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We describe an unfavourable outcome for the conservative management applied to a case of placenta percreta in a 32 year-old woman who referred to our obstetrics department with irregular vaginal bleeding. Her medical history pointed out she had undergone a corporeal caesarean one month before. Ultrasonography revealed a hyperechoic mass in the uterine cavity. After careful investigation by serial values of beta HCG, ultrasound, magnetic resonance imaging (MRI) and exploratory cystoscopy for assessing the degree of placental accretisation we decided to perform an inter-adnexal total hysterectomy with bilateral hypogastric artery ligation. To prevent immediate complications an early diagnosis and a prompt evaluation of the bleeding are important, while a careful follow up is also necessary for predicting any subsequent serious consequences.

Acute acalculous cholecystitis associated with Epstein Barr virus (EBV) infection is a known entity, as opposed to the extremely rare cases of cystic duct stenosis secondary to EBV- related inflammation. The authors present the case of a 10-year-old male patient admitted with altered general state, anorexia, painful and distended abdomen. The patient had a history of EBV acute hepatitis two years prior to the current presentation, diagnosed based on clinical examination (fever, vomiting, and severe pain of right upper abdominal quadrant), and abdominal ultrasound revealing acute acalculous cholecystitis with gallbladder hydrops; still no indication for surgical treatment was made. The clinical outcome was favorable, but during those two years he suffered two episodes of chronic acalculous cholecystitis exacerbation, which required a MRI examination, indicating gallbladder hydrops and narrowing of terminal segment of the cystic duct (secondary inflammatory processes). The biological investigations revealed cholestasis, hepatocytolysis and inflammatory syndrome and the abdominal-ultrasound indicates an acalculous gallbladder and gallbladder hydrops. After cholecystectomy, the histopathological examination revealed chronic inflammation of the gallbladder wall, setting the diagnosis of exacerbation of chronic acalculous cholecystitis. Particularly for the case is the development of cystic duct stenosis, after the EBV acute infection. The clinical and laboratory outcome (monitored after 1, 3, 6, and 12 months) was favorable.