Left subphrenic abscess associated with acute acalculous cholecystitis treated by emergent laparoscopic surgery: a case report

Abstract

A 95-year-old male, who had been in the referring hospital for schizophrenia for 75 years, developed a fever and cough. He was diagnosed with aspiration pneumonia and treated with intravenous antibiotics, but his condition did not improve. Therefore, thoracoabdominal contrast enhanced CT was performed, which revealed acute cholecystitis and concomitant left subphrenic abscess associated with gallbladder perforation. Then he was referred to our hospital for further evaluation and treatment. As the location of the abscess was atypical if it was due to gallbladder perforation, upper gastrointestinal endoscopy was conducted considering the possibility of the upper gastrointestinal perforation. However, there were no findings suggestive of tumors or ulcers, so we decided to perform emergent surgery. Cholecystectomy and intra-abdominal drainage were completed laparoscopically. Because no choleliths or debris were recognized during the surgery, he was diagnosed with acalculous cholecystitis. The treatment was completed by emergent surgery technically safely without preoperative conservative therapy though he was a very elderly patient. He was discharged to the referring hospital without any postoperative complications 17 days after surgery. Herein, we report a rare case of the left subphrenic abscess involved with gangrenous cholecystitis.