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Overview
Acute cholecystitis is a common disease, and the treatment chosen by most patients is cholecystectomy. Although anatomical variations are common during any surgical procedure, most cases are uncomplicated. For surgeons, acute cholecystitis combined with hernia will affect the surgical method and operation, and the risk of visceral hernia should be minimized. Today, let’s learn about a case of acute cholecystitis combined with hernia.
Case Description
html Eleven 76-year-old men were admitted to the hospital due to upper abdominal pain. The patient had fever (38.1°), accompanied by elevated white blood cells, hyperbilirubinemia, and elevated transaminases, alkaline phosphatase , and lipase . Abdominal and pelvic CT showed thickening of the gallbladder wall, perigallbladder fluid accumulation, and pancreatic related edema, consistent with the manifestations of acute cholecystitis and pancreatitis . The patient had previously undergone esophagogastric surgery, and although CT showed postoperative changes, multiple anatomic abnormalities were also found, including gallbladder found in incisional hernia (Figure 1).Figure 1. CT scan of
On the second day of admission, the test results showed that the condition improved and it was suspected of transient common bile duct stones. MRCP confirmed the diagnosis of acute calculus cholecystitis with cystic duct obstruction and patency of the common bile duct and pancreatic duct, and the decision was made to perform cholecystectomy and cholangiography. The right subcostal incision is selected, and the hernia sac goes directly deep into the subcutaneous tissue. After opening the hernia sac, the tip of the gallbladder was discovered. The gallbladder was found to be necrotic and perforated into the liver plate, but no serious infection occurred. The gallbladder is dissected from the hepatic plate, and the artery is identified and ligated; before ligating the cystic duct, the stones can be palpable by retrograde compression of the bile duct. The gallbladder was removed and pathological examination was performed. Pathological results showed acute calculi-gangrenous cholecystitis. The patient recovered well after the operation and was discharged from the hospital on the 3rd day. One month after the operation, the patient was in good condition and had no recurrence.
Summary
The patient in this case did not have an incarcerated hernia. Therefore, the doctor believed that it was safe to postpone hernia repair. At the same time, doctors recommend that patients follow up regularly and perform selective repair at the appropriate time to minimize the risk of hernia caused by organ herniation in the future.
Reference:
1. Backen T, Crawley WT, Bouchard T, Quan G. An incisional hernia containing a gangrenous gallbladder: a case report and review of the literature. J Surg Case Rep. 2022 Dec 7;2022(12):rjac536. doi: 10.1093/jscr/rjac536. PMID: 36518641; PMCID: PMC9731617.
