title: Laparoscopic cholecystectomy for acalculous cholecystitis in a neutropenic patient after chemotherapy for acute lymphoblastic leukemia.
abstract: Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy.
authors.affiliation: Department of General and Hematological Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Pielaciński
authors.affiliation: Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Ejduk
authors.affiliation: Chair and Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Wróblewski
authors.affiliation: Department of General and Hematological Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
authors.forename: Andrzej B
authors.initials: AB
authors.lastname: Szczepanik
keywords: acute acalculous cholecystitis; acute lymphoblastic leukemia; chemotherapy; laparoscopic cholecystectomy