Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient:A case report and review of the literature

BACKGROUND Acute acalculous cholecystitis(AAC)is inflammation of the gallbladder without evidence of calculi.Although rarely reported,its etiologies include hepatitis virus infection(e.g.,hepatitis A virus,HAV)and adult-onset Still’s disease(AOSD).There are no reports of HAV-associated AAC in an AOSD patient.CASE SUMMARY Here we report a rare case of HAV infection-associated AAC in a 39-year-old woman who had a history of AOSD.The patient presented with an acute abdomen and hypotension.Elevated hepatobiliary enzymes and a thickened and distended gallbladder without gallstones on ultrasonography suggested AAC,but there were no signs of anemia nor thrombocytopenia.Serological screening revealed anti-HAV IgM antibodies.Steroid treatment did not alleviate her symptoms,and she was referred for laparoscopic cholecystectomy.The resected gallbladder was hydropic without perforation,and her clinical signs gradually improved after surgery.CONCLUSION AAC can be caused by HAV in AOSD patients.It is crucial to search for the underlying etiology for AAC,especially uncommon viral causes.

Acute acalculous cholecystitis immediately after gastric operation:Case report and literatures review

Acute acalculous cholecystitis(AAC)is a rare complication of gastric surgery.The most commonly accepted concepts regarding its pathogenesis are bile stasis,sepsis and ischemia,but it has not been well described how to identify and manage this disease in the early stage.We report three cases of AAC in elderly patients immediately after gastric surgery,which were treated with three different strategies.One patient died 42 d after emergency cholecystectomy,and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage,respectively.These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery.We further reviewed reported cases of AAC immediately after gastric operation,which may expand our knowledge of this disease.

A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma

Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.

Acalculous cholecystitis:A rare presentation of leptospirosis progressing to Weil's disease

Leptospirosis is a zoonotic infection with higher incidence in tropics.Leptospirosis,is known for its variable manifestations,and is a clinical challenge for physicians in the tropics.Experienced clinicians,at times can mistake leptospirosis for non-medical conditions.A few reports of Leptospirosis presenting as acalculous cholecystitis was found in review of literature.We intent to highlight acalculous cholecystitis as a rare hut clinically significant presentation of leptospirosis.

O Measles-Associated Acute Acalculous Cholecystitis

Background Measles is a highly contagious viral infection whose complications most commonly involve the respiratory tract and the central nervous system. We report here what we think to be the first case of acute acalculous cholecystitis occurring during the course of measles. Case Presentation A 22-year-old female presented with fever, sore throat, coryza and an erythematous maculopapular eruption. The diagnosis of measles was confirmed by the presence of IgM antibodies to measles virus in the absence of IgG antibodies. After initial favorable evolution, she developed abdominal pain with positive Murphy’s sign and elevated liver enzymes. Ultrasonographic examination of the abdomen showed thickening (6.5 mm) of the gallbladder wall in the absence of stones or biliary tract dilatation. Evolution was spontaneously favorable, so that neither antibiotic therapy nor surgical intervention were necessary. Conclusion In the context of worldwide recent measles outbreak, we think that clinicians should be aware of the possible occurrence of acute acalculous cholecystitis, a pathology usually associated with a high rate of complications.

Spontaneous gallbladder perforation and colon fistula in hypertriglyceridemia-related severe acute pancreatitis:A case report

BACKGROUND Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis(SAP).However,neither spontaneous gallbladder perforation nor cholecysto-colonic fistula has been reported in acalculous acute pancreatitis patients.CASE SUMMARY A 31-year-old male presenting with epigastric pain was diagnosed with hypertriglyceridemia-related SAP.He suffered from multiorgan failure and was able to leave the intensive care unit on day 20.Three percutaneous drainage tubes were placed for profound exudation in the peripancreatic region and left paracolic sulcus.He developed spontaneous gallbladder perforation with symptoms of fever and right upper quadrant pain 1 mo after SAP onset and was stabilized by percutaneous drainage.Peripancreatic infection appeared 1 mo later and was treated with antibiotics but without satisfactory results.Then multiple colon fistulas,including a cholecysto-colonic fistula and a descending colon fistula,emerged 3 mo after the onset of SAP.Nephroscopy-assisted peripancreatic debridement and ileostomy were carried out immediately.The fistulas achieved spontaneous closure 7 mo later,and the patient recovered after cholecystectomy and ileostomy reduction.We presume that the causes of gallbladder perforation are poor bile drainage due to external pressure,pancreatic enzyme erosion,and ischemia.The possible causes of colon fistulas are pancreatic enzymes or infected necrosis erosion,ischemia,and iatrogenic injury.According to our experience,localized gallbladder perforation can be stabilized by percutaneous drainage.Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.CONCLUSION Gallbladder perforation and cholecysto-colonic fistula should be considered in acalculous SAP patients.