RESUMEN
BACKGROUND: Acute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication. OBJECTIVES: The study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis. MATERIALS AND METHODS: This was a retrospective study included patients with acute cholecystitis diagnosis, who presented to 'blinded for peer review' from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis. RESULTS: A total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utility CONCLUSION: Male patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.
Asunto(s)
Colecistitis Enfisematosa , Vesícula Biliar/patología , Recuento de Leucocitos/métodos , Pruebas de Función Hepática/métodos , Pruebas de Función Pancreática/métodos , Evaluación de Síntomas/métodos , Adulto , Biomarcadores/análisis , Diagnóstico Diferencial , Colecistitis Enfisematosa/sangre , Colecistitis Enfisematosa/diagnóstico , Colecistitis Enfisematosa/epidemiología , Colecistitis Enfisematosa/fisiopatología , Femenino , Gangrena , Humanos , Jordania/epidemiología , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Emphysematous cholecystitis is a rare presentation of cholecystitis and is caused by gas producing bacteria such as Clostridium perfringens, Klebsiella species or Escherichia coli. We describe a fatal case of a 82-year-old man who presented with abdominal pain, vomiting, fever and acute confusion. An ultrasound and subsequent CT scan showed emphysematous cholecystitis.
Asunto(s)
Dolor Abdominal/diagnóstico , Colecistitis Enfisematosa , Fiebre/diagnóstico , Vómitos/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Colecistitis Enfisematosa/diagnóstico , Colecistitis Enfisematosa/diagnóstico por imagen , Colecistitis Enfisematosa/fisiopatología , Resultado Fatal , Humanos , Masculino , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodosAsunto(s)
Antibacterianos/uso terapéutico , Colecistectomía/métodos , Técnicas de Diagnóstico del Sistema Digestivo , Colecistitis Enfisematosa , Fluidoterapia/métodos , Vesícula Biliar/cirugía , Bacterias Anaerobias/aislamiento & purificación , Colecistectomía/efectos adversos , Terapia Combinada , Colecistitis Enfisematosa/complicaciones , Colecistitis Enfisematosa/microbiología , Colecistitis Enfisematosa/fisiopatología , Colecistitis Enfisematosa/cirugía , Vesícula Biliar/irrigación sanguínea , Vesícula Biliar/patología , Gangrena Gaseosa/etiología , Gangrena Gaseosa/microbiología , Gangrena Gaseosa/fisiopatología , Humanos , Isquemia/etiología , Isquemia/fisiopatología , Periodo Perioperatorio/métodosRESUMEN
A 50-year-old man had a metastatic gastrointestinal stromal tumor that was refractory to imatinib. He was prescribed a 6-week course of treatment with oral sunitinib 50 mg/day. During the fourth week of his first cycle of treatment with the drug, the patient developed acute-onset, right upper quadrant pain associated with nausea, vomiting, and fever; laboratory tests revealed leukocytosis and mild hyperbilirubinemia. He was diagnosed with acute emphysematous cholecystitis, which was treated with broad-spectrum antibiotics and percutaneous cholecystostomy. His symptoms resolved, and he successfully completed his course of therapy with sunitinib. Using the Naranjo adverse drug reaction probability scale, a score of 5 was derived, which indicates that the likelihood was probable that this adverse event was caused by sunitinib.
