Acute lithiasic cholecystitis, pseudoneoplastic form, a cause of conversion for laparoscopic cholecystectomy

Acute lithiasic cholecystitis represents one of the most frequent pathologies of the digestive tract, most often requiring emergency surgical treatment. The prevalence of this condition increases with age and it affects women the most. Laparoscopic cholecystectomy is the preferred surgical treatment, as it diminishes postoperatory pain, it reduces the hospitalization period and medical and social costs, and it also provides a rapid postoperatory recovery. We present the case of an elder female patient, who presented with complex symptoms and signs, suggesting both lithiasic cholecystitis and a gallbladder neoplastic condition. Although there was preferred a laparoscopic cholecystectomy, the presence of an inflammatory process with intense sclerous reaction in the hepatocystic triangle led the conversion of laparoscopic cholecystectomy into an open, classical one. Due to the inflammatory process, the common bile duct (CBD) could not be explored. The subsequent practicing of a cholangiography on the drain tube highlighted the presence of an obstacle in the end zone of the CBD, which could not be removed until the second surgical intervention. The histopahological exams - from frozen sections to immunohistochemistry - had a crucial role in deciding patient's surgical management. The good evolution of the case and the final postoperatory result confirmed that the therapeutic manner chosen for this case was the appropriate one.