TITLE:
Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman
AUTHORS:
Vera Clérigo, Cláudia Rocha, André Rodrigues, Lígia Fernandes, Dora Sargento, Glória Silva
KEYWORDS:
Diabetes Mellitus, Elderly, Gangrenous Acute Cholecystitis
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.9,
September
2,
2014
ABSTRACT: In elderly patients,
numerous factors subsidize the diagnostic challenge and high incidence of
complications in this specific population, taking gangrenous cholecystitis as a
critical example. The aim of this work is to report an unusual case of
gangrenous choleystitis in an elderly diabetic women and its atypical clinical
presentation. A 79-year-old female patient came to our observation; her medical
history showed nausea and vomiting of about 2 hours which
rapidly ended with symptomatic therapy, without recurrence, and
a 3-week history of intermittent fever associated with productive cough. No
abdominal discomfort was declared. Physical examination of the abdomen was
negative. Laboratory analysis revealed leukocytosis with the remaining criteria
within the normal range. After 2 days, she started with a mildabdominal
pain in the epigastric region that rapidly progressed to
the right upper quadrant, right flank and right iliac fossa,
without nausea, vomiting or fever. Abdominal computer tomography findings
revealed thickness of the gall-bladder and
important densification of the vascular bed. Acute
cholecystitis was diagnosed. The patient was then submitted to a laparoscopic
cholecystectomy under general anaesthesia
with findings suggestive of gangrenous acute cholecystitis confirmed by histologic
examination of the specimen. Delays in diagnosing acute cholecystitis in
specific populations, such as elderly diabetics, result in a higher prevalence
of morbidity and mortality due to potentially serious complications as
gangrenous cholecystitis. Consequently, the diagnosis should be measured and
investigated promptly in order to prevent poor outcomes.