Synchronous Acute Appendicitis and Cholecystitis

Acute appendicitis and acute cholecystitis are two of the most commonly encountered surgical entities. Multiple hypotheses are behind their coexistence, which include pathogen predilection, and mucosal ischemia inducing portal vein bacteremia as the management of uncomplicated acute cholecystitis and acute appendicitis is surgical, for which a single operation for synchronous presentation is effective. Here, we report a case with coexistent acute cholecystitis and acute appendicitis managed at our institution.

A 30-year-old female presented with right upper quadrant abdominal pain for four days. The pain was radiating to the right shoulder, not related to fatty foods, associated with vomiting, anorexia, and burning micturition. On examination, she was vitally stable and afebrile with soft nondistended abdomen, a negative Murphy's sign, right lower quadrant rebound tenderness, and suprapubic tenderness. Laboratory tests showed leukocytosis (17.59 × 10⁹) and high ALT (40 IU/L) and AST (32.5 IU/L). Ultrasound showed a distended gallbladder with two echogenic intraluminal nonshadowing echogenicity, the largest measuring 0.57 cm. Due to the vague presentation we elected to go for computed tomography of the abdomen which showed a distended gallbladder with adjacent fat stranding, subhepatic appendix with distended tip and no surrounding fat stranding. She underwent diagnostic laparoscopy with cholecystectomy and appendectomy. The patient had an uneventful postoperative course and was discharge home on day 1.

We aim to shed light on the rare, but possible, synchronous coexistence of these diseases, raise the index of clinical suspicion. Management options for synchronous presentation can follow their asynchronous guidelines such as Tokyo and WSES.