A rare case report of acute acalculous cholecystitis in active chronic hepatitis C virus infection

Acute acalculous cholecystitis (AAC) is an inflammation of gallbladder with absence of gall stones or bile sludge. Daily cases reported about 90-95% of the acute cholecystitis present with gall stone, while only 5-15% occur without gall stones obstruction.AAC is reported associated with Epstein bar virus infection, hepatitis B virus and hepatitis A virus. Hepatitis C-induced AAC cases still rare. This case report presents a 49-years-old female patient with epigastric pain, nausea, yellowish sclera, tea urine color, pale stool and there was a history of the patient's husband with hepatitis C. On physical examination there was epigastric and right hypochondriac pain, and positive murphy sign. There was leukocytosis, hyperbilirubinemia and an increase in SGPT (1.360 U/L) and SGOT (1.720 U/L). Antibodies to HCV were positive. Abdominal ultrasonography showed cholecystitis with no biliary duct dilatation and no parenchymal liver disease appearance The patient was diagnosed with acute chronic hepatitis C and cholecystitis. Pathophysiology of hepatitis C induced AAC is not fully understood, but is thought to be due to complexes immune, directly infect gallbladder and proximal biliary epithelial cells uncontrolled, increased portal/septal myofibroblasts activity and inflammation. The presence of AAC with an increase in serum levels of SGOT and SGPT 5-10 times the normal limit should be suspected due to acute hepatitis viral infection. Further research still needs to be done to determine the relationship between hepatitis C and the incidence of AAC.

Clinical analysis of severe acute pancreatitis complicated with acute acalculous cholecystitis:a 39 cases report / 中国实用外科杂志

OBJECTIVE: To summarize the clinical characteristics of severe acute pancreatitis(SAP)complicated withacute acalculous cholecystitis(AAC).METHODS: The clinical data of 141 SAP patients admitted in the First Affiliated Hospital of Harbin Medical University from September 2012 to August 2017 were analyzed retrospectively. Among them,39 SAP patients were complicated with AAC. The clinical characteristics and key points of diagnosis and treatment ofSAP complicated with AAC were analyzed and compared with the basic data and treatment of patients without AAC.RESULTS: The incidence of SAP complicated with AAC was 27.7%(39/141). Compared with the non-AAC group,theAAC group had statistically significant differences in age [(48.8±12.5)years vs.(41.4±10.9)years], Balthazar CTSIscore [(6.8±1.3)vs.(5.7±1.3)],diabetes mellitus(35.9% vs. 18.6%), fasting time [(16.9±9.5)h vs.(12.2±7.6)h],incidence of ARDS(74.3% vs. 54.9%)and ARF(43.6% vs. 23.5%),and length of hospital stay [(33.7±19.6)d vs.(21.9±12.9)d](P<0.05). In the AAC group,8 patients underwent conservative treatment. 31 patients underwent invasivetreatment for severe gallbladder inflammation,among them 20 patients received PTGD and their condition improved. Themortality rates of patients in the AAC group were also higher than that in the non-AAC group(20.5% vs. 8.8%),butthere was no statistical significance(P=0.106).CONCLUSION: The AAC is one of the common complications in the latecourses of SAP. Early diagnosis and individualized treatment are crucial to improve the curative effects. For the patients,the early use of PTGD is a safe and effectivetreatment method,which is worthy of promotion.

Three patients with large area burns complicated by acute acalculous cholecystitis / 中华烧伤杂志

From April 2017 to April 2018, three male patients aged 46-71 years with large area burns were treated in our hospital. Acute acalculous cholecystitis (AAC) symptoms of the patients began to appear 15-81 days after injury. AAC was diagnosed 24-81 days after injury. Ultrasound-guided percutaneous transhepatic cholecystostomy was performed 26-82 days after injury. The symptoms subsided in 2 patients, and cholecystectomy was performed in 1 patient with gallbladder perforation 94 days after injury. The patients were cured and discharged 41-118 days after injury. No recurrence of cholecystitis occurred during 8-9 months of follow-up after discharge.

Ultrasonic features of acute acalculous cholecystitis developing at different stages of acute pancreatitis / 医学研究生学报

Objective Acute pancreatitis exhibits different clinical and ultrasonic features in patients complicated with acute acalculous cholecystitis ( AAC) at different stages .The aim of this study was to analyze the ultrasonic characteristics of acute pancreati-tis complicated with AAC at different stages . Methods We retrospectively analyzed the clinical data about 41 cases of acute pancrea-titis with moderate to severe AAC .According to whether AAC developed within or after 2 weeks of the onset of acute pancreatitis , we divided the patients into an early-stage group (n=18) and a late-stage group (n=23).We recorded the gallbladder size, gallbladder wall thickness , fluid around the gallbladder , biliary sludge deposition and the Murphy′s sign by ultrasonography , obtained AAC-related clinical and laboratory data concerning body temperature , Murphy′s sign, WBC count and C-reactive protein level , and analyzed the ultrasonic features of AAC at different stages in the acute pancreatitis patients. Results All the patients experienced a fever of >38.5℃, 38.89%with chills in the early onset group and 47.83%in the late onset group .Increases were observed in patients of the early-and late-stage groups in the WBC count ( 94.44%vs 82.61%) , the C-reactive protein level ( 100%vs 91.30%) , and the fluid volume around the gallbladder (94.44%vs 60.86%, P<0.05), but incidence rate of gallbladder wall thickening was significantly lower in the former than in the latter group (11.11%vs 78.26%, P<0.01). Conclusion AAC developing at different stages of acute pancreatitis has different ultrasonic features , with higher incidence rates of fluid around the gallbladder in the early stage and gallbladder wall thickening in the late stage.

Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation / Colecistite aguda acalculosa no lúpus eritematoso sistêmico: uma manifestação inicial rara

ABSTRACT Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

RESUMO A colecistite aguda acalculosa é uma manifestação gastrointestinal rara no lúpus eritematoso sistêmico e ainda mais rara como manifestação inicial. Foram descritos apenas dois casos até o momento. Os autores relatam o caso de uma mulher negra de 20 anos, com quadro de colecistite aguda acalculosa revelada pela tomografia computadorizada do abdome. Durante a hospitalização, a paciente foi diagnosticada com lúpus eritematoso sistêmico. Houve remissão completa dos sintomas após tratamento conservador com antibióticos. Iniciou-se tratamento com corticosteroides no ambulatório. Embora a colecistectomia seja o tratamento de escolha em casos de colecistite aguda acalculosa como complicação do lúpus eritematoso sistêmico, a paciente respondeu bem ao tratamento conservador; logo, a cirurgia não foi necessária. Este caso é único em razão do modo como o corticosteroide foi iniciado no atendimento ambulatorial. É importante lembrar que a colecistite aguda acalculosa pode ser a manifestação inicial do lúpus eritematoso sistêmico, embora sua ocorrência seja rara. Deve-se considerar a realização de tratamento conservador. A tomografia computadorizada do abdome foi determinante para que fosse feita uma melhor avaliação dacolecistite aguda acalculosa.

Chronic polyarthritis as isolated manifestation of toxocariasis / Poliartrite crônica como manifestação isolada da toxocaríase

ABSTRACT Human toxocariasis is a parasitic zoonosis mainly caused by Toxocara canis or Toxocara catiand is acquired by ingestion of the parasite’s embryonated eggs. Arthralgia and/or arthri-tis were reported in up to 17% of the cases, generally with acute duration (less than 6weeks). However, to our knowledge, chronic polyarthritis, as the isolated presentation ofToxocara infection, was not reported. One of the 5809 patients that was followed up at ourservice (0.017%) had chronic polyarthritis as the single manifestation of toxocariasis and wasdescribed herein. A 3-year-old girl was referred to our service with severe painful chronicpolyarthritis for a period longer than 10 weeks and morning stiffness of 30 min. Dog contactexposure history in the recreational areas of neighborhood was reported. Her exams showedhigh levels of eosinophils in peripheral blood (29%), bone marrow aspirate revealed markedeosinophilia (32%) and Toxocara enzyme-linked immunosorbent assay (Elisa) was positive(1:1280). She was treated with paracetamol (40 mg/kg/day) and thiabendazole (25 mg/kg/day)for 10 days, and all manifestations reduced. After eight months of follow-up, she was onclinical and laboratorial remission. In conclusion, we described a case of chronic polyarthri-tis, as isolated manifestation of toxocariasis, mimicking juvenile idiopathic arthritis andleukemia. Importantly, this zoonosis should be considered in patients with arthritis andeosinophilia.

RESUMO A toxocaríase é uma zoonose parasitária causada principalmente pelo Toxocara canis ou peloT. cati. É adquirida pela ingestão de ovos embrionados do parasita. A artralgia e/ou artriteforam relatadas em até 17% dos casos, geralmente com duração aguda (menos de seis sema-nas). No entanto, que se tem conhecimento, a poliartrite crônica como manifestação isoladada infecção por Toxocara ainda não foi descrita na literatura. Um dos 5.809 pacientes acom-panhados em nosso serviço (0,017%) exibiu poliartrite crônica como manifestação únicada toxocaríase e foi descrito neste estudo. Uma menina de três anos foi encaminhada aonosso serviço com poliartrite crônica dolorosa grave por um período superior a 10 semanase rigidez matinal diária de 30 minutos. Foi relatada história de exposição a contato comcão nas áreas de lazer do bairro. Seus exames revelaram níveis elevados de eosinófilos nosangue periférico (29%), o aspirado de medula óssea revelou eosinofilia acentuada (32%)e o ensaio imunoenzimático ligado a enzima (ELISA) para Toxocara foi positivo (1:1.280). Acriança foi tratada com paracetamol (40 mg/kg/dia) e tiabendazol (25 mg/kg/dia) durante10 dias e houve regressão de todas as manifestações. Depois de oito meses de seguimento,a pequena paciente estava em remissão clínica e laboratorial. Em conclusão, descreve-seum caso de poliartrite crônica como manifestação isolada da toxocaríase, que mimetizouuma artrite idiopática juvenil e leucemia. É importante ressaltar que essa zoonose deve serconsiderada em pacientes com artrite e eosinofilia.

Age, Predisposing Diseases, and Ultrasonographic Findings in Determining Clinical Outcome of Acute Acalculous Inflammatory Gallbladder Diseases in Children

We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.

Acute Acalculous Cholecystitis without Cholangitis As a Complication of Endoscopic Snare Papillectomy for Ampullary Adenoma / 대한췌담도학회지

Endoscopic snare papillectomy (ESP) for ampulla of Vater tumor (AVT) has been performed successfully instead of surgical ampullectomy (SA) because ESP is a less invasive procedure than SA. Hemorrhage, perforation and pancreatitis are relatively common complications of ESP and other rare complications such as cholangitis, liver abscess has been reported. Recently we encountered a case of acute acalculous cholecystitis after ESP for AVT, which was treated successfully with percutaneous cholecystostomy with intravenous antibiotics. We therefore report this case with a brief review of the literature.

Compromiso gastrointestinal agudo en pacientes con dengue por serotipo 4: Comunicación de un caso y revisión de la literatura / Acute gastrointestinal involvement in dengue disease by serotype 4: a case report and literature review

Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management.

El dengue es la arbovirosis más importante del mundo y causa un amplio espectro clínico. Presentamos el primer caso de dengue causado por el serotipo 4 (DENV-4) en Perú con compromiso gastrointestinal (colecistitis aguda alitiásica y hepatitis aguda moderada). Se presenta una revisión de la literatura médica sobre este tipo de presentación, enfatizando la importancia y características del dolor abdominal (hipocondrio derecho), el signo de Murphy, los hallazgos ultrasonográficos y la medición de las enzimas hepáticas para establecer el diagnóstico y manejo adecuado.

Acute acalculous cholecystitis after laparoscopic appendectomy in a young healthy patient: report of a case

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.

Acute Acalculous Cholecystitis in a Spinal Cord Injured Patient: A case report

Patients with spinal cord injury (SCI) have an increased prevalence of cholecystitis. Neurologically intact patients with cholecystitis usually complain biliary colic of the right upper quadrant (RUQ). Because of the inability to localize visceral pain in patients with SCI, the pattern of symptoms are quite different. We reported a case of 48-year-old man with C5 incomplete tetraplegia (ASIA C) who presented an increased spasticity and vague pain of RUQ and later diagnosed as an acute acalculous cholecystitis. Antibiotics treatment and Percutaneous Transhepatic Gall Bladder Drainage (PTGBD) were performed. An open cholecystectomy was performed after the laparoscopic cholecystectomy which failed due to severe adhesion. Postoperatively, patient recovered well without complications. We suggested that even a vague abdominal pain shouldn't be underestimated in SCI patients.

A Case of Acute Acalculous Cholecystitis Superimposed on the Nephrotic Syndrome

The nephrotic syndrome is characterized by generalized edema, hypoproteinemia(40 mg/m2/hr), and hypercholesterolemia(>200 mg/dL). It is reported that hypoalbuminemia, which is one of the four diagnostic criteria of the nephrotic syndrome, is associated with gallbladder wall thickening. An explanation for the thickened wall in hypoalbuminemic states is the accumulation of fluid in the subserosal layer of the gallbladder wall which contains the most areolar tissue. This report describes a patient who was initially diagnosed with the nephrotic syndrome at the age of 4 and subsequently developed acute acalculous cholecystitis at the age of 5.8 with an albumin level of 1.3 g/dL. The patient responded to fluid therapy, nasogastric suction, and broad spectrum antibiotics.

Diagnosis and Treatment of Acute Acalculous Cholecystitis: Analysis of 79 Cases / 中国普外基础与临床杂志

Objective To analysis the clinical characteristics, pathogenesis, diagnosis and treatment of acute acalculous cholecystitis.Methods Seventy-nine cases of acute acalculous cholecystitis from January 1996 to January 2003 were retrospectively reviewed.Results Of those 79 cases, 13 cases were treated non-operatively and 66 cases were treated operatively. Twenty-three cases were suppurative, 43 cases were gangrenous with perforation in 18 cases,which were proved by postoperative pathology. Seventy-six cases were cured and 3 cases were dead. Conclusion Keeping vigilant alert, observing dynamically as well as appropriate operative intervention are effective to improve the prognosis of acute acalculous cholecystitis.

Acute Acalculous Cholecystitis Associated with Systemic Lupus Erythematosus with Sjogren's Syndrome

Both systemic lupus erythematosus and Sjogren's syndrome are autoimmune diseases. Almost all organs can be involved but the gall bladder is an unusual site. We report a 39-year-old woman with systemic lupus erythematosus and Sjogren's syndrome presenting with acute acalculous cholecystitis. It is a very rare complication and, in the literature review, surgical interventions are mostly applied for treatment. In our case, high dose corticosteroid was tried and clinical manifestations and radiologic findings were improved.

A Case of Acute Acalculous Cholecystitis in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Several gastrointestinal complications have been reported in association with systemic lupus erythematosus (SLE),including mesenteric vasculitis,bowel perforation,gastric or duodenal ulcer,necrotizing enterocolitis,spontaneous peritonitis,pancreatitis,spontaneous rupture of the liver or spleen and hepatomegaly.Acute acalculous cholecystitis is a rare disease that occurs in only 5~10%of patients with acute cholecystitis,typically in seriously ill patients. Reports of gallbladder diseases in patients with SLE are very scarce.Only seven cases of SLE complicated with acalculous cholecystitis have been reported so far, but not in Korea.Six cases were treated surgically by cholecystectomy or cholecystostomy,and one case was treated without surgical intervention.We added a case in which acute acalculous cholecystitis accompanying SLE was treated successfully by corticosteroid without surgical intervention.