2025 Volume 75 Issue 2 Pages 153-156
Gangrenous cholecystitis (GC) is a severe and potentially fatal form of acute cholecystitis and therefore requires early surgical treatment. However, lack of specific abdominal symptoms of GC hinders its early diagnosis. Here we present the case of a patients with severe asymptomatic GC who was diagnosed with repeat imaging and persistently elevated inflammatory markers.
A 56-year-old man with a 26-year history of type 2 diabetes mellitus (DM) and 6-year history of hemodialysis due to DM nephropathy was diagnosed with acute cholecystitis based on computed tomography. He had no fever, abdominal pain, or abdominal tenderness and was initiated antibiotic treatment. While the patient did not develop abdominal pain or fever, laboratory tests such leukocytosis and high C-reactive protein level indicated inflammatory response. Follow-up computed tomography obtained seven days after treatment initiation revealed pericholecystic abscess, and he underwent emergency cholecystectomy. Intraoperative findings showed circumferential necrosis of the gallbladder, and pathological diagnosis was GC. The postoperative course was uneventful.
Early deterioration of acute cholecystitis to GC should be considered, regardless of the clinical findings, in patients with severe DM complications.
