Management of a Case of Gangrenous Cholecystitis Detected in the Emergency Department

Yıl 2021, Cilt: 3 Sayı: 2, 77 - 80, 31.08.2021

Oya Güven , Lale Tuna

Öz

Objective: Acute cholecystitis is a condition that most clinicians know how to examine and treat, however, evaluation of the radiological findings of gangrenous gallbladder disease and estimation of the urgency of the situation may not be familiar to the emergency physician. Case Report: A 79-year-old female patient was admitted to our Emergency Department with abdominal pain. Findings of cholecystitis were found in her examination and tests. No clear information could be obtained on computed tomography. Abdominal ultrasound was requested because a high probability of gallbladder pathology was considered in the diagnosis. Floating membranes (considered as a sign of gangrenous cholecystitis) were seen in the gallbladder and free fluid at the pelvic level were detected. Due to the comorbidities of our patient, percutaneous drainage catheter was initially planned by the General Surgeon, but due to the deterioration of her general condition, she was taken to emergency operation. Perforation was detected in the gallbladder neck during the operation. She was treated at the hospital for 30 days and was discharged with recovery. Results and Conclusion: Acute gangrenous cholecystitis is a rare cause of gallbladder diseases. It is difficult to diagnose for emergency physicians when clinical signs are unclear. In this article; we aimed to remind emergency physicians that the picture of cholecystitis can worsen rapidly, what should be considered in the examinations and complications.

Anahtar Kelimeler

Gangrenous cholecystitis, Floating membranes, acute cholecystitis, Emergency Department

Kaynakça

• 1. Fagan SP, Awad SS, Rahwan K, Hira K, Aoki N, Itani KM, et al. Prognostic factors for the development of gangrenous cholecystitis. Am Surg. 2003; 186: 481-5.
• 2. Özel A, ErtürkŞM. Safra Kesesi Hastalıkları. Türk RadyolojiSeminerleri Trd Sem3, 483-94; 2015. doi:10.5152/trs.2015.329.
• 3. Jeffrey RB, Liang FC, Wong W, Callen PW. Gangrenous cholecystitis: diagnosis by ultrasound. Radiology. 1983; 148: 219-21
• 4. Grand D, Horton KM, Fishman EK. CT of thegallbladder: spectrum of disease. AJR Am J Roentgenol. 2004; 183: 163-70.
• 5. Bennet GL, Rusinek H, Lisi V, Israel GM, Krinsky GA, Slywotzky CM, et al. CT findings in acute gangrenous cholecystitis. AJR 2002; 178: in acute gangrenous cholecystitis. AJR Am J Roentgenol 2002; 178: 275-81.
• 6. Simeone JF, Brink JA, Mueller PR, Compton C, Hahn PF, SainiS, et. al. The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign. American Journal of Roentgenology. 1989; 152(2), 289-290.
• 7. Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology. Radiol Clin North Am. 2003; 41: 1203-16
• 8. Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD Jr, Ngo C, et al. Real-time sonography in suspected acute cholecystitis:prospective evaluation of primary and secondary signs. Radiology. 1985; 155: 767-71.
• 9. Borzellino G, Sauderland S, Minicozzi AM, Verlato G, Di Pietranonj J, de Manzoni G, et al. Laparoscopic cholecystectomy for severe acute cholecystitis: a meta-analysis of results. Surg Endos. 2008; 22: 8-15.
• 10. Faraji M, Sharp R, Gutierrez E, Malikayil K, Sangi A. Perforated gangrenous gallbladder in an asymptomatic patient. Cureus. 2020; 12(4).