Advocate Illinois Masonic Medical Center Palos Heights, IL
Ahmed Abuhasna, DO1, Sufyan AbdulMujeeb, DO2, Marc Fine, MD2 1Advocate Illinois Masonic Medical Center, Palos Heights, IL; 2Advocate Lutheran General, Niles, IL
Introduction: Cholecystitis, marked by inflammation of the gallbladder, presents in both acute and chronic forms. Chronic cholecystitis, though less common, signifies persistent inflammation of the gallbladder. While most cases are gallstone-related, approximately 5 to 10% fall under chronic acalculous cholecystitis. Diagnostic imaging typically shows thickened gallbladder wall on ultrasound, CT, and MRI scans. In cases where these findings are inconclusive, HIDA scans are often preferred, serving as the diagnostic mainstay for chronic acalculous cholecystitis. The primary treatment entails laparoscopic cholecystectomy.
Case Description/Methods: We report a case of a 61-year-old female who presented with postprandial right upper quadrant (RUQ) pain with fatty and non-fatty food alike. Subsequent work up with further imaging included ultrasound, HIDA, CT scan, and gastric emptying study. All of which showed no substantial abnormalities. EGD was also pursued, but showed no findings to explain postprandial RUQ pain. Due to persistent symptoms and subsequent significant weight loss, empiric cholecystectomy was suggested. Shortly after surgery, all of her symptoms resolved and she started to gain back the weight she had lost. Pathology revealed chronic acalculous cholecystitis.
Discussion: Chronic acalculous cholecystitis usually tends to have some imaging abnormality either in the form of thickened gallbladder wall or reduced ejection fraction on HIDA. In cases such as this one, having a high clinical suspicion of pain secondary to biliary etiology can lead to correct management and shows that empiric cholecystectomy can be a reasonable option after exhausting all avenues.
Figure: Figure 1: Herniation of mucosal glands into the muscularis layer
Disclosures:
Ahmed Abuhasna indicated no relevant financial relationships.
Sufyan AbdulMujeeb indicated no relevant financial relationships.
Marc Fine indicated no relevant financial relationships.
Ahmed Abuhasna, DO1, Sufyan AbdulMujeeb, DO2, Marc Fine, MD2. P1875 - Empiric Cholecystectomy in Postprandial RUQ Pain: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
