Acalculous Cholecystitis Publications (1314)


Acalculous Cholecystitis Publications

Pediatr Hematol Oncol
Pediatr Hematol Oncol 2017 Jan 13:1-5. Epub 2017 Jan 13.
d Division of Paediatric Infectious Disease, Royal Aberdeen Children's Hospital and Institute of Medical Sciences, University of Aberdeen , UK.

Acute cholecystitis in patients who are not candidates for surgery is often managed with percutaneous transhepatic gallbladder drainage (PT-GBD). Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with a lumen-apposing metal stent (LAMS) is an effective alternative to PT-GBD. We compared the technical success of EUS-GBD vs PT-GBD, as well as patient outcomes, numbers of adverse events (AEs), length of hospital stay, pain scores, and repeat interventions. Read More

We performed a retrospective study to compare EUS-GBD vs PT-GBD at 7 centers (5 in the United States, 1 in Europe, and 1 in Asia), from 2013 through 2015, in management of acute cholecystitis in patients who are not candidates for surgery. A total of 90 patients (56 men) with acute cholecystitis (61 calculous, 29 acalculous) underwent EUS-GBD (n=45) or PT-GBD (n=45). Data were collected on technical success, clinical success (resolution of symptoms or laboratory and/or radiologic abnormalities within 3 days of intervention), and need for repeat intervention. Characteristics were compared using t tests for continuous variables and the χ2 test, or the Fisher exact test, when appropriate, for categorical variables. Adverse events were graded according to American Society for Gastrointestinal Endoscopy definitions and compared using the Fisher exact test. Post-procedure pain scores were compared using the Mann-Whitney U test.
Baseline characteristics, type, and clinical severity of cholecystitis were comparable between groups. In the EUS-GBD group, noncautery LAMS were used in 30 patients and cautery-enhanced LAMS were used in 15. Technical success was achieved for 98% of patients in the EUS-GBD and 100% of the patients in the PT-GBD group (P=.88). Clinical success was achieved by 96% of patients in the EUS-GBD group and 91% in the PT-GBD group (P=.20). There was a nonsignificant trend toward fewer AEs in the EUS-GBD group (5 patients, 11%) than in the PT-GBD group (14 patients, 32%)(P=.065). There were no significant differences in the severity of the AEs: mild, 2 in the EUS-GBD group vs 5 in the PT-GBD group (P=.27); moderate, 4 vs 3 (P=.98); severe, 1 vs 3 (P =.62); or deaths, 1 vs 3 (P=.61). The mean post-procedure pain score was lower in the EUS-GBD group than in the PT-GBD group (2.5 vs 6.5; P<.05). The EUS-GBD group had a shorter average length of stay in the hospital (3 days) than the PT-GBD group (9 days) (P<.05) and fewer repeat interventions (11 vs 112)(P<.05). The average number of repeat interventions per patients was 0.2 ± 0.4 EUS-GBD group vs 2.5±2.8, in the PT-GBD group (P<.05). Median follow-up after drainage was comparable in EUS-GBD group (215 days; range 1-621 days) vs the PT-GBD group (265 days; range, 1-1638 days).
EUS-GBD has similar technical and clinical success compared to PT-GBD and should be considered an alternative for patients who are not candidates for surgery. Patients who undergo EUS-GBD seem to have shorter hospital stays, lower pain scores, and fewer repeated interventions, with a trend toward fewer AEs. A prospective, comparative study is needed to confirm these results.

Urology 2016 Dec 27. Epub 2016 Dec 27.
Department of Urology, Jichi Medical University, Tochigi, Japan. Electronic address:

A 71-year-old man with metastatic renal cell carcinoma presented with abdominal pain during treatment with axitinib. The diagnoses were axitinib-induced pneumatosis intestinalis (PI) and acute acalculous cholecystitis (AC). The patient's condition improved with antibiotics, bowel rest, and discontinuation of the axitinib therapy. Read More

This is the first case report in the literature. PI and AC induced by other vascular endothelial growth factor receptor tyrosine kinase inhibitors are usually self-limiting upon discontinuation of those uses, but can be life-threatening in some cases. We need to be aware of axitinib-induced PI and AC to avoid delayed or inappropriate treatments for them.

Oxf Med Case Reports
Oxf Med Case Reports 2016 Nov 4;2016(11):omw074. Epub 2016 Nov 4.
Columbia Asia Hospital , Kirloskar Business Park , Hebbal , Bangalore.

Dengue fever is a mosquito-borne arthropod-borne viral (arboviral) tropical disease in humans affecting 50-528 million people worldwide. The acute abdominal complications of dengue fever are acute appendicitis, acute pancreatitis, acute acalculous cholecystitis and non-specific peritonitis. Acute pancreatitis with new onset diabetes in dengue shock syndrome (DSS) is very rarely reported. Read More

We describe a case of 30-year-old man admitted in intensive care unit and was diagnosed with DSS with RT-PCR, NS1 antigen and dengue IgM antibody being positive. Abdominal ultrasound and computerized tomography confirmed acute pancreatitis. Patient required insulin after recovery. Diabetes mellitus caused by DSS is under-reported and lack of awareness may increase mortality and morbidity.

J Trop Med
J Trop Med 2016 29;2016:5917934. Epub 2016 Nov 29.
Deen Dayal Upadhyay Hospital, Hari Nagar, Clock Tower, New Delhi, Delhi 110064, India.

Introduction. Dengue fever is an arboviral disease, which is transmitted by mosquito vector and presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Unless we are aware of these presentations, diagnosis as well as early initiation of treatment becomes difficult. Read More

We studied the various clinical presentations of dengue infection during an outbreak of disease in 2015. Materials and Methods. A total of 115 confirmed cases of dengue infection from Department of Medicine of Deen Dayal Upadhyay Hospital, New Delhi, were enrolled in this observational study. Results. The common signs and symptoms of dengue infection were fever, headache, body ache, backache, retro-orbital pain, bleeding manifestations, and rash in 100%, 87%, 86%, 58%, 41%, 21%, and 21%, respectively. Nonspecific or warning signs and symptoms included vomiting, weakness, abdominal pain, breathlessness, vertigo, sweating, and syncope. Other possible signs and symptoms of coinfections, comorbidities, or complications included diarrhea, sore throat, and neurological manifestations. There were seven patients with coinfections and four with comorbidities. The final diagnosis of these patients was DF (73%), DHF (16.5%), DSS (1.7%), and EDS (4.3%). Among EDS patients, the atypical presentations included encephalopathy, lateral rectus nerve palsy, acalculous cholecystitis, and myocarditis. Four patients required ICU care and there was no death in this study. Conclusion. Knowledge of atypical presentations is a must for early diagnosis and timely intervention to prevent life-threatening complications.

Semin. Ultrasound CT MR
Semin Ultrasound CT MR 2016 Dec 17;37(6):549-560. Epub 2016 Aug 17.
Liver Imaging Team, Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey. Electronic address:

Liver function assessment by hepatocyte-specific contrast-enhanced magnetic resonance imaging is becoming a new biomarker. Liver function can be assessed by T1 mapping (reduction rate) and signal intensity measurement (relative enhancement ratio) before and after GD-EOB-DTPA (gadoxetic acid) administration, as alternative to Tc-99m galactosyl serum albumin scintigraphy, 99m Tc-labeled mebrofenin scintigraphy, and indocyanine green clearance test. Magnetic resonance imaging assessment of liver function can enable diagnosis of cirrhosis, nonalcoholic fatty liver disease associated fibrosis and steatohepatitis, primary sclerosing cholangitis, toxic hepatitis, and chemotherapy and radiotherapy-related changes, which may be only visible on hepatobiliary phase images. Read More

Simple visual assessment of signal intensity at hepatobiliary phase images is important for the diagnosis of different patterns of liver dysfunction including diffuse, lobar, segmental, and subsegmental forms. Furthermore, preoperative assessment of liver function is feasible before oncologic hepatic surgery, which may be important to prevent posthepatectomy liver failure and to estimate future remnant volume. Functional magnetic resonance cholangiography obtained by T1-weighted images at hepatobiliary phase can allow diagnosis of acalculous cholecystitis, biliary leakage, bile reflux to the stomach, sphincter of oddi dysfunction, and lesions with communication to biliary tree. Functional information can be easily obtained when Gd-EOB-DTPA is used for liver magnetic resonance imaging.

Case Rep Med
Case Rep Med 2016 26;2016:6796094. Epub 2016 Oct 26.
Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

This case reveals the complexities and challenges in the diagnosis of acute Epstein-Barr virus (EBV) infection, indicating the potential relationship between EBV infection and severe icteric hepatitis, acalculous cholecystitis, and lymphocytic vasculitis. We suggest including EBV infectious mononucleosis in the list of differential diagnoses when any of these clinical syndromes (or a combination thereof) occurs without apparent cause, especially in the presence of lymphocytosis. To our knowledge, this is the first report to suggest the possible role of EBV in the pathogenesis of cutaneous lymphocytic vasculitis. Read More

Also it is possible that EBV infection triggered the flare-up of the underlying rheumatologic disease. Therefore, it could be assumed that a part of the clinical syndrome (e.g., dermatologic manifestations) might be related to the flare-up of the underlying rheumatologic disease.

J. Gastroenterol. Hepatol.
J Gastroenterol Hepatol 2016 Oct;31(10):1673
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Intern. Med.
Intern Med 2016;55(20):3043-3046. Epub 2016 Oct 15.
Division of Rheumatology, Fukuoka Red Cross Hospital, Japan.

Acute acalculous cholecystitis (AAC) is a severe disease seen in critically ill patients, including those with autoimmune diseases. We herein report the case of a 41-year-old female who developed macrophage activation syndrome (MAS) accompanied by a recurrence of Kikuchi disease. Abdominal imaging revealed marked thickening of the gallbladder wall and pericholecystic fluid, typically found in AAC. Read More

Treatment with intravenous pulse methylprednisolone induced in a significant improvement in the gallbladder wall, resulting in no need for surgical intervention. We should consider that patients with MAS may therefore sometimes develop AAC and that early immunosuppressive therapy can be effective in AAC cases associated with rheumatic or autoimmune diseases.

Surg Case Rep
Surg Case Rep 2016 Dec 12;2(1):111. Epub 2016 Oct 12.
Department of Pathology, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.