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A case report of acute gangrenous cholecystitis presenting as right lower quadrant abdominal pain

Year: 2025

Type: article

Abstract: RATIONALE: Acute gangrenous cholecystitis (AGC) is a life-threatening complication of acute cholecystitis that is characterized by early diagnostic difficulties due to nonspecific imaging and laboratory findings. The clinical presentation is a critical diagnostic tool. Although the typical pain location in AGC is the right upper quadrant, a few patients exhibit atypical abdominal pain locations, posing additional challenges to an already difficult diagnosis. PATIENT CONCERNS: This report describes the case of a 71-year-old female patient with pain in the right lower quadrant as the primary manifestation. Computed tomography revealed gallbladder wall edema, cholecystitis, and abdominopelvic effusion. Abdominal paracentesis revealed greenish fluid with significantly elevated amylase and lipase levels. DIAGNOSES: Laparoscopic examination, including histopathological findings, confirmed gangrenous cholecystitis. INTERVENTIONS: Laparoscopic cholecystectomy was performed, and postoperative antibiotic therapy and wound care were administered. OUTCOMES: The patient recovered uneventfully and was discharged on postoperative day 6. The follow-up showed no complications. LESSONS: This rare case highlights that AGC should be considered in patients with right lower quadrant pain, even in those without the classic right upper quadrant symptoms. Timely imaging (ultrasound, computed tomography), paracentesis with fluid amylase/lipase testing, and early laparoscopic exploration are essential for early diagnosis and intervention to improve the outcomes. This case aims to enhance the awareness of atypical presentations of AGC and aid early diagnosis.

Source: Medicine

DOI: 10.1097/md.0000000000046398

Authors: Jun Gao, Hao Sun, Xiyan Qin, Zhide Sun

Institution: Chengde Medical University

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950