title: Acute acalculous cholecystitis as a rare manifestation of chronic mesenteric ischemia. A case report.
abstract: BACKGROUND
  Symptomatic chronic mesenteric ischemia (CMI) is an uncommon condition that usually presents with intestinal angina, sitophobia and unintentional weight loss. Acute acalculous cholecystitis (AAC) has very rarely been described in the settings of CMI.
  
  
  METHODS
  We describe a case of a 73year old man that developed an AAC as a complication of CMI. The patient underwent a simultaneous cholecystectomy and open aortic revascularization which was successful. At 24 months of follow-up the patient is clinically well and regained weight.
  
  
  CONCLUSIONS
  Ischemia has been considered an important etiology for the development of AAC. In the settings of CMI, an AAC might develop has a herald sign of progression to acute mesenteric ischemia and infarction, as the cystic artery is a terminal artery with no collateral network. Performing the aortic revascularization simultaneously with the cholecystectomy might prevent this possible fatal outcome.
  
  
  CONCLUSIONS
  This case reinforces aortic and visceral occlusive disease as a possible risk factor for the development of AAC, and discusses the treatment controversies when managing both conditions simultaneously.
authors.affiliation: Hospital Santa Maria (CHLN), Lisboa, Portugal. Electronic address: ryan@campus.ul.pt.
authors.forename: Ryan
authors.initials: R
authors.lastname: Melo
authors.affiliation: Lisbon Medical Academic Centre, Portugal; Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: M Pedro
authors.affiliation: Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Silvestre
authors.affiliation: Lisbon Medical Academic Centre, Portugal; Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: P Freire
authors.affiliation: Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Pereira
authors.affiliation: Lisbon Medical Academic Centre, Portugal; Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: Ruy
authors.initials: R
authors.lastname: Fernandes E Fernandes
authors.affiliation: Lisbon Medical Academic Centre, Portugal; Hospital Santa Maria (CHLN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Fernandes E Fernandes
keywords: Acute acalculous cholecystitis; Acute-on-chronic mesenteric ischemia; Case report; Chronic mesenteric ischemia; Open aortic revascularization