SHM Converge Scientific Abstract ePoster Gallery-Chronic Mesenteric Ischemia a Risk Factor for Acute Acalculous Cholecystitis?

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This case report describes a possible association between chronic mesenteric ischemia (CMI) and acute acalculous cholecystitis (AAC). CMI, usually caused by atherosclerosis, leads to reduced bowel blood flow and can cause postprandial pain, food fear, and weight loss. AAC is gallbladder inflammation without gallstones and has traditionally been linked to critical illness, though it may also occur in less obviously ill patients.<br /><br />The patient was a 60-year-old woman with coronary artery disease, tobacco use, a year of chronic epigastric pain, and 110-pound unintentional weight loss. Prior workup had shown complete occlusion of the proximal superior mesenteric artery (SMA), but no intervention was done. She presented with 4 days of sudden, constant right upper quadrant pain, tachycardia, RUQ tenderness, and a positive Murphy sign.<br /><br />Laboratory studies showed marked inflammation and leukocytosis, including WBC 35,000, ESR 85, CRP 43.4, and elevated alkaline phosphatase. Imaging revealed a distended gallbladder with wall thickening, pericholecystic fat stranding, and sludge, but no gallstones. The SMA thrombosis was again seen. A HIDA scan was unremarkable.<br /><br />A multidisciplinary team initially planned SMA angiography and stenting while deferring cholecystectomy because the gallbladder appeared hydropic rather than severely inflamed. However, the procedure was converted to open SMA endarterectomy because distal access to the SMA was difficult. Intraoperatively, bile staining and a necrotic gallbladder were found, leading to open cholecystectomy. Pathology confirmed acute gangrenous cholecystitis. The patient recovered without complications.<br /><br />The report emphasizes that AAC may signal mesenteric ischemia and possibly impending bowel infarction, suggesting clinicians should consider mesenteric vascular evaluation when AAC occurs in patients with vascular risk factors or chronic abdominal symptoms.

Asset Subtitle

Muhammad Ahmed

Meta Tag

Author List Manha Azam, Md Shahnoor Amin, Muhammad Ahmed, Narmeen Rehman, Sikander Chohan, Zarina Alam

Category Clinical Vignettes

Concept Chronic Mesenteric Ischemia

Concept Acalculous Cholecystitis

Concept Superior Mesenteric Artery Occlusion

Concept Mesenteric Ischemia

Concept Gallstones

Distinguished Non-Finalist

Presenter Organization Wayne State University SoM

Presenting Author Muhammad Ahmed

Track Adult

Keywords

chronic mesenteric ischemia

acute acalculous cholecystitis

superior mesenteric artery occlusion

gangrenous cholecystitis

mesenteric ischemia

right upper quadrant pain

atherosclerosis

weight loss

biliary inflammation

vascular risk factors

Chronic Mesenteric Ischemia

Acalculous Cholecystitis

Superior Mesenteric Artery Occlusion

Mesenteric Ischemia

Gallstones