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The great imitator: Acute gangrenous Cholecystitis

Allyne Topaz, MD, Lauren Poliakin, MD, Luca Milone, MD. The Brooklyn Hospital Center

Acute gangrenous cholecystitis mimicking acute cardiovascular diseases may lead to a delay in surgical management of cholecystitis. Common symptoms associated with ischemic heart disease, such as chest pain and shortness of breath, may also be associated with noncardiac conditions, like cholecystitis. Acute cholecystitis can causes transient or dynamic ECG changes, likely secondary to gallbladder distension. We have reported 2 cases in a period of 2 months, where the patients presented with cardiac-like symptoms. Both patients were admitted for management of acute cardiovascular conditions, and eventually diagnosed with acute cholecystitis on abdominal ultrasound. The patients were female and obese. Minimally invasive cholecystectomy was performed for both patients, which subsequently led to improvement of symptoms postoperatively.

Case 1: An 81 year old obese female presented to the emergency department with tachycardia and complaints of chest pain and right upper quadrant pain. Her ECG showed atrial fibrillation. Immediate focus and workup surrounded the atrial fibrillation; including  imaging to rule out mesenteric ischemia. Abdominal ultrasound showed multiple gallstones with features of acute cholecystitis. After resuscitation, the patient underwent a laparoscopic subtotal cholecystectomy for acute gangrenous cholecystitis. The degree of inflammation necessitated stapled removal of the gallbladder with placement of a JP drain. The patient recovered well postoperatively. 

Case 2: A 59 year old obese female with a long standing cardiac history presented to the emergency department with complaints of chest pain and epigastric pain. The patient was admitted for further work-up and management of acute coronary syndrome. After life threatening cardiac conditions were ruled out, an abdominal ultrasound showed multiple gallstones with evidence of acute cholecystitis. Robotic assisted subtotal cholecystectomy was performed. The patient had a left sided gallbladder. Given the degree of inflammation, a partial cholecystectomy including lysis of adhesions, and needle decompression was performed. A postoperative ERCP was later performed revealing a small bile leak necessitating sphincterotomy. The patient did well postoperatively and was discharged uneventfully. 

Acute gangrenous cholecystitis may manifest with cardiac-like symptoms postponing the patient's work-up and treatment of cholecystitis. Cholecystitis is a common surgical condition that requires prompt recognition and diagnosis. Timely recognition of gangrenous cholecystitis provides proper treatment and can prevent unnecessary interventions.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95366

Program Number: P005

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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