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Cholesterol crystal embolism leading to perforation of the gallbladder
Janine Tappenden1, Simon K Suvarna, Roger Ackroyd
1Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
Insights
Cholesterol crystal embolism (CCE) rarely causes gallbladder perforation. This case highlights the importance of considering CCE in patients with abdominal pain and atherosclerosis for timely diagnosis and management.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Pathology
Background:
- Cholesterol crystal embolism (CCE) is a rare complication of atherosclerotic arterial disease.
- Gallbladder perforation due to CCE is an exceptionally infrequent occurrence.
Observation:
- A 64-year-old male presented with acute abdominal pain and peritonitis.
- Imaging revealed peri-hepatic fluid; the gallbladder appeared normal but contained calculi.
- Laparotomy identified a pin-hole perforation in the gallbladder fundus with bile leakage.
Findings:
- Histological examination of the gallbladder confirmed chronic cholecystitis.
- Obliteration of mural arteries by cholesterol crystals confirmed CCE as the cause.
Implications:
- CCE should be considered in patients with abdominal pain and a history of atherosclerotic disease.
- Early diagnosis and management, including risk factor modification, are crucial.
- This case underscores the importance of recognizing rare vascular complications in gallbladder disease.
Background:
Cholesterol crystal embolism (CCE) from atherosclerotic arterial disease leading to perforation of the gallbladder is rare. We describe our experience of managing a patient with perforation of gallbladder caused by CCE.
Methods:
A 64-year-old man was admitted to this hospital because of acute abdominal pain with clinical features suggestive of peritonitis. He was known to suffer from atherosclerotic peripheral arterial disease and had undergone aortobifemoral bypass 17 years ago. A CT scan showed a collection of peri-hepatic fluid. The gallbladder was normal in appearance but contained multiple calculi. At laparotomy, free bile was observed in the peritoneal cavity, leaking from a pin-hole size peroration of the fundus of the gallbladder. Hence cholecystectomy was performed.
Results:
The patient made an uneventful recovery. Histological study of the gallbladder showed chronic cholecystitis and obliteration of the lumen of the mural arteries with cholesterol crystals within, indicating CCE.
Conclusions:
Although perforation of the gallbladder following CCE of its mural arteries is rare, the diagnosis should be considered in patients with abdominal pain and known atherosclerotic arterial disease. Management should include an early recognition of this condition, prompt institution of treatment, prevention of further insults by discontinuing or avoiding predisposing factors, and modification of cardiovascular risk factors.
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