Laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports

Abstract

BACKGROUND

Gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious course. We herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis, who safely underwent laparoscopic cholecystectomy (LC) and both demonstrated a good outcome.

CASE SUMMARY

Case 1: An 89-year-old female. She underwent abdominal contrast-enhanced computed tomography (CECT) due to abdominal pain and diarrhea. Her gallbladder wall indicated the absence of contrast enhancement, thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent LC. Although her gallbladder demonstrated diffuse necrosis and it was also partly perforated, she was able to be discharged without any serious complications. Case 2: A 91-year-old female. She made an emergency visit with a chief complaint of abdominal pain. Abdominal CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder wall. She was diagnosed with gangrenous cholecystitis and underwent LC. Her gallbladder had swelling and diffuse necrosis. Although her preoperative blood culture was positive, she showed a good outcome following surgery.

CONCLUSION

Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery, if an early diagnosis can be made and appropriate treatment can be carried out, then even very elderly individuals may be discharged without major complications.

Keywords: Gangrenous cholecystitis; Laparoscopic cholecystectomy; Elderly people; Critical view of safety; Tokyo guidelines 2018; Case report

Core Tip: Gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alteration in the gallbladder wall and often follows acute and serious course. We report on two cases of very elderly people diagnosed with gangrenous cholecystitis, who safely underwent laparoscopic cholecystectomy and made good progress. If early diagnosis of gangrenous cholecystitis and an appropriate treatment method can be carried out, even very elderly individuals may be discharged without major complications. Our paper will be very informative and useful to the readers of World Journal of Clinical Cases in today's aging society, and will be frequently cited.