Acute acalculous cholecystitis immediately after gastric operation: Case report and literatures review

Table 1 Clinical data of the three cases

	Case 1	Case 2	Case 3
First admission
Gender	Male	Male	Male
Age (yr)	54	79	72
BP (mmHg)	130/70	120/80	120/80
Diagnosis	Gastric cancer	Gastric cancer	Gastric cancer
Gallbladder disease	No	No	No
Surgery	Total gastrectomy	Total gastrectomy	Distal gastrectomy
Anastomosis	Roux-en Y	Roux-en Y	Billroth I
Complications	No	No	Infection of abdominal cavity and the incision
Time of feeding	Day 7	Day 7	Day 22
Time of discharge	Day 8	Day 9	Day 28
Pathology	Poorly differentiated adenocarcinoma	Poorly differentiated adenocarcinoma	Mucinous adenocarcinoma
TNM stage	T2bn0m0	T4aN3M0	T4an3m0
Onset of acute acalculous cholecystitis after gastric surgery
Symptoms	Fever, upper abdominal discomfort, vomiting	Fever, upper abdominal pain	Fever, upper abdominal pain, vomiting
Onset time	Day 13	Day 9	Day 38
Incentive	Postprandial	Postprandial	Postprandial
Temperature (°C)	39.5	38.5	38
BP (mmHg)	100/60	90/60	160/100
Physical examination	Percussion pain of hepatic region	Percussion pain of hepatic region	Tenderness of right upper quadrant abdomen
Septic shock	Day 1 after onset	Day 0 after onset	No septic shock
WBC (109/L)	24.35	17.8	11.9
PLT (109/L)	121	106	403
Amyl (U/L)	46	73	74
TB/CB (μmol/L)	6.7/5	85/74	11.4/6
ALT/AST (U/L)	47/51	225/671	27/22
r-GT (U/L)	118	338	61
PCT (ng/mL)	21.23	> 100	NA
CRP (mg/L)	136.3	138.1	NA
Cr (μmol/L)	156	151	52
APTT/PT (s)	36.8/16.5	42.8/18.7	40.8/13.3
INR	1.33	1.62	1.16
CT performance	Pericholecystic fluid collection, gallbladder enlargement	Pericholecystic, abdominal and pelvic fluid collection, gallbladder enlargement	NA
Ultrasonography	Thickened wall of enlarged gallbladder	NA	Thickened wall of enlarged gallbladder
Severity grading (Tokyo guideline)	Severe	Severe	Mild
Treatment for acute acalculous cholecystitis
Time of treatment	36 h after onset	17 h after onset	10 h after onset
Type of treatment	Cholecystostomy	Cholecystectomy	Interventional percutaneous gallbladder drainage
Ascites	No	400 mL	No
Gallbladder size (cm)	8 × 4	10 × 6	10 × 4.5
Gangrene formation	Yes	Yes	NA
Complications	No	Hepatic failure and respiratory dysfunction	No
Pathology	Necrosis of gallbladder wall	Necrosis of gallbladder wall	NA
Survival	Yes	No	Yes
Time of recovery or death	Day 14 after the treatment	Day 42 after the treatment	Day 5 after the treatment

NA: Not available; BP: Blood pressure; WBC: White blood cell; PLT: Platelet; Amyl: Amylase; TB/CB: Total bilirubin/Conjugated bilirubin; ALT/AST: Alanine aminotransferase/Aspartate aminotransferase; r-GT: r-Glutamyl transferase; PCT: Procalcitonin; CRP: C reactive protein; Cr: Creatinine; APTT/PT: Activated partial thromboplastin time/Prothrombin time; INR: International normalized ratio.