Abstract
A 69-year-old man was admitted to the hospital because of gradually increasing difficulty in eating in 10 days of medication for his chief complaint of epigastric pain at another hospital. There was tenderness covering from the epigastrium to right hypochondriac region. On blood analysis, white blood cell count was 13850/μml, platelet count was 92000/μml, and CRP was 35.5mg/dl, indicating severe infection. Abdominal CT scan revealed subdiaphragmatic ascites and thickening of the gallbladder, presenting cholecystitis. There were no apparent stones. Upon laparotomy, there were large volumes of purulent ascites and Eiterbelag in the fundus of the gallbladder, and a perforation of the gallbladder. Histopathological findings included bleeding and infiltration of neutrophile over the full thickness of the cystic wall and necrosis of the cystic wall at the perforated site. Arteriosclerosis was observed in arteriolae.
Attention has come to be paid to the presence of arteriosclerosis as an underlying disease for acalculous cholecystitis in outpatients. It is thought that acaluculous cholecystitis is caused by ischemia due to arteriosclerotic occlusion of arteriolae. In this case, ischemia due to arteriosclerosis might cause the disease.
