Acute acalculous cholecystitis complicated by penetration into the liver after coronary artery bypass grafting.
BACKGROUND
Perforation or penetration due to acute acalculous cholecystitis is a rare complication after open-heart surgery. The mortality rate of this disease is high.


METHODS
A 71-year-old woman complained of a sudden onset of right upper abdominal pain with development of peritoneal signs at 21 days after coronary artery bypass grafting. Abdominal ultrasonography and laboratory examination performed at 1 day earlier had revealed no abnormalities. Neither anticoagulants nor antiplatelet agents were administered following the bypass operation. An exploratory laparotomy was performed to locate a presumed embolization to the superior mesenteric artery.


RESULTS
Laparotomy revealed acute acalculous cholecystitis complicated by penetration into the liver, causing a subserosal hematoma. The hematoma had ruptured into the abdominal cavity. A cholecystectomy was performed. The gallbladder wall which was in contact with the liver was necrotic. Most of the gallbladder mucosa was necrotic. Microscopical examination revealed atherosclerosis of the cystic artery which was partially obstructed by thrombus.


CONCLUSIONS
Given the atherosclerotic condition of the cystic artery, hypotension during the bypass in combination with postoperative total parenteral nutrition and hypovolemia may have induced the cystic artery thrombosis. Surgeons who manage patients with cardiovascular disease should be aware of this potentially lethal development.
Fujii
H
H
Second Department of Surgery, Osaka City University Medical School, Japan.
Kubo
S
S
Tokuhara
T
T
Suehiro
S
S
Yamamoto
T
T
Kinoshita
H
H
D000208:Acute Disease; D000368:Aged; D002763:Cholecystectomy; D002764:Cholecystitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D016896:Treatment Outcome