Laparoscopic cholecystectomy of acute acalculous cholecystitis patient : a rare case presentation

Acuteacalculouscholecystitis (AAC) is definited by the inflammation of the gallbladder with absence of calculi and presenting all the symptoms of the cholecystitis (upper quadrant abdominal pian , vomiting and nauseas). Acuteacalculouscholecystitis (AAC) is characterized by gallbladder inflammation without cystic duct obstruction due to gallstones. It is clinically indistinguishable from acute calculous cholecystitis (ACC)[1]Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period[2]. et al., IJSIT, 2017, 6(6), 722-727 Hai Hu IJSIT (www.ijsit.com), Volume 6, Issue 6, November-December 2017 723 CASE PRESENTATION A 56-year-old woman presented toTongji University Affilisted Shanghai East Hospital of abdominal pain complaining of right flank and epigastric pain radiating to the right upperquadrant and back.Although the patient washaving regular bowel movements without gross blood.An examination ofthe abdomen revealed tenderness in the right upper quadrant and negative aMurphy’s sign. The routine laboratorytests were unremarkable,laboratory test results were as follows: white blood cell(WBC) count;4.52*10^9/L, hemoglobin(Hb); 115.0g/L,platelet count; 167*10^9/L,asaspartate aminotransferase; 20U/L , alanine aminotransferase; 9U/L ,total bilirubin;9.5umol/L .Biological examinations revealed moderate cystolysis and clolestasishydatid serology and serum tumor markers were nagatives :carcinoembryonic antigen (CEA) and carbohydrateAntigen (CA). Abdominal Ultrasonography revealed a gallbladderwall rough (Fig1) Magnatic resonance Cholangiopancreatography(MRCP) showed long cystic duct (Fig3).DX(Radiologic diagnosis) showed Both sides were symmetrical; the trachea was centered; the mediastinum was not widened; two, the lung markings increased. Two pulmonary hilum size as usual. No tortuous widened aortic calcification. There was no obvious abnormality in heart shape and size. Both sides of the diaphragm were light and the ribs were sharp(Fig 2)。 et al., IJSIT, 2017, 6(6), 722-727 Hai Hu IJSIT (www.ijsit.com), Volume 6, Issue 6, November-December 2017 724 et al., IJSIT, 2017, 6(6), 722-727 Hai Hu IJSIT (www.ijsit.com), Volume 6, Issue 6, November-December 2017 725 Operation mode: The patient’s gallbladder was no stone ,.no polyps ,and the diagnotic was AAC and underwent a laparoscopic colecystectomy without any compliactions. Laparoscopic cholecystectomy processus was: The skin is initially prepared with chlorhexidine from just below the nipple line to the inguinal ligaments and laterally to the anterior superior iliac spine[3]. 1CM longitudinal incision is made at the inferior aspect of the umbilicus, and 10MM trocar was inserted into the abdominal cavity to fill the abdominal cavity with CO2, and the pressure in the abdominal cavity reached 14MMHg. Insert in laparoscopic laparoscopy, guided in the right costal margin in 3MM trocar, in 5MM trocar a subxiphoid implantation. The exploration showed that the gallbladder was about 6 x 3 x 3CM, and the cystic hyperplasia of the gallbladder floor and the cystic duct were elongated. The anatomic structure of the gallbladder triangle is clear. After separating the adhesion, the cystic duct was separated from the cystic artery (Fig6)with an ultrasonic knife, and the plastic duct was clamped off the gallbladder duct at the 0.5CM of the common bile duct[4]. The gallbladder is removed from the gallbladder bed, removed and removed from the umbilicus. The operation was successful, bleeding less than 20ML, no blood transfusion. Normal saline irrigation gallbladder cavity, check the abdominal cavity without bleeding, intradermal absorption line suture incision, the patient returned to the ward safe. et al., IJSIT, 2017, 6(6), 722-727 Hai Hu IJSIT (www.ijsit.com), Volume 6, Issue 6, November-December 2017 726 The operation was successful and preoperative routine antibiotic injection was used. After operation: On the first day after operation, the patient complained of abdominal incision pain, fever, nausea, vomiting and other complaints, has been discharged. Physical examination: the temperature was36 degree C, the heart rate was 80 beats /minute, 20 breaths / min, blood pressure 110/80mmhg. There was no obvious abnormality in auscultation of heart and lung. No yellow staining of sclera. Abdominal flat, soft abdomen, no obvious tenderness, no rebound pain and muscle defense. Surgical incision dry, no redness, bleeding. Hospital discharge and health education: After discharge, outpatient follow-up, the recent low fat digestible diet, such as abdominal distension, abdominal pain and diarrhea and other timely treatment.