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Case 184: Hot Gallbladder

This lady has had three days of severe upper abdominal pain. This pain began as a retrosternal pain following food. The pain was felt through to the back. It then settled in the right upper quadrant. Initial ultrasound scan was normal, HIDA scan then showed an obstructed cystic duct. By then the clinical picture of acute cholecystitis was clear and the patient was brought to theatre. An open cholecystectomy was required.

1. What complication has occurred?

The process of acute cholecystitis has progressed to frank necrosis of the gallbladder wall.

2. What is the required treatment?

Urgent cholecystectomy.

This can often still be possible laparoscopically, however, conversion to open procedure is more likely when the process has been continuing for more than three or four days. It is in these cases that there is an inflamed, thickened, friable, and haemorrhagic omental mass wrapped around the gallbladder. There is often also an ileus which makes laparoscopic access difficult.

The case for acutely operating an all patients presenting with cholecystitis before this situation develops is supported by the literature.


Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.



The Historical Perspective
THE EARLY OPERATION FOR ACUTE SEVERE CHOLECYSTITIS: THE RIEDEL PAPER; AN INTRODUCTION AND TRANSLATION