A Case of Gallbladder Amyloidosis With Perforative Cholecystitis Treated by Emergency Surgery

Abstract

An 85-year-old man was brought to our hospital by ambulance with the chief complaint of lower back pain. Physical examination revealed diffuse abdominal tenderness, and laboratory tests showed marked renal dysfunction and elevated levels of inflammatory markers. Abdominal computed tomography revealed free air and fluid accumulation in the right upper abdomenalong with intraluminal gas within the gallbladder, raising the suspicion of gallbladder perforation. We performed emergency surgery, and as intraoperative exploration revealed perforation at the gallbladder fundus with bile peritonitis, laparoscopic subtotal cholecystectomy was carried out. Postoperatively, the patient was admitted to the intensive care unit under continued intubation and sedation; however, hemodynamic instability persisted despite intensive management and the patient died approximately 8 hours after surgery. Postoperative histopathological examination revealed evidence of acute cholecystitis with deposition of Amyloid A (AA) type amyloid in the vascular walls of the gallbladder, which led to the diagnosis of gallbladder amyloidosis. Although gallbladder amyloidosis is rare, it carries the potential risk of rapid systemic deterioration and should be considered in the differential diagnosis of acute cholecystitis. Careful selection of treatment strategies and perioperative management are essential.