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Gangrenous cholecystitis in a non-elderly man taking opioids
Tatsuo Kanda1,2, Naho Maruyama3, Moeka Kasuga3
1Department of General Medicine, Uonuma Kikan Hospital, Japan.
Journal of Rural Medicine : JRM
|April 20, 2026
Summary
Ultrasound is valuable for diagnosing acute gangrenous cholecystitis in patients with abnormal liver function tests, even without abdominal pain. Opioid use requires high suspicion for this condition if fever and abnormal liver tests are present.
Area of Science:
- Gastroenterology
- Radiology
- Oncology
Background:
- Acute gangrenous cholecystitis is a severe gallbladder inflammation.
- Opioid use can mask typical symptoms like abdominal pain.
- Non-elderly patients with cancer may present atypically.
Purpose of the Study:
- To report a case of acute gangrenous cholecystitis in a non-elderly male patient on opioids.
- To emphasize the diagnostic utility of ultrasound in the absence of abdominal pain.
- To highlight the importance of considering this diagnosis in patients with risk factors.
Main Methods:
- A case study of a man in his 50s with oropharyngeal cancer.
- Diagnostic imaging included ultrasound and contrast-enhanced computed tomography.
- Clinical presentation included fever and liver dysfunction.
Main Results:
- Ultrasound revealed gallbladder enlargement, wall thickening, sludge, and intraluminal membranes.
- CT confirmed acute gangrenous cholecystitis with ascites.
- The patient underwent successful surgery and recovered.
Conclusions:
- Ultrasound is effective for diagnosing acute gangrenous cholecystitis with abnormal liver function tests, even without pain.
- Fever and abnormal liver tests in opioid-taking patients warrant aggressive imaging for cholecystitis.
- Painless cholecystitis should be carefully considered in patients on opioid therapy.
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