscopic appendectomy.
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Affiliation(s)
- Ki Hoon Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Su Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - So-Hyun Nam
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwan U Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woon-Won Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Han Kim
- Department of Anesthesiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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