PMID- 37525805
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230802
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 6
DP  - 2023 Jun
TI  - Acute Cholecystitis Presenting With Atypical Radiologic or Laboratory Findings: A 
      Case Report.
PG  - e41217
LID - 10.7759/cureus.41217 [doi]
LID - e41217
AB  - Acute cholecystitis is the most common presentation of gallbladder (GB) disease. 
      It has an incidence of around 200,000 cases a year in the United States (US) and 
      affects approximately 20 million individuals in the US. In most cases, it 
      presents with a history of symptomatic gallstones. Initial management includes 
      intravenous hydration and antibiotics, bowel rest, and analgesia. Complicated 
      cases are typically resolved with surgery (laparoscopic cholecystectomy). The 
      pathogenesis of acute cholecystitis is most often explained by obstruction of the 
      cystic duct. Research has shown that there are more contributing factors than 
      just obstruction alone. We present a case of a 38-year-old Hispanic woman who 
      came to our emergency department with a chief complaint of the anterior chest 
      wall and epigastric pain. Physical examination was remarkable for epigastric 
      tenderness and negative Murphy's sign. She had no fever. Cardiac troponins and 
      electrocardiogram (EKG) were negative. Initial labs showed no sign of infection 
      with white blood cell (WBC) count within the normal range, and only mildly 
      elevated aspartate aminotransferase (AST), alanine transaminase (ALT), and total 
      bilirubin. Follow-up abdominal computerized tomography (CT) scan without contrast 
      and right upper quadrant (RUQ) abdominal ultrasound showed cholelithiasis without 
      evidence of cholecystitis. An hepatobiliary iminodiacetic acid (HIDA) scan on day 
      three of admission revealed an obstruction of the cystic duct. The patient was 
      scheduled for laparoscopic cholecystectomy with an intraoperative cholangiogram. 
      The surgery was uneventful; it was remarkable for a very distended, inflamed, and 
      edematous GB, which had to be decompressed with a lap needle for removal. It is 
      evident that acute cholecystitis may not always present with the classic 
      diagnostic criteria, including laboratory results (leukocytosis, elevated 
      C-reactive protein) and physical exam findings (fever, RUQ pain, and + Murphy's 
      sign). However, a thorough work-up can be just as effective in diagnosis.
CI  - Copyright (c) 2023, Aleman Espino et al.
FAU - Aleman Espino, Erik
AU  - Aleman Espino E
AD  - Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of 
      Osteopathic Medicine, Fort Lauderdale, USA.
FAU - Kazaleh, Mallory
AU  - Kazaleh M
AD  - Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of 
      Osteopathic Medicine, Fort Lauderdale, USA.
FAU - Zaglul, Javier
AU  - Zaglul J
AD  - Internal Medicien, Larkin Community Hospital, Hialeah, USA.
FAU - Frontela, Odalys
AU  - Frontela O
AD  - Internal Medicine, Larkin Community Hospital, Hialeah, USA.
LA  - eng
PT  - Case Reports
DEP - 20230630
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10387353
OTO - NOTNLM
OT  - acute calculus cholecystitis
OT  - atypical presentation
OT  - clinical case report
OT  - gangrenous cholecystitis
OT  - nonspecific abdominal pain
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/08/01 06:45
MHDA- 2023/08/01 06:46
PMCR- 2023/06/30
CRDT- 2023/08/01 03:37
PHST- 2023/05/02 00:00 [received]
PHST- 2023/06/30 00:00 [accepted]
PHST- 2023/08/01 06:46 [medline]
PHST- 2023/08/01 06:45 [pubmed]
PHST- 2023/08/01 03:37 [entrez]
PHST- 2023/06/30 00:00 [pmc-release]
AID - 10.7759/cureus.41217 [doi]
PST - epublish
SO  - Cureus. 2023 Jun 30;15(6):e41217. doi: 10.7759/cureus.41217. eCollection 2023 
      Jun.