Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman


In elderly patients, numerous factors subsidize the diagnostic challenge and high incidence of complications in this specific population, taking gangrenous cholecystitis as a critical example. The aim of this work is to report an unusual case of gangrenous choleystitis in an elderly diabetic women and its atypical clinical presentation. A 79-year-old female patient came to our observation; her medical history showed nausea and vomiting of about 2 hours which rapidly ended with symptomatic therapy, without recurrence, and a 3-week history of intermittent fever associated with productive cough. No abdominal discomfort was declared. Physical examination of the abdomen was negative. Laboratory analysis revealed leukocytosis with the remaining criteria within the normal range. After 2 days, she started with a mildabdominal pain in the epigastric region that rapidly progressed to the right upper quadrant, right flank and right iliac fossa, without nausea, vomiting or fever. Abdominal computer tomography findings revealed thickness of the gall-bladder and important densification of the vascular bed. Acute cholecystitis was diagnosed. The patient was then submitted to a laparoscopic cholecystectomy under general anaesthesia with findings suggestive of gangrenous acute cholecystitis confirmed by histologic examination of the specimen. Delays in diagnosing acute cholecystitis in specific populations, such as elderly diabetics, result in a higher prevalence of morbidity and mortality due to potentially serious complications as gangrenous cholecystitis. Consequently, the diagnosis should be measured and investigated promptly in order to prevent poor outcomes.

Share and Cite:

Clérigo, V. , Rocha, C. , Rodrigues, A. , Fernandes, L. , Sargento, D. and Silva, G. (2014) Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman. Case Reports in Clinical Medicine, 3, 503-507. doi: 10.4236/crcm.2014.39110.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Contini, S., Corradi, D., Busi, N., Alessandri, L., Pezzarossa, A. and Scarpignato, C. (2004) Can Gangrenous Cholecystitis Be Prevented? A Plea against a “Wait and See” Attitude. Journal of Clinical Gastroenterology, 38, 710-716.
[2] Bingener, J., Stefanidis, D., Richards, M.L., Schwesinger, W.H. and Sirinek, K.R. (2005) Early Conversion for Gangrenous Cholecystitis: Impact on Outcome. Surgical Endoscopy, 19, 1139-1141.
[3] Grant, R.L. and Tie, M.L.H. (2002) False Negative Biliary Scintigraphy in Gangrenous Cholecystitis. Australasian Radiology, 46, 73-75.
[4] Bennett, G.L., Rusinek, H., Lisi, V., Israel, G.M., Krinsky, G.A., Slywotzky, C.M. and Megibow, A. (2002) CT Findings in Acute Gangrenous Cholecystitis. American Journal of Roentgenology, 178, 275-281.
[5] Fry, D.E., Cox, R.A. and Harbrecht, P.J. (1981) Gangrene of the Gallbladder: A Complication of Acute Cholecystitis. Southern Medical Journal, 74, 666-668.
[6] Fagan, S.P., Awad, S.S., Rahwan, K., Hira, K., Aoki, N., Itani, K.M., et al. (2003) Prognostic Factors for the Development of Gangrenous Cholecystitis. American Journal of Surgery, 186, 481-485.
[7] Stefanidis, D., Bingener, J., Richards, M., Schwesinger, W., Dorman, J. and Sirinek, K. (2005) Gangrenous Cholecystitis in the Decade before and after the Introduction of Laparoscopic Cholecystectomy. JSLS, 9, 169-173.
[8] Stefanidis, D., Sirinek, K.R. and Bingener, J. (2006) Gallbladder Perforation: Risk Factors and Outcome. Journal of Surgical Research, 131, 204-208.
[9] Laurell, H., Hansson, L.E. and Gunnarsson, U. (2006) Acute Abdominal Pain among Elderly Patients. Gerontology, 52, 339-344.
[10] Katz, D.S., Rosen, M.P., Blake, M.A., et al. (Expert Panel on Gastrointestinal Imaging) (2010) Appropriateness Criteria® Right upper Quadrant Pain. American College of Radiology, Reston.
[11] Nikfarjam, M., Niumsawatt, V., Sethu, A., Fink, M.A., Muralidharan, V., Starkey, G., Jones, R.M. and Christophi, C. (2011) Outcomes of Contemporary Management of Gangrenous and Non-Gangrenous Acute Cholecystitis. International Hepato-Pancreato-Biliary Association, 13, 551-558.
[12] Morrow, D.J., Thompson, J. and Wilson, S.E. (1978) Acu-techolecystitis in the Elderly: A Surgical Emergency. Archives of Surgery, 113, 1149-1152.
[13] Borzellino, G., Sauerland, S., Minicozzi, A.M., Verlato, G., Di Pietrantonj, C., de Manzoni, G., et al. (2008) Laparoscopic Cholecystectomy for Severe Acute Cholecystitis. A Meta-Analysis of Results. Surgical Endoscopy, 22, 8-15.
[14] Chau, C.H., Siu, W.T., Tang, C.N., Ha, P.Y., Kwok, S.Y., Yau, K.K., et al. (2006) Laparoscopic Cholecystectomy for Acute Cholecystitis: The Evolving Trend in an Institution. Asian Journal of Surgery, 29, 120-124.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.