Acute gangrenous cholecystitis

Colecistitis gangrenosa aguda

INTRODUCTION: Acute gangrenous cholecystitis is a severe complication of acute cholecystitis that usually has an acute course.

CASE PRESENTATION: A 91-year-old female patient presented with right upper quadrant abdominal pain. She referred to a history of poorly controlled type 2 diabetes mellitus. Abdominal palpation showed right upper quadrant pain. Ultrasound showed a gallbladder with enlarged walls and pericholecystic fluid. Contrast-enhanced computed tomography showed an enlarged gallbladder with thickened and discontinuous walls. These findings led to the diagnosis of acute gangrenous cholecystitis. During surgery, an enlarged gallbladder and evidence of necrosis with biliary fluid leakage were found. Histopathological examination revealed gangrenous changes characterized by necrosis of all layers of the gallbladder, with acute inflammatory cellular infiltrate, edema, hemorrhage, and granulation tissue in the serous portion.

DISCUSSION: Patients with poorly controlled diabetes mellitus tend to develop milder symptoms secondary to diabetic polyneuropathy or gallbladder denervation. Ultrasonography is the first-line imaging modality, but its findings may be similar to those of acute cholecystitis. Other imaging techniques, such as computed tomography or magnetic resonance imaging, are more useful.

CONCLUSION: Acute gangrenous cholecystitis may present with mild pain or even without symptoms, especially in elderly patients with a history of diabetes mellitus. Preoperative diagnosis is difficult. This condition requires immediate recognition, prompt diagnosis, and adequate treatment.