Gangrenous cholecystitis in a non-elderly man taking opioids

Objective: To describe a case of acute acalculous gangrenous cholecystitis in a non-elderly man taking opioids, highlighting the diagnostic value of ultrasound in the absence of abdominal pain. Patient and Methods: A man in his 50s with a history of advanced right oropharyngeal cancer was referred to us with fever and liver dysfunction. Ultrasound examination revealed an enlarged gallbladder and wall thickening with fullness of biliary sludge and intraluminal membranes. Murphy sign was not detected by ultrasound examination. Contrast-enhanced computed tomography also confirmed acute gangrenous cholecystitis with ascitic fluid. Results: Urgent surgery was successfully performed. Acute gangrenous cholecystitis was confirmed. He is now well at 1 year post-admission. Conclusion: We reconfirmed that ultrasound examination is useful for the diagnosis of acute gangrenous cholecystitis in patients presenting with abnormal liver function tests, even if they are free of abdominal symptoms. In patients taking opioids, even without abdominal symptoms, the presence of fever and abnormal liver function tests should prompt high suspicion for gangrenous cholecystitis and warrant aggressive imaging. Careful attention should be paid to painless cholecystitis in patients taking opioids.