Acute Acalculous Cholecystitis: About an Unusual Cause

Abstract

Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of gallstones and with multifactorial pathogenesis. Mainly seen in patients with multiple comorbidities or immunosuppressive states, being associated with greater morbidity and mortality compared to the lithiasic entity.
Patient, female, 50 years old, with recent SARS-CoV-2 infection. Used teleconsultation for epigastric pain with dorsal irradiation, with four days of evolution, associated with nausea, with symptomatic improvement that day. An urgent abdominal ultrasound, analytical study and upper digestive endoscopy were requested.
The ultrasound showed “acute acalculous cholecystitis”. She was referred to the emergency department, with subsequent laparotomy revealing a pyloric perforation caused by a fishbone with contiguity vesicular inflammation.
Acute acalculous cholecystitis comprises from 2%-15% of all cases of acute cholecystitis and occurs mainly over the age of 60 and in males. Our patient did not have the typical biotype, comorbidities and clinical features of this pathology.
Recent SARS-CoV-2 infection has raised suspicion of a possible etiological role, opposed after surgery. Ingestion of foreign bodies is considered common, mostly presenting a benign course, with complications in less than 1% of cases. The patient presented few predisposing factors of foreign bodies ingestion. A computerized tomography scan in the pre-surgical period could have clarified the etiology and contributed to guide the procedure.
Here is a clinical case of an unusual pathology, of rare etiology, in an atypical patient, with a successful outcome in the middle of the COVID-19 pandemic.