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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.

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.

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.

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]