|
1
|
Zanchetta M, Adani GL, Micheletti G, Poto GE, Piccioni SA, Carbone L, Monteleone I, Sandini M, Marrelli D, Calomino N. Perforated Calculous Cholecystitis and Incidental Squamous Cell Carcinoma of the Gallbladder-A Complex Relationship with a Difficult Management in the Acute Setting. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:452. [PMID: 40142263 PMCID: PMC11944027 DOI: 10.3390/medicina61030452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 02/23/2025] [Accepted: 03/04/2025] [Indexed: 03/28/2025]
Abstract
The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC.
Collapse
Affiliation(s)
- Matteo Zanchetta
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Gian Luigi Adani
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Giorgio Micheletti
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Gianmario Edoardo Poto
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Stefania Angela Piccioni
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Ludovico Carbone
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Ilaria Monteleone
- Diagnostic Imaging Unit, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy
| | - Marta Sandini
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Natale Calomino
- Kidney Transplant Unit, Department of Medicine, Surgery and Neuroscience, Siena University Hospital, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| |
Collapse
|
|
2
|
Ghio M, Billiot A, Zagory JA, Brandt ML. Cholecystitis secondary to Salmonella typhi: a rare pathology with an unreported management option—a case report and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This report describes the presentation and course of treatment for one of the youngest reported cases of empyema of the gallbladder. Given the rare occurrence of this disease process, we elected to proceed with a systematic review of the literature. This is only the 7th case series discussing pediatric empyema of the gallbladder due to Salmonella typhi in the literature, and the second case ever reported in the USA.
Case presentation
We report a case of a previously healthy 13-month-old girl who presented with diffuse peritonitis and equivocal imaging studies. Diagnostic laparoscopy revealed purulent peritonitis. The gallbladder was distended with intraluminal pus. Laparoscopy was converted to laparotomy to facilitate exposure, and a cholecystostomy tube was placed. Cultures from the fluid were positive for Salmonella typhi. The patient received a 14-day course of intravenous Ceftriaxone followed by 14 days of oral amoxicillin and clavulanate. A cholangiogram performed 8 weeks after surgery confirmed normal biliary anatomy. The cholecystostomy tube was removed. The patient recovered uneventfully and is doing well over 9 months later.
Conclusion
There is no consensus on treatment with options reported ranging from medical management with antibiotic therapy to more invasive procedures such as cholecystostomy tube or cholecystectomy. Less invasive management options are an alternative for Salmonella cholecystitis.
Collapse
|
|
3
|
Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
Collapse
Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
| |
Collapse
|
|
4
|
Iqbal S, Khajinoori M, Mooney B. A case report of acalculous cholecystitis due to Salmonella paratyphi B. Radiol Case Rep 2018; 13:1116-1118. [PMID: 30233740 PMCID: PMC6138858 DOI: 10.1016/j.radcr.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/24/2018] [Accepted: 07/08/2018] [Indexed: 12/11/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare condition occurring in only 5%-10 % of patients with acute cholecystitis. Systemic illness caused, for example, by E coli, Klebsiella pneumoniae, Vibrio cholera, and Salmonella species can result acute inflammation of gallbladder wall. It is a surgical emergency and if left untreated can lead to high mortality due to gangrene or perforation of gallbladder. We managed a 60-year-old female with clinical presentation of acute cholecystitis caused by Salmonella-induced gastroenteritis. Prompt use of radiological modalities such as computer tomography (CT scan) and ultrasound played an important role in pathologic diagnosis, overall follow up, and management of the patient.
Collapse
Affiliation(s)
- Syma Iqbal
- Barwon Health, 2 Villiers Drive Point cook, Victoria 3030, Australia
| | - Mesooma Khajinoori
- Barwon Health, Ryrie Street & Bellerine Street, Geelong, Victoria 3220, Australia
| | - Brendon Mooney
- South West Healthcare, 25 Ryot St, Warrnambool, Victoria 3280, Australia
| |
Collapse
|
|
5
|
Unusual Manifestation of Live Staphylococcus saprophyticus, Corynebacterium urinapleomorphum, and Helicobacter pylori in the Gallbladder with Cholecystitis. Int J Mol Sci 2018; 19:ijms19071826. [PMID: 29933576 PMCID: PMC6073424 DOI: 10.3390/ijms19071826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022] Open
Abstract
Culture-independent studies have identified DNA of bacterial pathogens in the gallbladder under pathological conditions, yet reports on the isolation of corresponding live bacteria are rare. Thus, it is unclear which pathogens, or pathogen communities, can colonize the gallbladder and cause disease. Using light microscopy, scanning electron microscopy, culture techniques, phylogenetic analysis, urease assays and Western blotting, we investigated the presence of live bacterial communities in the gallbladder of a cholecystitis patient after cholecystectomy. 16S rRNA gene sequencing of isolated bacterial colonies revealed the presence of pathogens most closely resembling Corynebacterium urinapleomorphum nov. sp., Staphylococcus saprophyticus and Helicobacter pylori. The latter colonies were confirmed as H. pylori by immunohistochemistry and biochemical methods. H. pylori cultured from the gallbladder exhibited both the same DNA fingerprinting and Western cagA gene sequence with ABC-type EPIYA (Glu-Pro-Ile-Tyr-Ala) phosphorylation motifs as isolates recovered from the gastric mucus of the same patient, suggesting that gastric H. pylori can also colonize other organs in the human body. Taken together, here we report, for the first time, the identification and characterization of a community consisting of live S. saprophyticus; C. urinapleomorphum, and H. pylori in the gallbladder of a patient with acute cholecystitis. Their potential infection routes and roles in pathogenesis are discussed.
Collapse
|
|
6
|
Yamashita Y, Kimura T, Tanaka N, Yazaki M, Itagaki T, Joshita S, Umemura T, Matsumoto A, Mori H, Wada S, Tanaka E. Salmonella Enteritidis cholecystitis with chronic granulomatous disease. IDCases 2018; 12:49-52. [PMID: 29942748 PMCID: PMC6011139 DOI: 10.1016/j.idcr.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We describe a 40-year-old woman with Salmonella cholecystitis complicating adult-onset X-linked chronic granulomatous disease (CGD) caused by a de novo mutation in the paternal-origin CYBB gene. CGD was diagnosed by familial genetic analysis of the CYBB gene encoding NADPH oxidase gp91phox after detection of a refractory subcutaneous abscess at the age of 28. At age 40, she began experiencing frequent fever and diarrhea over a period of 3 months that were refractory to antibacterial treatment. Cholecystitis was evident. Her symptoms improved after percutaneous trans-hepatic gallbladder aspiration puncture with stand-by cholecystectomy. Salmonella enterica serotype Enteritidis (S. Enteritidis) was detected in blood, stool, and bile acid samples. Due to her suppressed bactericidal ability caused by CGD, S. Enteritidis was considered to have translocated from the gut to reside in the gallbladder, causing her repeated enteritis and sepsis. When encountering CGD with recurrent salmonellosis, the possibility of cholecystitis should be considered as another infection focus.
Collapse
Affiliation(s)
- Yuki Yamashita
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Naoki Tanaka
- Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan, and Research Center for Agricultural Food Industry, Shinshu University, Matsumoto, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan
| | - Tadashi Itagaki
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Satoru Joshita
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akihiro Matsumoto
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiromitsu Mori
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Eiji Tanaka
- Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
|
7
|
Gunn JS, Marshall JM, Baker S, Dongol S, Charles RC, Ryan ET. Salmonella chronic carriage: epidemiology, diagnosis, and gallbladder persistence. Trends Microbiol 2014; 22:648-55. [PMID: 25065707 PMCID: PMC4252485 DOI: 10.1016/j.tim.2014.06.007] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 12/13/2022]
Abstract
Typhoid (enteric fever) remains a major cause of morbidity and mortality worldwide, causing over 21 million new infections annually, with the majority of deaths occurring in young children. Because typhoid fever-causing Salmonella have no known environmental reservoir, the chronic, asymptomatic carrier state is thought to be a key feature of continued maintenance of the bacterium within human populations. Despite the importance of this disease to public health, our understanding of the molecular mechanisms that catalyze carriage, as well as our ability to reliably identify and treat the Salmonella carrier state, have only recently begun to advance.
Collapse
Affiliation(s)
- John S Gunn
- Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, The Ohio State University, OH, USA.
| | - Joanna M Marshall
- Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, The Ohio State University, OH, USA
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Oxford University, Oxford, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sabina Dongol
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
|
8
|
A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi. Case Rep Med 2014; 2014:758583. [PMID: 25161668 PMCID: PMC4137699 DOI: 10.1155/2014/758583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 06/23/2014] [Indexed: 01/25/2023] Open
Abstract
Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases.
Collapse
|
|
9
|
Abstract
OBJECTIVE Radiologic findings in Salmonella infections are not well described. In most patients, Salmonella infections produce mild and self-limiting clinical manifestations and therefore are treated empirically with antibiotics. Radiologic investigations are usually performed for patients with severe clinical manifestations or complications and for patients with unusual findings. CONCLUSION This pictorial essay illustrates various imaging findings in culture-proven cases of Salmonella infection, described broadly as common and uncommon manifestations.
Collapse
|
|
10
|
Rabie ME, Al Dousary HM, Ageely HM, Shaban AN. Salmonellal acute acalcular cholecystitis complicated by biliary candidal obstruction: An unusual presentation. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2011.00558.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
11
|
Abstract
Infections of the gastrointestinal tract can often involve the gallbladder. Infection probably plays a role in the formation of gallstones but is more commonly thought to contribute to acute illness in patients. Acute calculous cholecystitis caused by an impacted gallstone is often complicated by secondary bacterial infection and is a major cause of morbidity and even mortality in patients. A wide variety of organisms can be associated with acute acalculous cholecystitis, a less common but potentially more severe form of acute cholecystitis. This review focuses on infections and their role in the above-mentioned processes involving the gallbladder.
Collapse
Affiliation(s)
- Kabir Julka
- Division of Gastroenterology, University of Washington, Seattle, WA 98195, USA
| | | |
Collapse
|