Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis.

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.

[A vomiting, old man with abdominal pain and fever]. / Een brakende, oude man met buikpijn en koorts.

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.

Colecistitis eosinofílica: causa infrecuente de colecistitis aguda / Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

La colecistitis eosinofílica (CE) es una enfermedad rara caracterizada por una infiltración eosinófila de la vesícular biliar. Su etiopatogenia es desconocida, aunque se han postulado múltiples hipótesis. Las manifestaciones clínicas y de laboratorio no difieren de otras causas de colecistitis. El diagnóstico es histológico y suele realizarse tras el análisis de la pieza quirúrgica. Presentamos el caso de una mujer de 24 años, con clínica de fiebre, dolor en hipocondrio derecho y vómitos. Las pruebas de imagen evidenciaban una colecistitis alitiásica, tras lo cual se realizó una colecistectomía urgente. Los hallazgos histológicos de la pieza quirúrgica revelaban una colecistitis eosinofílica. En este caso, no se encontró causa que justificase el cuadro

Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found

Emphysematous cholecystitis in a patient with gastrointestinal stromal tumor treated with sunitinib.

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.