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Published on: March 28, 2025
Acute and chronic acalculous cholecystitis associated with aortic dissection
Fuyuki F Inagaki1, Yoshiaki Hara2, Masako Kamei2
1Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan inagaki-tky@umin.ac.jp.
Acalculous cholecystitis, a rare gallbladder disease, can be linked to aortic dissection. This study presents two cases, highlighting acute and chronic ischemic forms potentially caused by reduced blood flow.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Pathology
Background:
- Acalculous cholecystitis (AC) is a severe condition with unclear pathogenesis.
- Aortic dissection is a critical cardiovascular emergency.
Observation:
- Two patients with aortic dissection developed acalculous cholecystitis.
- Case 1 presented with acute ischemic cholecystitis post-aortic dissection exacerbation.
- Case 2 showed chronic ischemic cholecystitis with gallbladder perforation after prolonged aortic dissection management.
Findings:
- Histological examination revealed distinct acute (necrotized cholecystitis, thrombi) and chronic (fibrosis, hemosiderosis) ischemic changes in the gallbladder.
- Chronic acalculous cholecystitis (CAC) is documented here for the first time in association with aortic dissection.
- Aortic dissection may be an underlying risk factor for both acute and chronic AC.
Implications:
- Reduced splanchnic blood flow secondary to aortic dissection is a potential mechanism for AC.
- This association broadens the understanding of AC etiology.
- Recognition of this link may improve diagnosis and management of AC in patients with aortic dissection.
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