P3507 - Unveiling the Unseen: Diverse Presentations of Cholecystitis in a Two Case Series

Walaa Hasan, MD, Kavina Sathiyasothy, MD, Roma Patel, MD, Ahmed Omran, MD, Michael Viksjo, MD
Trinitas Regional Medical Center, Elizabeth, NJ

Introduction: Acute cholecystitis is a common gastrointestinal condition typically presents with symptoms such as right upper quadrant pain, fever, and tenderness. However, incidental findings of painless acute cholecystitis are rare and pose a diagnostic challenge due to the absence of classical symptoms.

Case Description/Methods: We report two patients incidentally diagnosed with acute cholecystitis during CT scans for unrelated health issues. In initial case, a 60-year-old male with a history of type 2 diabetes mellitus (DM) presented with suicidal ideation. Initial lab results were significant for hypokalemia and hypomagnesemia. A CT scan of abdomen identified an intrarenal calculus, but no evidence of an infectious process was observed. In subsequent days, his white blood cell count and liver enzymes exhibited an upward trend. Complaints of dysuria and hematuria prompted a repeat CT scan, revealing a markedly distended gallbladder with fat stranding, indicative of acute cholecystitis. Ultrasonography of the gallbladder depicted biliary sludge, gallbladder wall thickening, and pericholecystic fluid. Although he experienced mild nonspecific abdominal pain during this period, a laparoscopic cholecystectomy was performed, unveiling perforated gangrenous cholecystitis. In the second case, a 47-year-old female with a history of type 2 DM initially presented with bilateral lower extremity edema, accompanied by dysuria. Lab results were consistent with diabetic nephropathy. An abdominal ultrasound revealed a linear echogenic structure in the posterior gallbladder wall, indicating layering gallstones or wall calcification (porcelain gallbladder) with pericholecystic fluid, suggesting acute cholecystitis. A robotic cholecystectomy was performed. Both patients were discharged post-surgery without complications. Postoperative pathology reports for both patients confirmed the diagnosis.

Discussion: Incidentally discovered acute cholecystitis during unrelated health imaging underscores the varied presentations of the condition and the need for heightened awareness in diabetic patients. The rarity of painless acute cholecystitis stresses the importance of considering the diagnosis despite atypical symptoms. Prompt diagnosis through imaging requires vigilance to prevent complications, highlighting the significance of timely intervention, including conservative and surgical measures, for favorable outcomes.


Disclosures:


Walaa Hasan, MD, Kavina Sathiyasothy, MD, Roma Patel, MD, Ahmed Omran, MD, Michael Viksjo, MD. P3507 - Unveiling the Unseen: Diverse Presentations of Cholecystitis in a Two Case Series, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.