Risk of gallbladder necrosis due to acute cholecystitis

On July 10, 2018, Vinh International Hospital admitted Mr. LV H, born in 1959, in Chau Dinh commune, Quy Chau district, Nghe An province. The patient had suffered from pain under the right rib many times but did not pay much attention. This time, the pain lasted for 3 days and increased. He was admitted to the hospital with severe pain under the right rib, fever, and slightly yellow eyes.

Preoperative ultrasound image. Photo: Kim Chung

Through clinical examination and ultrasound, doctors discovered a large gallbladder with a 4mm thick wall, many stones and bile sludge inside (the largest stone was 13mm in size) and 1 stone stuck 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 indicated for laparoscopic cholecystectomy.

BSCKII Luong Tu Hai Thanh - Deputy Director of Vinh International Hospital, who directly performed the surgery for the patient, said: During the surgery, it was found that the gallbladder had a thick wall with 2 points near the front of the necrosis, bile seeped around the gallbladder, and the omentum was heavily adhered to the abdominal wall. The colon and the mantle of fat covered the gallbladder, the tissue around the neck of the gallbladder and the common bile duct was thick and swollen, so it was very difficult to release and cut the gallbladder and remove the gallbladder because there were many stones and large stones.

Image of gallbladder and gallstones being surgically removed from the patient's body. Photo: Kim Chung.

After surgery, the patient no longer felt pain, could eat normally, no longer had 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 stones, the optimal treatment is cholecystectomy. The surgical method of choice is laparoscopic surgery, except in some cases where the condition is delayed and causes pericholecystic abscess or gangrenous cholecystitis causing total peritonitis, requiring open surgery.

Gallbladder stones 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.

80% of gallstones are asymptomatic, the remaining 20% ​​of cases are often manifested by pain under the right rib or epigastric region, which can occur once or recur many times. Due to the location of the pain, many patients are subjective or mistakenly think it is due to stomach pain and arbitrarily take painkillers or stomach medicine. Meanwhile, each time the pain under the right rib due to gallstones is a cholecystitis, if mild the pain will go away on its own, but the most dangerous thing is that many times of repeated inflammation always have the potential risk of acute inflammation leading to gallbladder necrosis.

To prevent gallstones, Dr. Luong Tu Hai Thanh - Deputy Director of Vinh International Hospital recommends: "Everyone needs to change to a healthy lifestyle, increase physical activity, combine a hygienic diet, reduce fat, increase the amount of fresh vegetables and fruits rich in Vitamin B, C to increase fat and starch metabolism; Along with that, it is necessary to periodically deworm to avoid infections and parasites of the digestive tract"./.