A Case of Asymptomatic Perforated Gangrenous Cholecystitis in a Diabetic Patient: A Critical Condition

Abstract

Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis (AC) with ischemia and necrosis of the gallbladder (GB) wall. Patients with GC are sicker than the usual AC patients, and their surgical treatment is more complex and linked with a higher risk of morbidity and mortality. Typically, the first imaging modality used to assess patients with clinically suspected AC is ultrasound. However, if the ultrasound results were inconclusive, a CT scan might help evaluate these individuals. Our study presents a 62-year-old male who presented with mild right upper quadrant discomfort. However, an abdominal computed tomography CT scan showed a pericholecystic fluid collection with a sign of GB perforation that was managed with subtotal cholecystectomy. Five days after the operation, the patient was discharged to home in excellent condition.

Keywords: case report; cholecystitis; cholelithiasis; gangrenous cholecystitis; subtotal cholecystectomy.

Figure 1. Preoperative abdominal CT with contrast shows (a) air-filled gallbladder and (b) the gallbladder revealed wall thickening and focal mural disruption, with a pericholecystic fluid collection

Figure 2. Intraoperative image

A Kocher incision was done. Intraoperatively, there were severe abdominal adhesions, a ruptured gallbladder, subhepatic pus, and the absence of identifiable structures in Calot's triangle (frozen Calots) prompted a choice to proceed with a subtotal cholecystectomy.

Figure 3. Postoperative abdominal CT with contrast shows mixed gas–fluid attenuation in gallbladder fossa consistent with surgical (normal) findings