Cholescintigraphy in Acute Acalculous Cholecystitis

Acute acalculous cholecystitis is a relatively rare but potentially lethal condition if not treated promptly. Since stones are not present, diagnostic procedures such as ultrasound or other radiological procedures are frequently not helpful. Tc-99m iminodiacetic acid scan results were analyzed in 11 proven cases of acute acalculous cholecystitis. All had positive tests with nonvisualization of the gallbladder giving a sensitivity of 100%. Tc-99m iminodiacetic acid cholescintigraphy is a highly reliable test and is easily performed even in acutely ill patients and should be the test of choice in all patients predisposed to and suspected of acute acalculous cholecystitis.     

Acute Cholecystitis Complicating Unrelated Disease: Etiological Considerations

The phenomenon of acute cholecystitis complicating an unrelated operation has been reported with increasing frequency, and may be preceded by a variety of operative procedures and a lack of previous biliary tract symptoms. Among eight such patients treated by us, seven developed acute cholecystitis postoperatively, and in one it was discovered during operation for bleeding duodenal ulcer. Two patients had undergone wide excision of the breast; two, highly selective vagotomy; one, nephrolithotomy; one, truncal vagotomy and gastroenterostomy; and one, left hemicolectomy and colostomy. In three patients, urgent cholecystectomy was performed, and four were treated conservatively with subsequent elective cholecystectomy. Histopathological studies revealed acute and chronic cholecystitis in all eight patients and cholelithiasis in four. One patient died in septic shock. Numerous contributing factors have been suggested, including hypovolemia and biliary stasis, as well as the presence of stones. It would appear that chronic cholecystitis or other biliary pathology, as found in our eight patients, is a major factor in the development of this manifestation.     

Unusual Presentation of Mucosal Hypersensitivity Secondary to Gastroesophageal Reflux Disease

We report an unusual presentation of Gastroesophageal reflux disease in a 14-yr-old boy with cervical dysphagia and vomiting immediately after swallowing. Reflux disease was diagnosed by the combination of eosinophils on esophageal biopsies and abnormal 24-h pH results. The cervical site of dysphagia demonstrated acid-induced hypersensitivity to esophageal distension with water or air. The patient's symptoms resolved with marked acid suppression, which was made difficult because intact capsules of omeprazole initially could not be ingested.     

Enterically Transmitted Non-A, Non-B Hepatitis Mimicking Acute Cholecystitis

Objectives : To study the significance of cholecystitislike presentation and increased gallbladder wall thickness (GBWT) in patients with acute viral hepatitis (AVH). Methods : Sixty-seven consecutive patients with acute viral hepatitis (hepatitis A:3, hepatitis B:13, and enterically transmitted non-A, non-B hepatitis: 51) were included in this prospective study. Clinical assessment and sonographic evaluation of the GBWT were carried out every week until recovery from acute hepatitis. Results : The clinical presentation in 16 patients with hepatitis A and B and in 29 patients with enlerically transmitted non-A, non-B hepatitis (ET-NANB hepatitis) was typical of AVH, and the mean GBWT in these patients was 6.16 ± 2.23 mm and 7.28 ± 2.93 mm, respectively. The remaining 22 patients with ET-NANB hepatitis presented with features suggestive of acute cholecystitis (fever, severe pain, and tenderness right hypoehondrium), and the mean GBWT in these patients (10.18 ± 2.58 mm) was significantly higher compared with the rest of the patients with AVH ( p < 0.001). The mean GBWT in patients with AVH (7.31 ± 0.97 mm) was significantly higher compared with controls (1.76 ± 2.17 mm) ( p < 0.001). All patients with acute cholecystitis-like presentation recovered with conservative medical management. A time-dependent normalization of the thickened gallbladder wall was observed in all the patients within 6 wk. Conclusion : A proportion of our patients with ET-NANB hepatitis presented with acute cholecystitislike picture and had markedly thickened gallbladder wall on ultrasonography. These patients made an uneventful recovery, and the sonographic abnormalities disappeared within 6 wk.     

Gallstones

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