Risk of gallbladder necrosis due to acute cholecystitis

On July 10, 2018, Vinh International Hospital admitted Mr. LV H, born in 1959, from Chau Dinh commune, Quy Chau district, Nghe An province. The patient had experienced pain in the right lower rib area several times before but paid little attention to it. This time, the pain lasted continuously for 3 days and intensified. He was admitted to the hospital with severe pain in the right lower rib area, fever, and mild jaundice.

Pre-operative ultrasound image. Photo: Kim Chung

Through clinical examination and ultrasound, doctors discovered an enlarged gallbladder with a wall thickness of 4mm, containing numerous gallstones and biliary sludge (the largest measuring 13mm), and one gallstone lodged in the neck of the gallbladder.

The patient was diagnosed with acute cholecystitis due to gallstones according to Tokyo Guidelines 2013 (TG13). After 2 days of antibiotic treatment, the patient was scheduled for laparoscopic cholecystectomy.

Dr. Luong Tu Hai Thanh, Deputy Director of Professional Affairs at Vinh International Hospital, who directly performed the surgery on the patient, said: During the surgery, it was observed that the gallbladder wall was thickened with two points of near-necrosis on the anterior surface, bile was seeping around the gallbladder, and the omentum was heavily adhered to the abdominal wall. The colon and fatty tissue were enveloping the gallbladder, and the tissue around the cystic duct and common bile duct was inflamed, thickened, and edematous. Therefore, the process of freeing and removing the gallbladder was very difficult due to the presence of many large stones.

The image shows the gallbladder and gallstones being surgically removed from the patient's body. Photo: Kim Chung.

After the surgery, the patient was pain-free, able to eat and drink normally, no longer had a fever or jaundice, and the surgical wound was dry. He was discharged after 4 days of treatment.

In all cases of acute cholecystitis caused by gallstones, the optimal treatment is surgical removal of the cholecyst. The surgical method of choice is laparoscopic surgery, except in some cases where delayed treatment leads to pericholecystic abscess or necrotizing cholecystitis causing generalized peritonitis, requiring open surgery.

Gallstones are an increasingly common disease, with a higher incidence in women than in men due to the role of estrogen in increasing cholesterol levels in bile and progesterone in slowing the release of bile from the gallbladder.

Eighty percent of gallstone cases are asymptomatic, while the remaining 20 percent typically present with pain in the right lower rib area or epigastric region, which may be a single episode or recurrent. Due to the location of the pain, many patients underestimate it or mistake it for stomach pain and self-medicate with painkillers or stomach medications. However, each episode of right lower rib pain due to gallstones is a sign of cholecystitis (inflammation of the gallbladder). While mild pain may resolve on its own, the most dangerous aspect of repeated inflammation is the risk of acute inflammation leading to gallbladder necrosis.

To prevent gallstones, Dr. Luong Tu Hai Thanh, Deputy Director of Professional Affairs at Vinh International Hospital, recommends: “Everyone needs to change to a healthy lifestyle, increase physical activity, combine it with a hygienic diet, reduce fat and cholesterol, and increase the amount of fresh fruits and vegetables rich in Vitamins B and C to increase the metabolism of fats and carbohydrates; along with that, regular deworming is necessary to avoid infections and parasites in the digestive tract.”