A Case of Acute Cholecystitis with Biliary Peritonitis due to Transudation of Bile from the Gallbladder Treated by Laparoscopic Surgery

Abstract

A 72-year-old man presented with right upper quadrant pain on the first day after surgery for prostate cancer. Contrast-enhanced CT images revealed a thickened gallbladder wall with marked edema and surrounding ascites, but the gallbladder lumen was collapsed and no blood flow disturbance in the gallbladder wall was observed. He was diagnosed with moderate acute acalculous cholecystitis and started receiving antibiotic treatment. However, his condition became severe on the next day, and an emergency surgery was performed. Intraoperative findings revealed the swollen gallbladder due to bile effusion in the subserosal layer and biliary peritonitis caused by bile transudation. The subserosal layer was easily dissected ; thus, the procedure was laparoscopically completed by removing the gallbladder, washing the peritoneal cavity and placing a drain. There was no evidence of perforation of the resected gallbladder, but bile effusion in the subserosal layer was observed. Therefore, the definitive diagnosis of acute acalculous cholecystitis with biliary peritonitis due to transudation of bile from the gallbladder was made. Such a case as we presented here is rare ; however, it could be possible to make an early diagnosis based on marked imaging findings, if we know them well. Early laparoscopic cholecystectomy could be technically easy and a promising treatment option due to the characteristic of the subserosal edema.