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Acute acalculous cholecystitis (AAC) resulting in gallbladder perforation in a solid organ transplant recipient: a
B A Feltis1, D A Lee, R W Gruessner
1Department of Surgery, University of Minnesota Medical School, Minneapolis, USA.
Insights
Gallbladder perforation is a serious risk for transplant patients with acute acalculous cholecystitis (AAC). Early suspicion in kidney transplant recipients can prevent severe outcomes.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Critical Care Medicine
Background:
- Acute acalculous cholecystitis (AAC) can lead to gallbladder perforation, increasing patient morbidity and mortality.
- Patients with systemic diseases (e.g., diabetes, cardiovascular disease) and those who are chronically immunosuppressed face higher perforation risks.
- Solid organ transplant recipients often meet both high-risk criteria due to their underlying conditions and immunosuppressive therapy.
Observation:
- This report details an uncommon case of gallbladder perforation secondary to AAC in a kidney transplant recipient.
- The patient was otherwise healthy, highlighting that perforation can occur even without significant comorbidities beyond the transplant itself.
Findings:
- Gallbladder perforation is a recognized, albeit infrequent, complication of AAC.
- Transplant recipients are a population at elevated risk for this severe complication.
Implications:
- A high index of suspicion for gallbladder perforation is crucial in managing transplant recipients presenting with AAC.
- Prompt diagnosis and intervention in this high-risk group can mitigate severe morbidity and mortality.
- This case underscores the need for vigilance regarding AAC complications in immunocompromised patient populations.
Abstract:
Gallbladder perforation is a frequent complication of acute acalculous cholecystitis (AAC), resulting in substantially increased morbidity and mortality. Two groups of patients are at increased risk for perforation: those with systemic diseases (especially peripheral vascular disease, intrinsic heart disease, or diabetes) and those who are chronically immunosuppressed. The current population of solid organ transplant recipients meets both criteria. We describe an unusual case of gallbladder perforation as a complication of AAC in an otherwise healthy kidney transplant recipient. Because transplant recipients are at increased risk for gallbladder perforation, maintaining a high index of suspicion for this complication will help avoid the increased morbidity and mortality associated with this diagnosis.