Acute Gangrenous Acalculous Cholecystitis After Laparoscopic Roux-en-Y Gastric Bypass: a Case Report

Abstract

A 46-year-old male with a body mass index (BMI) of 36.6 had been diagnosed with type 2 diabetes (T2DM) for 5 years. Preoperative diagnosis also included hypertension, obstructive sleep apnea–hypopnea syndrome (OSAHS), hyperlipidemia, and non-alcoholic fatty liver disease (NAFLD). Preoperative ultrasound screening found no gallstone. The patient underwent LRYGB with a 50-cm biliopancreatic limb and a 200-cm alimentary limb. He recovered well and was discharged 2 days after surgery. One week after the operation, the patient was re-admitted to the hospital and complained that the pain in the upper right quadrant of the abdomen spread to his back. The pain was persistent in the following 2 days without any relief. He had no fever, but the blood test showed elevated white blood cell count (WBC) and C-reactive protein (CRP). Direct and indirect bilirubin were both normal. Computerized tomography (CT) scan demonstrated no signs of internal hernia or leak, and ultrasound screening showed the gallbladder wall thickened as a sign of cholecystitis. We immediately decided to have a laparoscopic exploration, considering the obvious abdominal pain and the inflammation. The gangrenous gallbladder was clearly visible during the surgery (Figs. 1 and 2). We checked carefully around the abdominal cavity and then decided to have laparoscopic cholecystectomy for the patient. The patient recovered well after the surgery. WBC and CRP returned to normal before he was discharged.