PDF(Pubmed)
Abstract：
Gangrenous cholecystitis is a potentially fatal complication of acute cholecystitis that presents with right upper quadrant pain and sepsis. Due to the overlap in clinical features with ascending cholangitis, gangrenous cholecystitis can be easily misdiagnosed, resulting in treatment delay. While the gold standard of diagnosis of gangrenous cholecystitis is direct visualization during surgery and tissue sampling to pathology, some imaging features can guide the diagnosis to appropriate early surgical treatment of gangrenous cholecystitis. A 78-year-old female presented to the emergency department with right upper quadrant pain, sepsis, and altered mental status. Imaging findings on ultrasound and CT were suggestive of gangrenous cholecystitis. However, clinically the patient presented with ascending cholangitis symptoms. Instead of an emergent cholecystectomy, percutaneous cholecystostomy (PTC) was performed. After the PTC, the patient worsened clinically and despite surgical intervention, the patient expired due to septic shock and multiple organ failure.
摘要：
坏疽性胆囊炎是急性胆囊炎的潜在致命并发症，表现为右上腹疼痛和败血症。由于临床特征与上行性胆管炎重叠，坏疽性胆囊炎很容易误诊,导致治疗延迟。虽然坏疽性胆囊炎诊断的金标准是手术和组织取样到病理的直接可视化，一些影像学特征可以指导坏疽性胆囊炎的早期手术治疗。一名78岁的女性因右上腹疼痛出现在急诊科，脓毒症,和改变精神状态。超声和CT的影像学表现提示坏疽性胆囊炎。然而,临床上，患者出现上行性胆管炎症状。而不是紧急胆囊切除术，经皮胆囊造口术（PTC）。在PTC之后,患者在临床上恶化，尽管进行了手术干预，患者因感染性休克和多器官功能衰竭而死亡。
