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Case Report
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| Perforated gangrenous cholecystitis with concurrent Clostridium perfringens bacteraemia masquerading as adenomyomatosis of the gallbladder: A case report | ||||||
| Natalie LY Ngu1, Alexander Olaussen1,2,7, Jessica Wong3, Hayden Snow3, Mark Cullinan4,6, Paul J. Sitzler4,5 | ||||||
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1Intern, General Surgery, Sandringham District and Memorial Hospital, Alfred Health, Melbourne, Victoria, Australia.
2Adjunct Senior Lecturer Monash University, Department of Community Emergency Health and Paramedic Practice. 3Registrar, General Surgery, Sandringham District and Memorial Hospital, Alfred Health, Melbourne, Victoria, Australia. 4Consultant Surgeon, General Surgery, Sandringham District and Memorial Hospital, Melbourne, Victoria, Australia. 5Head of Unit, General Surgery, Sandringham District and Memorial Hospital, Melbourne, Victoria, Australia. 6Senior Lecturer, Monash University, Department of Surgery, School of Clinical Sciences. 7National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. | ||||||
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| How to cite this article |
| Natalie LY Ngu, Olaussen A, Wong J, Snow H, Cullinan M, Sitzler PJ. Perforated gangrenous cholecystitis with concurrent Clostridium perfringens bacteraemia masquerading as adenomyomatosis of the gallbladder: A case report. Int J Case Rep Images 2017;8(3):179–183. |
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Abstract
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Introduction:
Clostridium perfringens (C. perfringens) is an unusual cause of bacteraemia in the healthy, immunocompetent host. Similarly, acalculous cholecystitis is rare in the absence of critical illness or preceding trauma. We present, to the best of our knowledge, the first documented case of concurrent C. perfringens bacteraemia and acalculous cholecystitis in a previously well human.
Case Report: An apparently healthy 56-year-old male was presented with sepsis of unknown origin, and was treated for a respiratory infection and incidentally found to have gallbladder mural thickening on a computed tomography (CT) chest scan. An abdominal ultrasound (USG) demonstrated adenomyomatosis of the gallbladder, without evidence of acute cholecystitis or gallstones. The initial blood sample hemolyzed, however, subsequent specimens showed raised inflammatory markers, neutrophilia and thrombocytopenia. The patient continued to deteriorate clinically and biochemically. At 30 hours from presentation, blood cultures demonstrated a C. perfringens bacteraemia and intravenous antibiotics were commenced. Following these findings and the development of right upper quadrant abdominal pain, biliary sepsis was suspected and the patient taken to theatre. During laparoscopic cholecystectomy, a perforated and gangrenous gallbladder was identified and the intraoperative cholangiogram demonstrated no retained stones. Acute gangrenous cholecystitis was confirmed on histopathology. Postperatively, the patient recovered quickly and was discharged with oral antibiotics. Conclusion: We present a case of acalculous cholecystitis in a patient with an unusual clinical presentation and lack of positive imaging findings. In this setting, the need for definitive surgical intervention and clinical suspicion of cholecystitis was recognized with the finding of C. perfringens bacteraemia despite imaging suggesting adenomyomatosis. This case highlights that acalculous cholecystitis can occur in patients without risk factors, and can be complicated by atypical bacteraemia, even in previously healthy individuals. | |
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Keywords:
Acalculous cholecystitis, adenomyomatosis, Bacterae-mia, Clostridium perfringens
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Author Contributions
Natalie LY Ngu – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Alexander Olaussen – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Jessica Wong – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Hayden Snow – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published Mark Cullinan – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published Paul Sitzler – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2017 Natalie LY Ngu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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