A Case of Acute Acalculous Cholecystitis Occurred by Occlusive Ileus after Total Gastrectomy

Abstract

A 71-year-old man visited our hospital complaining of abdominal distension and pain. He was diagnosed as having an intestinal obstruction. His medical history revealed a total gastrectomy about two years previously. His symptoms improved on fasting, but he had a high fever immediately after having a meal. He was given an antibiotic, but his condition failed to improve and he went into septic shock on the 8th admission day. Physical examination revealed right upper quadrant tenderness. Abdominal computed tomography showed distension of the gallbladder. The patient underwent percutaneous transhepatic gallbladder drainage (PTGBD) under a diagnosis of acute cholecystitis. He was treated with PMX-DHP for the septic shock, and continuous hemodiafiltration for acute renal failure. There were no gallstone and common bile duct stone in contrast imaging of the PTGBD tube. His general condition improved in June and he was discharged in August. Although the occurrence of acute acalculous cholecystitis (AAC) is unusual, its clinical course is rapidly progressive and serious. Therefore, it is important to consider the possibility of AAC, particularly in cases with a postgastrectomy intestinal obstruction.