PDF(Pubmed)
Abstract：
BACKGROUND: Gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious course. We herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis, who safely underwent laparoscopic cholecystectomy (LC) and both demonstrated a good outcome.
METHODS: Case 1: An 89-year-old female. She underwent abdominal contrast-enhanced computed tomography (CECT) due to abdominal pain and diarrhea. Her gallbladder wall indicated the absence of contrast enhancement, thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent LC. Although her gallbladder demonstrated diffuse necrosis and it was also partly perforated, she was able to be discharged without any serious complications. Case 2: A 91-year-old female. She made an emergency visit with a chief complaint of abdominal pain. Abdominal CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder wall. She was diagnosed with gangrenous cholecystitis and underwent LC. Her gallbladder had swelling and diffuse necrosis. Although her preoperative blood culture was positive, she showed a good outcome following surgery.
CONCLUSIONS: Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery, if an early diagnosis can be made and appropriate treatment can be carried out, then even very elderly individuals may be discharged without major complications.
METHODS: Case 1: An 89-year-old female. She underwent abdominal contrast-enhanced computed tomography (CECT) due to abdominal pain and diarrhea. Her gallbladder wall indicated the absence of contrast enhancement, thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent LC. Although her gallbladder demonstrated diffuse necrosis and it was also partly perforated, she was able to be discharged without any serious complications. Case 2: A 91-year-old female. She made an emergency visit with a chief complaint of abdominal pain. Abdominal CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder wall. She was diagnosed with gangrenous cholecystitis and underwent LC. Her gallbladder had swelling and diffuse necrosis. Although her preoperative blood culture was positive, she showed a good outcome following surgery.
CONCLUSIONS: Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery, if an early diagnosis can be made and appropriate treatment can be carried out, then even very elderly individuals may be discharged without major complications.
摘要：
背景：坏疽性胆囊炎是急性胆囊炎的一种形式，它涉及胆囊壁的坏疽改变，并且通常遵循急性和严重的病程。我们在此报告了两例早期诊断为坏疽性胆囊炎的老年人，他们安全地接受了腹腔镜胆囊切除术（LC），并且都表现出良好的预后。
方法：案例1：一名89岁女性。由于腹痛和腹泻，她接受了腹部对比增强计算机断层扫描（CECT）。她的胆囊壁显示没有对比增强，从而导致坏疽性胆囊炎的诊断，因此她接受了LC。虽然她的胆囊表现为弥漫性坏死，也有部分穿孔，她能够出院，没有任何严重的并发症。案例2：一名91岁的女性。她因腹痛而进行了紧急访问。腹部CECT显示胆囊肿胀和胆囊壁的连续性模糊。她被诊断为坏疽性胆囊炎并接受了LC。她的胆囊肿胀和弥漫性坏死。尽管她的术前血培养呈阳性，她在手术后表现出良好的结果。
结论：虽然在手术前很难明确诊断坏疽性胆囊炎，如果可以做出早期诊断并可以进行适当的治疗，那么即使是非常年老的人也可以出院而没有重大并发症。
方法：案例1：一名89岁女性。由于腹痛和腹泻，她接受了腹部对比增强计算机断层扫描（CECT）。她的胆囊壁显示没有对比增强，从而导致坏疽性胆囊炎的诊断，因此她接受了LC。虽然她的胆囊表现为弥漫性坏死，也有部分穿孔，她能够出院，没有任何严重的并发症。案例2：一名91岁的女性。她因腹痛而进行了紧急访问。腹部CECT显示胆囊肿胀和胆囊壁的连续性模糊。她被诊断为坏疽性胆囊炎并接受了LC。她的胆囊肿胀和弥漫性坏死。尽管她的术前血培养呈阳性，她在手术后表现出良好的结果。
结论：虽然在手术前很难明确诊断坏疽性胆囊炎，如果可以做出早期诊断并可以进行适当的治疗，那么即使是非常年老的人也可以出院而没有重大并发症。
