Acalculous hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is associated with a high mortality rate. We present a case of acalculous hemorrhagic cholecystitis with hematoma in the gallbladder lumen, which was diagnosed using magnetic resonance imaging (MRI). The T1- & T2-weighted MRI revealed gallbladder distension with a hypointense intraluminal hematoma. The excellent tissue contrast provided by MRI is useful for detecting hematomas in the cases of hemorrhagic cholecystitis.
Acalculous Cholecystitis ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Hematoma ; Magnetic Resonance Imaging

No abstract available.
Cholecystitis ; Emphysematous Cholecystitis* ; Pneumoperitoneum*

PURPOSE: We evaluated the therapeutic efficacy and complications of percutaneous cholecystostomy in acalculou s acute cholecystitis. MATERIALS AND METHODS: We performed percutaneous cholecystostomy under ultrasound guidance for the treatment of 18 patients with acalculous acute cholecystitis. We retrospectively analyzed the therapeutic efficacy and complications. RESULTS: A dramatic improvement in clinical condition was observed in 16(88%) patients within 24 --48 hours. One patient was successfully treated with second trial because of technical failure at initial trial. No major complications occured except a gallbladder laceration. Most of patients complained minor symptoms such as fever, pain, mild dyspnea and refered pain to right shoulder, and these symptoms were resolved within one week. There was no complications related to vasovagal reflex. CONCLUSION: In the treatment of acalculous acute cholecystitis, percutaneous cholecystostomy is a safe and effective method.
Acalculous Cholecystitis* ; Cholecystitis, Acute ; Cholecystostomy* ; Dyspnea ; Fever ; Gallbladder ; Humans ; Lacerations ; Reflex ; Retrospective Studies ; Shoulder ; Ultrasonography

Emphysematous cholecystitis is an uncommon form of acute cholecystitis characterized by the presence of gas within the wall, lumen of the gall bladder or biliary ducts. Clinically it is very similar to ordinary farm. But since the risk of perforation is five times that expected from ordinary cholecystitis, early diagnosis and appropriate surgical treatment are important. We could diagnose these cases by the simple abdomen, abdominal ultrasound and abdominal CT by the presence of air in the lumen and the wall of the gall bladder. Percutaneous trans hepatic gall bladder drainage (PTGBD) for decompression was used because poor general condition of patients and later, we could successfully perform the cholecystectomy without any complication. We presented two cases of emphysematous cholecystitis with review of the relevant literature on the subject.
Abdomen ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Decompression ; Drainage ; Early Diagnosis ; Emphysematous Cholecystitis* ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Bladder

Emphysematous cholecystitis is an uncommon condition which may mimic acute cholecystitis. But it differs from acute cholecystitis in its relatively greater frequency in men and diabetics and has graver prognosis. The condition is diagnosed by demonstration of air in lumen,wall of gallbladder and/or pericholecystic space using a variety of radiographic techniques: simple abdominal radiography, ultrasonography and CT scanning. One illustrative case is presented herein and the pertinent literature is reviewed.
Cholecystitis, Acute ; Emphysematous Cholecystitis* ; Gallbladder ; Humans ; Male ; Prognosis ; Radiography, Abdominal ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: Frequency of combined CBD stones on cholelithiasis has been known to range 5~20% in several reports, and diagnostic tools are USG, MDCT, MRCP and ERCP. Predictive factors of CBD stone for cholelithiasis were diameter of CBD, elevated liver enzyme, multiple small sized GB stones and concurrent pancreatitis. However, unsuspected CBD stone for acute cholecystitis is troublesome for patients and surgeons. METHODS: We retrospectively reviewed Percutaneous gallbladder drainage (PGBD) for acute complicated cholecystitis from October 1996 to October 2006. Indications for PGBD are clinical symptoms (sepsis) & signs of peritonitis and radiologic findings such as GB empyema, gangrenous cholecystitis and pericholecystic fluid collection. Total laparoscopic cholecystectomy was 1,357 cases, and PGBD for acute complicated cholecystitis was 13.8%. RESULTS: Combined CBD stone rate was 13.6%. Whereas, unsuspected CBD stone was 0.5% (9 cases), 7 in calculous and 2 in acalculous cholecystitis. No. of stone was 1 in 7 cases, 2 in 1 case and 3 in 1 case. Size of stone was less than 5 mm in all cases. Diameter of CBD was not increased in all cases (less than 1 cm) and liver enzymes showed no elevation in all cases. Management for unsuspected CBD stone was preoperative endoscopic lithotripsy in 8 cases and postoperative fluoroscopic lithotripsy in 1 case. CONCLUSION: Cholecystography following PGBD for acute complicated cholecystitis is a useful diagnostic modality for detection of unsuspected CBD stone.
Acalculous Cholecystitis ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Cholecystography ; Cholelithiasis ; Drainage ; Empyema ; Gallbladder ; Humans ; Lithotripsy ; Liver ; Pancreatitis ; Peritonitis ; Retrospective Studies

Portal and superior mesenteric vein thrombosis (PMVT) may occur, rarely though, secondary to hypercoagulable states, cirrhosis with portal hypertension, pancreatitis, peritonitis, inflammatory bowel disease and intraabdominal abscess. However, PMVT induced by acute acalculous cholecystitis has not been reported yet. We recently experienced a case of acute acalculous cholecystitis complicating PMVT. A 38-year-old male was admitted for RUQ pain, chill and fever without any previous medical history in particular and diagnosed as acute acalculous cholecystitis and PMVT. The diagnosis of PMVT secondary to acute acalculous cholecystitis was possible since there was no other cause of thrombosis. This patient's condition was improved without any complication after cholecystectomy and anticoagulant regimen. Thus, we report a case of PMVT secondary to acute acalculous cholecystitis for the first time in Korea.
Abscess ; Acalculous Cholecystitis ; Adult ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute* ; Diagnosis ; Fever ; Fibrosis ; Humans ; Hypertension, Portal ; Inflammatory Bowel Diseases ; Korea ; Male ; Mesenteric Veins* ; Pancreatitis ; Peritonitis ; Portal Vein* ; Thrombosis*

Laparoscopic surgery is now a commonly used procedure for biliary tract disease because of the small incision, the shorter hospital stay, lower postoperative pains, and prompt recovery. Acute or subacute cholecystitis has been considered a contraindication because the procedure becomes time consuming and complicated. However, improvements in surgical technique and development of better surgical equipment has lead to interest in the use of laparoscopy for acute cholecystitis. However, the proper timing for the operation is still questionable. The authors analyzed 28 cases of laparoscopic cholecystectomies performed for acute cholecystitis between January 1992 and first half of 1997 in order to determine the clinical significant of using a laparoscopic cholecystectomy for patients with acute cholecystitis. For all 28 cases of histopathologically confirmed acute cholecystitis, we analyzed the of surgical method, mean hospital stay, mean operating time, and postoperative analgesic requirement. Each subjects were also analysed year by yearly to determine laparoscopic cholecystectomy for acute cholecystitis. As to histopathologic type, 81% were calculous cholecystitis, and 19% were acalculous cholecystitis. Empyema cases accounted for 46% of the total number of cases. During the 1992, all cases was treated by using a gas technique, but in 1995, the gas technique was used in only 60% of the cases. In 1996, a gasless technique surpassed gas technique was used in 57.2% of the cases. In 1997, all cases were treated by using a gasless technique. The mean hospital stay gradually decreased through the years from 6.75 days in '92, to 5.85 days in '95, 5.8 days in '96 and 5 days in '97. The mean operation time also showed a decrease from 100 min in '92, to 139 min. in '95, 104.64 min in '96 and 90 min in '97. A postoperative analgesic was used 1.5 times in '95, 1.14 times in '95, 1 time in '96 and 0.8 time in '97. In conclusion, the laparoscopic approach to treating acute cholecystitis has reduced the hospital stay, and the mean operation time due to the use of a gasless technique and to development of better laparoscopic instruments. Also, the use of the gasless technique is more treat cost effectiveness, so, the gasless laparoscopic technique is becoming popular as a way to acute cholecystitis in the laparoscopic era.
Acalculous Cholecystitis ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute* ; Cost-Benefit Analysis ; Empyema ; Humans ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Surgical Equipment

Acalculous Cholecystitis ; microbiology ; Adult ; Cholecystitis, Acute ; diagnosis ; microbiology ; Enzyme-Linked Immunosorbent Assay ; Humans ; Leptospirosis ; complications ; diagnosis ; Male ; Pancreatitis ; etiology ; microbiology

Transarterial chemoembolization (TACE) is reportedly a useful palliative treatment in patients with unresectable or recurred hepatocellular carcinoma. Post-TACE complications are common; however, acute cholecystitis after TACE is rare. We herein report a case of a 73-year-old woman who presented with emphysematous cholecystitis and pneumobilia following TACE. Computed tomography performed for evaluation of her tumor status before TACE incidentally showed gallbladder and common bile duct stones. After TACE, she complained of severe epigastric pain with a positive Murphy's sign. Computed tomography showed emphysematous cholecystitis and pneumobilia. She was successfully treated with emergent biliary stone removal by endoscopic retrograde cholangiopancreatography.
Aged ; Carcinoma, Hepatocellular ; Chemoembolization, Therapeutic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis, Acute ; Common Bile Duct ; Emphysematous Cholecystitis ; Female ; Gallbladder ; Humans ; Palliative Care