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Background/Objectives: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by abnormal blood vessel formation, leading to recurrent epistaxis, cutaneous and mucosal telangiectases, and visceral arteriovenous malformations (AVMs). Hepatic involvement may result in complications such as high-output heart failure, portal hypertension, and biliary ischemia. We report an uncommon case of ischemic cholecystitis in a patient with HHT. Methods: A 57-year-old male with HHT type 1, including gastric telangiectases and hepatic AVMs, presented with anemia, melena, epigastric pain, and a history of recurrent epistaxis. Imaging revealed gastric telangiectases and liver AVMs, consistent with HHT. Following an episode of severe epistaxis and aspiration pneumonia, the patient developed right upper quadrant pain. Results: Abdominal CT and ultrasound identified thickening of the gallbladder wall, segmental enhancement defects, and a perivesicular fluid effusion, suggestive of acalculous cholecystitis. A laparoscopic cholecystectomy was performed, revealing ischemic cholecystitis with necrotic gallbladder walls. Conclusions: This case underscores the potential for ischemic cholecystitis in patients with HHT and liver involvement, particularly under conditions of acute hemodynamic instability. Clinicians should be vigilant in recognizing this rare complication, especially in patients with established HHT and associated hepatic vascular anomalies. [ABSTRACT FROM AUTHOR]

Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by portal cavernoma (PC). Acute acalculous cholecystitis (AAC) represents an infrequent clinical manifestation of PCC. Given the inadequacy of documentation within medical literature, AAC may go undiagnosed among patients with PC presenting symptoms of right upper quadrant pain. The current study aims to report a case of acute acalculous cholecystitis secondary to portal cavernoma, focusing on radiological findings, with a brief review of literature.

The association of appendicitis with synchronous cholecystitis in a child has not yet been reported. Only a few case reports and series have been described involving adults. We describe an 11-year-old female who presented with complaints of right-sided pain abdomen with a history of right inguinal hernia as well. Clinical presentation and imaging were suggestive of calculous cholecystitis, appendicitis, and right inguinal hernia. A single-stage laparoscopic cholecystectomy, appendicectomy, and herniotomy were done using only four standard ports for cholecystectomy with minor modification of port position. The patient had a favorable recovery and had no complications on follow-up. A synchronous association of such common diseases is rare and needs to be kept in mind. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiogenic shock (CS) or heart failure can develop ischemic cholecystitis from a systemic low-flow state. Cholecystectomy in high-risk patients is controversial. Percutaneous cholecystostomy tube (PCT) is often the chosen intervention; however, data on PCT as definitive treatment are conflicting. Data on cholecystectomy in these patients are limited. This study discusses outcomes following laparoscopic cholecystectomy (LC) in this patient population. Methods: This is a retrospective review of patients who underwent LC from 2015 to 2019 while hospitalized for CS or heart failure. Surgical services are provided by fellowship-trained minimally invasive surgeons at a single, academic, tertiary-care center. Patient characteristics are reported as frequencies' percentages for categorical variables. Odds ratio is used to determine the association between comorbidities and complications. Results: Twenty-four patients underwent LC. Around 83% were white and 79% were male. Many were anticoagulated (88%), with Class IV heart failure (63%), and required vasopressors (46%) at the time of surgery. Fourteen of 24 (58%) had at least one circulatory device at the time of surgery: extracorporeal membrane oxygenation, left ventricular assist device, Impella, tandem heart, and total artificial heart. Four patients (17%) had PCT preoperatively. Fifteen days were the average interval between diagnosis and surgery. Pneumoperitoneum was tolerated by all, and 0% converted to open. Most common complication was bleeding (52%). Nine patients (37.5%) underwent 21 reoperations, one of which (4%) was related to cholecystectomy. Mortality occurred in 5 patients (20.8%); interval between cholecystectomy and mortality ranged 6–30 days. Conclusion: Although high risk, LC is a treatment option in patients with ischemic cholecystitis at risk for death from sepsis. [ABSTRACT FROM AUTHOR]

The article recounts a challenging day in a Rwandan ICU on September 23, where two critically ill patients with identical symptoms, including unremitting fever, altered mental states, and multi-organ dysfunction, were evaluated for possible viral hemorrhagic fever (VHF). Despite antibiotic treatment, their conditions worsened, with persistent bleeding complicating management.

Abstract Background Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. Case presentation An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. Conclusion Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

Aim: The clinical picture of acute stoneless cholecystitis can be seen in a wide range from mild lesions to the size that threatens the patient’s life. In this study, we aimed to contribute to the literature by investigating the relationship between patients with acute stone-free cholecystitis and diabetes mellitus (DM). Materials and Methods: Patients were analyzed for age, sex, and blood tests. Descriptive statistics for numerical variables are presented as mean, standard deviation, min-max values. Non-parametric test procedures were performed on non-normally distributed data. In this context, dependent and independent sample t-test and Mann-Whitney U test were used to determine the relationships between the parameters. Spearman’s correlation analysis was used, and chi-square analysis was performed to evaluate the relationship between categorical data. Results: The parameters measured by complete blood count and biochemistry were as follows: neutrophil: 56.72±23.17, C-reactive protein (CRP): 38.31±7.70, aspartate aminotransferase (AST): 78.86±25.80, alanine aminotransferase (ALT): 73.59±159.90, gamma glutamyl transferase (GGT): 142.99±236.08, urea: 37.14±24.41, creatinine: 0.90±0.50, glucose: 115.42±53.70, white blood cell: 8.49±6.66, percentage of neutrophils: 63.80±14.10, platelet: 245.63±84.62. There was a positive correlation between CRP and AST, CRP and ALT, CRP and GGT, and ALT and GGT in DM+ patients. Conclusion: It can be said that advanced age and the presence of DM increase the risk of stoneless cholecystitis, and blood parameters are used to show the presence of infection. In addition, deterioration in liver function tests increases more in patients with DM.

We present a 20 years old male with no known comorbid in emergency complaining of pain localized to the right upper quadrant for two days, followed by fever (101F) with 15-16 episodes of vomiting, which were non-bilious and containing food particles. The patient was vitally stable on examination and had a mild jaundiced look; the abdomen was soft and tender over the right hypochondrium. Ultrasound of the abdomen showed a hypoechoic liver and thick-walled acalculous gall bladder along with pericholecystic fluid, suggesting acute cholecystitis. On further evaluation, the diagnosis of gangrenous cholecystitis was made, and an emergency exploratory laparotomy along with a cholecystectomy was performed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility. Methods: Retrospective data was collected from 314 patients who had undergone a hepatobiliary iminodiacetic acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Sixty‐three patients who were diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. We measured their health‐related quality of life using the HRQoL SF‐12 v2 (Health Related Quality of Life Short Form‐12 version 2) questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t‐test to assess statistically significant differences. Results: 94% (n = 31/33) of the participants in the non‐cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n = 2/30) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF‐12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain. Conclusion: The results of our retrospective analysis demonstrate an improvement in both the physical and mental health‐related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility. [ABSTRACT FROM AUTHOR]

Immunocompromised patients with hematologic malignancies, particularly those treated with anti-CD20 antibodies such as rituximab and obinutuzumab, are known to be at risk of prolonged infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Prolonged administration or combination therapy with antiviral medications reportedly yields favorable outcomes in these patients. However, knowledge regarding the adverse events associated with such therapeutic approaches is limited. Herein, we report a case of acute acalculous cholecystitis (AAC) following extended administration of nirmatrelvir/ritonavir (NMV/r) in a 68-year-old Japanese man with persistent SARS-CoV-2 infection. The patient had received obinutuzumab and bendamustine for follicular lymphoma and was diagnosed with coronavirus disease 2019 (COVID-19) approximately one year after treatment initiation with these drugs. Subsequently, he was admitted to a different hospital, where he received antiviral drugs, monoclonal antibodies, and steroids. Despite these interventions, the patient relapsed and was subsequently transferred to our hospital due to persistent SARS-CoV-2 infection. Remdesivir administration was ineffective, leading to the initiation of extended NMV/r therapy. One week later, he exhibited elevated gamma-glutamyl transpeptidase (GGT) levels, and one month later, he developed AAC. Cholecystitis was successfully resolved via percutaneous transhepatic gallbladder drainage and administration of antibiotics. We speculate that extended NMV/r administration, in addition to COVID-19, may have contributed to the elevated GGT and AAC. During treatment of persistent SARS-CoV-2 infection with extended NMV/r therapy, patients should be carefully monitored for the appearance of findings suggestive of biliary stasis and the development of AAC. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Leptospirosis is an important zoonosis worldwide. Due to nonspecific clinical manifestation and poor recognition in non‐epidemic area, there is often a delay in diagnosis and treatment. Early diagnosis from Metagenomic next‐generation sequencing test is crucial for timely intervention. We presented a case of a 19‐year‐old male patient who developed leptospirosis infection characterized by acalculous cholecystitis and septic shock after typhoon events. Metagenomic next‐generation sequencing (mNGS) helped to early diagnose leptospirosis infection. Finally, the patient achieved full recovery following the antibiotic treatment in addition to supportive care and was discharged. [ABSTRACT FROM AUTHOR]

Background: Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. Case presentation: An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. Conclusion: Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations. [ABSTRACT FROM AUTHOR]

This article discusses the occurrence of acute acalculous cholecystitis (AAC) in patients with dengue fever. Dengue fever is a mosquito-borne disease that is a significant public health threat globally. The study reviewed 12 cases of dengue-associated AAC in Singapore from 2006 to 2015. The patients presented with symptoms such as right hypochondrial pain, fever, and abnormal liver tests. The study found that none of the patients required surgery or invasive procedures, and all were discharged without complications. The article highlights the need for further research on this atypical manifestation of dengue fever. [Extracted from the article]

Intracholecystic papillary neoplasm (ICPN) of the gallbladder is a relatively new concept and a rare neoplasm. ICPNs are found in 0.4% of cholecystectomies. ICPNs are commonly associated with low-to high-grade dysplasia and can be found with invasive foci. To the best of our research, <100 cases (n = 92) are reported worldwide and only 27 cases have been reported in India. We present a case of ICPN with a detailed review of the literature to illuminate the pitfalls of this entity, which is rarely encountered in routine reporting. [ABSTRACT FROM AUTHOR]

Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. This case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously. [ABSTRACT FROM AUTHOR]

Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively. [ABSTRACT FROM AUTHOR]

Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5–10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Background: Gallstones are a well-known risk factor for acute cholecystitis. However, their role as a risk factor for gallbladder perforation (GBP) remains unclear. Therefore, this study aimed to determine the effect of gallstones on the development of GBP. Materials and methods: This large-scale retrospective cohort study enroled consecutive patients who underwent cholecystectomy for acute cholecystitis. The primary endpoint was the role of gallstones as a risk factor for developing GBP. Secondary endpoints included the clinical characteristics of GBP, other risk factors for GBP, differences in clinical outcomes between patients with acalculous cholecystitis (AC) and calculous cholecystitis (CC), and the influence of cholecystectomy timing. Results: A total of 4497 patients were included in this study. The incidence of GBP was significantly higher in the AC group compared to the CC group (5.6% vs. 1.0%, P< 0.001). However, there were no differences in ICU admission and hospital stay durations. The incidence of overall complications was significantly higher in the AC group than in the CC group (2.2% vs. 1.0%, P <0.001). Patients with AC had a higher risk of developing GBP than those with CC (odds ratio, 5.00; 95% CI, 2.94-8.33). In addition, older age (≥ 60 years), male sex, comorbidities, poor performance status, and concomitant acute cholangitis were associated with the development of GBP. Furthermore, the incidence of GBP was significantly higher in the delayed cholecystectomy group than in the early cholecystectomy group (2.0% vs. 0.9%, P <0.001). Conclusions: AC is a significant risk factor for GBP. Furthermore, early cholecystectomy can significantly reduce GBP-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to clarify the incidence, therapeutic modality, and prognosis of acute acalculous cholecystitis and to reveal its optimal treatment strategy. Methods: As a project study of the Japanese Society for Abdominal Emergency Medicine, we performed a questionnaire survey of demographic data and perioperative outcomes of acute acalculous cholecystitis treated between January 2018 and December 2020 from 42 institutions. Results: In this study, 432 patients of acute acalculous cholecystitis, which accounts for 7.04% of acute cholecystitis, were collected. According to the Tokyo guidelines severity grade, 167 (38.6%), 202 (46.8%), and 63 (14.6%) cases were classified as Grade I, II, and III, respectively. A total of 11 (2.5%) patients died and myocardial infarction/congestive heart failure was the only independent risk factor for in‐hospital death. Cholecystectomy, especially the laparoscopic approach, had more preferable outcomes compared to their counterparts. The Tokyo guidelines flow charts were useful for Grade I and II severity, but in the cases with Grade III, upfront cholecystectomy could be suitable in some patients. Conclusions: The proportions of severity grade and mortality of acute acalculous cholecystitis were found to be similar to those of acute cholecystitis, and laparoscopic cholecystectomy is recommended as an effective treatment option. (UMIN000047631). [ABSTRACT FROM AUTHOR]

Key Clinical Message In patients with symptoms of viral infection and marked thickening of the gallbladder wall, it is important to suspect acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis. Abstract A 35‐year‐old Japanese man presented with fever, abdominal right upper quadrant pain, and liver dysfunction. Positive immunoglobulin M and ‐G antibodies and negative nuclear antigen for Epstein–Barr virus were observed. Abdominal ultrasonography revealed a markedly thickened gallbladder wall. Acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis was diagnosed.

Key Clinical Message: In patients with symptoms of viral infection and marked thickening of the gallbladder wall, it is important to suspect acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis. A 35‐year‐old Japanese man presented with fever, abdominal right upper quadrant pain, and liver dysfunction. Positive immunoglobulin M and ‐G antibodies and negative nuclear antigen for Epstein–Barr virus were observed. Abdominal ultrasonography revealed a markedly thickened gallbladder wall. Acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis was diagnosed. [ABSTRACT FROM AUTHOR]

Key Clinical Message When seeing patients who present with atypical lymphocytes and abdominal pain without accompanying symptoms of pharyngitis or lymphadenopathy, acalculous cholecystitis caused by CMV infection should be considered as a differential diagnosis. Abstract A teenage man presented with a fever and epigastric pain. The patient tested positive for cytomegalovirus IgG and IgM. Abdominal ultrasonography and contrast‐enhanced CT revealed hepatosplenomegaly and gallbladder wall thickening. MRI did not identify gallstones or tumorous lesions. He was diagnosed with infectious mononucleosis and acalculous cholecystitis caused by cytomegalovirus.

Introduction: acute cholecystitis is a common disease in adults but relatively rare in children. It is characterized by inflammation of the gallbladder, most commonly caused by gallstones or bile sludge. Acalculous cholecystitis, which occurs without the presence of stones, is a more common form in children and is often associated with systemic or critical illnesses. Case Report: we present the case of a six-year-old girl who presented with a twenty-five-day history of fever, malaise, abdominal pain, and jaundice. Laboratory findings showed leukocytosis and elevated liver enzymes, while abdominal ultrasound revealed gallbladder distension without the presence of stones. A diagnosis of acute acalculous cholecystitis was made. The patient was admitted to the hospital and started on antibiotic therapy and supportive care. During hospitalization, she developed a rash and episodes of elevated temperature. After a multidisciplinary consultation, the therapy was adjusted, and the patient was discharged home with recommendations for follow-up. At the follow-up appointment, inflammatory markers and bilirubin levels had returned to normal ranges. Conclusion: this case emphasizes the importance of continuous monitoring of patients with systemic symptoms and using imaging methods to assess disease progression. Further investigation is necessary to precisely determine the cause of the systemic inflammatory response in such cases. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted to compare the efficacy and safety of ligature application with metallic clip application for cystic duct ligation in laparoscopic cholecystectomy. Methods: This was a cross-sectional study conducted between May 2021 and May 2022 for a duration of 12 months among patients undergoing laparoscopic cholecystectomy (elective or emergency) for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition) in the Department of General Surgery, PSG Hospitals, Coimbatore. Patients were assigned to either Group A (cystic duct occlusion with ligatures) or Group B (cystic duct occlusion with metallic clips). Results: The study found significantly less operating time in the clip group compared to the ligature group. The mean clip/ligature time of the ligature group was 12.30 ± 4.36, and that of the clip group was 8.67 ± 2.87. The mean difference in the clip/ligature time between the study groups was statistically significant, with a p-value of <0.001. We found a significantly shorter time to clip the ligation of the cystic duct as compared to the ligature technique. Both groups found all subjects to have no post-op complications or interventions. In both groups, the median hospital stay was 3 days (IQR 2.0 to 3.0), p-value 0.3589. The surgery and post-surgery follow-up of 1 month were uneventful in both groups. Conclusions: Metal clips are frequently used to tie up the cystic duct, but they have their own limitations and complications. There are equally effective alternative methods available. One such method is the simple, safe, and economical suture ligation of the cystic duct. Although the use of ligatures is associated with a longer duct occlusion time and thereby total surgical duration and also needs greater surgical expertise, they can be used as an equivalent alternative to clips, especially in patients with wide and short cystic ducts. [ABSTRACT FROM AUTHOR]

Background. Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion. Albeit uncommon, the presentation of this patient's symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high. [ABSTRACT FROM AUTHOR]

Postprandial hyperinsulinemic hypoglycemia, although rare, is a well-documented complication that can manifest after upper gastrointestinal surgery. Despite its potential for severe morbidity, the underlying pathogenesis and optimal treatment strategies for this condition remain insufficiently understood. This report presents a compelling case of postprandial hypoglycemia following Billroth-II gastrojejunostomy, characterized by a marked increase in postprandial insulin levels, accompanied by the exaggerated response of incretin hormones. The incretin effect in this patient was found to be exceptionally high, measuring at approximately 90%. While nutritional interventions proved ineffective in alleviating the patient's symptoms, the administration of octreotide significantly attenuated the exaggerated postprandial insulin and incretin response, substantially ameliorating both the symptoms and postprandial hypoglycemia. Monthly subcutaneous injections of long-acting repeatable octreotide were initiated, resulting in the complete resolution of symptomatic postprandial hypoglycemia. Although the patient developed acalculous cholecystitis and gallstone cholangitis 2 years after commencing octreotide therapy, she has remained free from symptomatic postprandial hypoglycemia for more than 4 years. Our case underscores the efficacy of somatostatin analogs in the management of postprandial hyperinsulinemia after gastrointestinal surgery, shedding light on the potential involvement of incretin hormones in the pathophysiology of this condition. [ABSTRACT FROM AUTHOR]

Most hepatitis A infections are acute, self-limiting, and asymptomatic. In rare instances, an extrahepatic complication, like acute cholecystitis, may emerge. Acute cholecystitis is inflammation of the gallbladder wall and is classified into calculous and acalculous. About 90%–95% of cases are brought on by bile duct stones. Acute acalculous cholecystitis (AAC) can be brought on by the structural and functional abnormalities in the gallbladder brought on by viral hepatitis infection. Here, we present a 20-year-old female patient with AAC associated with hepatitis A infection. The patient came with acute epigastric pain, fever, and elevated liver function test. Computed tomography scan examination showed the results of diffuse thickening of the gallbladder wall (8 mm) and pericholecystic fluid without any calculous found, and the serology for viral hepatitis suggested acute hepatitis A infection with positive anti-hepatitis A virus (HAV) immunoglobulin M. Gallbladder distention, thickening of the gallbladder wall, the absence of an acoustic shadow or biliary sludge, perivesical liquid buildup, and the absence of dilatation of the intra- and extrahepatic bile ducts are among the ultrasonographic criteria for diagnosing AAC. Hepatitis A testing should be considered in patients suspected of having acalculous cholecystitis of an undefined etiology in markedly deranged liver function tests in adult patients.

Key Clinical Message: When seeing patients who present with atypical lymphocytes and abdominal pain without accompanying symptoms of pharyngitis or lymphadenopathy, acalculous cholecystitis caused by CMV infection should be considered as a differential diagnosis. A teenage man presented with a fever and epigastric pain. The patient tested positive for cytomegalovirus IgG and IgM. Abdominal ultrasonography and contrast‐enhanced CT revealed hepatosplenomegaly and gallbladder wall thickening. MRI did not identify gallstones or tumorous lesions. He was diagnosed with infectious mononucleosis and acalculous cholecystitis caused by cytomegalovirus. [ABSTRACT FROM AUTHOR]

The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. The article reports a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms. Kruskall-Wallis test, Fisher's Exact test, and Spearman rank correlation were used for statistical analysis. The patients were divided into three groups depending on the timing of the operation: 0–3 days, 4–7 days, or 8–10 days from the onset of symptoms. 1117 patients were studied over a year. The time from the onset of symptoms to EC did not affect the post-operative complications and mortality, the conversion, and the reintervention rate. The time represented a significant risk factor for intraoperative complications (0–3 days, 2.8%; 4–7 days, 5.6%; 8–10 days, 7.9%; p = 0.01) and subtotal cholecystectomies (0–3 days, 2.7%; 4–7 days, 5.6%; 8–10 days, 10.9%; p < 0.001). ACC is an evolutive inflammatory process and, as the days go by, the local and systemic inflammation increases, making surgery more complex and difficult with a higher risk of intraoperative complications. We recommend performing EC for ACC as soon as possible, within the first ten days of the onset of symptoms. [ABSTRACT FROM AUTHOR]

COVID-19 is a multisystem disease and sometimes patient can present with life threatening extra-pulmonary manifestations. Amongst GI symptoms nausea, vomiting, abdominal pain and diarrhoea are common. Severe hepatobiliary manifestations like acute pancreatitis, acute hepatitis and cholecystitis are rare in SARS-CoV-2 infection. In this case series we described three cases presented with hepatobiliary manifestations. All of them had acute abdominal pain and finally proven to be the case of acute pancreatitis and acalculous cholecystitis in addition to classical COVID-19 symptoms. Two of them had severe symptoms and required high volume of oxygen, while one case (acalculous cholecystitis) had mild symptom only. All of them recovered successfully. High degree of clinical suspicion is required while managing atypical presentation of COVID-19 cases. This is also vital to refer the cases to advance care hospitals in time to ensure multidisciplinary care. [ABSTRACT FROM AUTHOR]

INTRODUCTION Acalculous cholecystitis only accounts for 5-15% of cholecystitis cases but more commonly leads to complications such as sepsis. It often develops in the setting of other underlying conditions such as trauma, burns, and strokes, so is therefore frequently overlooked in patients with no comorbidities. CASE REPORT We present a case of acalculous cholecystitis secondary to sepsis from presumed urinary tract infection. The disease presented within six hours of a negative Computer Tomography (CT) scan of the abdomen and pelvis with intravenous contrast. This patient had no underlying conditions that would increase suspicion for severe sepsis or cholecystitis. Following presentation with altered mental status, the patient was admitted to the intensive care unit for sepsis management. Shortly after arrival to the intensive care unit, the patient developed right upper-quadrant pain that prompted the discovery of rapid development acalculous cholecystitis on ultrasound. A percutaneous cholecystostomy was placed, and the patient was discharged in stable condition. CONCLUSION This case reinforces the importance of considering acalculous cholecystitis in patients who present with sepsis and then develop right upper-quadrant pain. A point-of-care ultrasound or repeat abdominal CT should be considered to rule out acalculous cholecystitis. While septic patients may commonly present with variable symptoms, the absence of right upper-quadrant pain or markedly elevated bilirubin does not rule out the rapid development of acalculous cholecystitis. [ABSTRACT FROM AUTHOR]

Background and aims: Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results: We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion: We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to understand the incidence and clinical significance of acalculous cholecystitis in patients with acute hepatitis E (HE). Patients and methods A single center enrolled 114 patients with acute HE. All patients underwent imaging of the gallbladder, and patients with gallstones and cholecystectomy were excluded. Results Acalculous cholecystitis was found in 66 patients (57.89%) with acute HE. The incidence in males was 63.95%, which was significantly higher than in females (39.29%) (P = 0.022). The mean length of hospital stay and the incidence of spontaneous peritonitis in patients with cholecystitis (20.12 ± 9.43 days and 9.09%, respectively) were significantly higher than those in patients without cholecystitis (12.98 ± 7.26 days and 0%, respectively) (P

OBJECTIVE: To assess the incidence of acute acalculous cholecystitis in patients with dengue fever and assess its association with laboratory parameters. METHODOLOGY: This cross-sectional study was conducted in Creek General Hospital, United Medical and Dental College, Karachi, Pakistan, from September 2020 to October 2021. Patients were included in the study through consecutive sampling. After their informed consent, all adult patients diagnosed with dengue fever, based on serological tests, were included in this study. Exclusion criteria were co-existing cholelithiasis, chronic liver disease, hemolytic and rheumatological disorders, metabolic syndrome, dyslipidemia, chronic kidney disease, use of oral contraceptive pills, pregnant females, enteric fever, vasculitis and recent surgery or trauma.The ultrasonographic features of these patients were recorded along with other laboratory investigations. SPSS ver 23.0 was used to analyze the data. Student t-tests and Chi-square tests were used to assess the association between the variables, and a P-value of

Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This case series presents two cases of acute acalculous cholecystitis (AAC)—a rare condition—in young women with central nervous system (CNS) lesions. Both patients had significant neurologic deficits and no well-known risk factors or presence of comorbidities (such as diabetes or a history of cardiovascular or cerebrovascular disease). Early diagnosis is important in cases of AAC owing to its high mortality rate; however, due to neurological deficits in our cases, accurate medical and physical examinations were limited, thereby leading to a delay in the diagnosis. The first case was of a 33-year-old woman with multiple fractures and hypovolemic shock due to a traumatic accident; she was diagnosed with hypoxic brain injury. The second case was of a 32-year-old woman with bipolar disorder and early-onset cerebellar ataxia who developed symptoms of impaired cognition and psychosis; she was later diagnosed with autoimmune encephalopathy. In the first case, the duration between symptom onset and diagnosis was 1 day, but in the second case, it was 4 days from diagnosis based on the occurrence of high fever. We emphasize that if a young woman presents with high fever, the possibility of AAC should be considered, particularly if a CNS lesion is present because it may pose difficulty in the evaluation of typical symptoms of AAC. Careful attention is thus required in such cases. [ABSTRACT FROM AUTHOR]

Background. Blackwater fever (BWF) is a severe clinical syndrome occurring as a complication of malarial infection characterized by intravascular hemolysis, hemoglobinuria, and acute renal failure in people exposed to Plasmodium falciparum and, to some extent, in people who were exposed to medications like quinine and mefloquine. The exact pathogenesis of classic BWF remains unclear. The mechanism leading to damage to the red blood cells (RBCs) can be immunologic nonimmunologic, leading to massive intravascular hemolysis. Case Presentation. We present a case of classic blackwater fever in a 24-year-old otherwise previously healthy male without any history of antimalarial prophylaxis use, returning from recent travel to Sierra Leone. He was detected to have P. falciparum malaria in the peripheral smear test. He was treated with artemether/lumefantrine combination therapy. Unfortunately, his presentation was complicated by renal failure and was managed with plasmapheresis and renal replacement therapy. Conclusion. Malaria continues to be a parasitic disease that can have devastating effects and continues to be a challenge globally. Although cases of malaria in the United States are rare and cases of severe malaria, mainly attributed to P. falciparum, are even more uncommon. Care should be taken to retain a high level of suspicion to consider the diagnosis, especially in returning travelers from endemic areas. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses a rare case of a 90-year-old man with recurrent acalculous cholecystitis in a parastomal hernia, which required surgical management with open cholecystectomy. The patient had a history of bladder carcinoma and ileal conduit surgery. The case highlights the challenges of managing cholecystitis in a hernia, the need for careful dissection, and the potential risks of recurrence despite conservative treatment. The authors emphasize the importance of further research on the safety of closing hernial defects during cholecystectomy. [Extracted from the article]

Background: This study aimed to understand the incidence and clinical significance of acalculous cholecystitis in patients with acute hepatitis E (HE). Patients and methods: A single center enrolled 114 patients with acute HE. All patients underwent imaging of the gallbladder, and patients with gallstones and cholecystectomy were excluded. Results: Acalculous cholecystitis was found in 66 patients (57.89%) with acute HE. The incidence in males was 63.95%, which was significantly higher than in females (39.29%) (P = 0.022). The mean length of hospital stay and the incidence of spontaneous peritonitis in patients with cholecystitis (20.12 ± 9.43 days and 9.09%, respectively) were significantly higher than those in patients without cholecystitis (12.98 ± 7.26 days and 0%, respectively) (P < 0.001 and P = 0.032). Albumin, total bile acid, bilirubin, cholinesterase, and prothrombin activity in patients with cholecystitis were significantly inferior to those in patients without cholecystitis (P < 0.001, P < 0.001, P < 0.001, P < 0.001 and P = 0.003, respectively). After correction by multivariate analysis, albumin and total bile acid were found to be closely related to acalculous cholecystitis in HE. Conclusion: Acalculous cholecystitis is very common in patients with acute HE, and may serve as a predictor of increased peritonitis, synthetic decompensation, and longer hospital stay. [ABSTRACT FROM AUTHOR]

Hepatitis A virus (HAV) has some life‐threatening extrahepatic complications, such as acute acalculous cholecystitis (AAC). We present HAV‐induced AAC in a young female, based on clinical, laboratory, and imaging findings, and conduct a literature review. The patient became irritable, which progressed to lethargy, as well as a significant decline in liver function, indicating acute liver failure (ALF). She was immediately managed in the intensive care unit with close airway and hemodynamic monitoring after being diagnosed with ALF (ICU). The patient's condition was improving, despite only close monitoring and supportive treatment with ursodeoxycholic acid (UDCA) and N‐acetyl cysteine (NAC). [ABSTRACT FROM AUTHOR]

Relatively recently, the concept that immunoglobulin G4 (IgG4)‐related disease is a distinct chronic inflammatory disorder rather than a subset of Sjögren's syndrome has been accepted. IgG4‐related disease (IgG4‐RD) is a fibro‐inflammatory systemic immune‐mediated condition that can affect the pancreas, salivary glands, and lymph nodes. Almost every organ may be impacted synchronously or metachronously by this illness, which causes the development of sclerotic masses of varying sizes. Numerous other rheumatic diseases can present with characteristics of IgG4‐RD, making it difficult to distinguish between them. However, cases of IgG4‐RD involving the bilateral orbits, and pancreas with biological abnormalities are rare. We present a case of an 18‐year‐old female with vitiligo since the age of 3 years who presented with acute pancreatitis and acalculous cholecystitis, bilateral orbital masses, palpebral edema, and eosinophilia. The patient was diagnosed with IgG4‐RD in keeping with clinical presentation and the elevated serum IgG4 level and after elimination of other differential diagnoses. The patient's symptoms gradually relieved after glucocorticoid therapy. This case presents an uncommon combination of clinical features infrequently reported in the literature. Multi‐organ IgG4‐RD is a multisystemic mass, commonly creating diagnostic challenges for clinicians. Furthermore, and more importantly, it highlights the need to keep a differential of IgG4‐RD in mind, to aid in the early and correct treatment of the disease. [ABSTRACT FROM AUTHOR]

(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/−16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis. [ABSTRACT FROM AUTHOR]

Abstract Background Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management. Main body This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions. Conclusion Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.

In this review, we highlight current understanding of the pathogenesis of acalculous cholecystitis, as well as its key imaging and clinical features. We also review what happens after a diagnosis and outline current interventional methods. [ABSTRACT FROM AUTHOR]

Acute acalculous cholecystitis has been associated with critically ill and elderly patients.In the pediatric population, the etiology of this pathology could be an uncommon but potentially significant complication of Epstein-Barr virus infection. This virus is very common in young adults and is associated with fatigue, muscle aches, fever, and in some instances can present with transaminitis and jaundice. This transient hepatocellular injury could lead to gallbladder inflammation. We are going to present our experience and treatment in two patients that presented with abdominal pain and a positive mononucleosis test.

Objective: To determine the ultrasound findings in patients with dengue fever and to evaluate their relationship with laboratory parameters. Study Design and Setting: This prospective cross-sectional study was conducted at –removed for blind review--- from September 2020 to August 2021. Methodology: A total of 248 patients diagnosed with dengue fever, fulfilling the exclusion and inclusion criteria, were included in the study. Demographic data was recorded on a structured proforma. Serological confirmation along with complete blood counts and liver function tests were obtained. Abdominal and chest ultrasounds were conducted in all patients. The ultrasonographic features of these patients were analyzed with laboratory investigations through SPSS version 23. Student’s t-test and Chi-square tests were used assessingess the association between the ultrasonographic findings and laboratory features. A P-value of <0.05 was considered significant. Results: The most common ultrasonographic feature among dengue patients was acalculous cholecystitis (49.6%) followed by hepatomegaly (47.2%), splenomegaly (46.8%), altered echotexture of the liver (46.4%), ascites (37.5%) and pleural effusion (7.3%). Acalculous cholecystitis and ascites were significantly associated with severe thrombocytopenia and increasing hematocrit. Acalculous cholecystitis, ascites, pleural effusion and altered echotexture of the liver were associated with raised transaminases. A low platelet count showed the strongest relationship with sonographic features of capillary leak syndrome. Conclusion: Ultrasound is a useful investigation to diagnose severe, critical dengue. The development of ultrasonographic features should prompt proactive management of these patients in order to prevent emergence of severe complicated dengue. [ABSTRACT FROM AUTHOR]