Abstract
A 52-year-old man admitted for nausea, fever, and right hypochondrial pain was found in abdominal ultrasonography to have a swollen stone-free gallbladder with thickened walls. He was diagnosed as having acute acalculous cholecystitis and immediately treated with percutaneous transhepatic gallbladder aspiration (PTGBA), yielding suppurative bile. His fever and abdominal pain did not disappear, however, necessitating emergency cholecystectomy 48 hours after symptom onset. Laparotomy showed necrotic change in the gallbladder wall. Despite acute septic shock, his general condition immediately improved with hemoperfusion with polymyxin B-immobilized fiber. He was discharged on hospital day 36. Bile culture test showed Aeromonas hydrophila and Clostridium perfringens. Some reports state that these bacteriae infections are highly progressive, causing sepsis followed by multiple organ failure and death. Aeromonas and Clostridium infection accompanied by acute acalculous cholecystitis thus requires particularly vigilant monitoring.
