Acute Cholecystitis, A Rare Complication Following Routine Colonoscopy: Case Series and Literature Review

Abstract

Colonoscopy is a commonly performed low-risk gastrointestinal procedure that may rarely result in a serious complication. Patients presenting with abdominal pain and fever after colonoscopy may have acute cholecystitis. The underlying mechanisms are unclear. Such patients usually present within 72 hours of the procedure. Treatment includes intravenous antibiotics and cholecystectomy. We present our experience of two such cases; a 56-year-old man and a 21-year-old man, both of whom developed acute calculus cholecystitis within 48 hours after a routine colonoscopy. Their symptoms resolved after cholecystectomy.

Acute cholecystitis following elective colonoscopy

“…Acute cholecystitis is not routinely listed as a complication in colonoscopy guidelines. Indeed, there are just 15 published cases in the literature, as presented in table 1 1–10. There are no published case reports in the literature that describe cholecystitis attributed to an isolated gastroscopy.…”

“…There is no consensus regarding why this phenomenon can occur following colonoscopy; however, there are several theories. The most prescribed to notion is that the dehydration resulting from bowel preparation is significant enough to inspissate bile within the cystic duct, interfering with both local lymphatic and venous outflow and increasing the intraluminal pressures of these vessels 1 2 4 7–9 17. The gallbladder wall first becomes distended and oedematous and is then infiltrated by neutrophils 17.…”

“…In the instance that a patient has existing cholelithiasis, it has been proposed that mechanical manipulation of the patient during colonoscopy could dislodge a small gallstone into the gallbladder neck or cystic duct, causing inflammation in the manner described above 4 9…”

“…The inflammation secondary to thermal injury from electrosurgical polypectomy during colonoscopy could be the driving factor for acute cholecystitis 6 9. This rationale is less widely accepted and can be counterargued easily when one considers the fact that not all the published cases of acute cholecystitis as a complication of colonoscopy in the literature used electrosurgery for their polypectomies, and indeed some of them did not involve polypectomies at all.…”

“…Acute cholecystitis is a rare complication of colonoscopy, with just 15 published cases in the literature1–10 and no current consensus regarding the pathogenesis of this sequela. Given the potential consequences of this condition and the importance of prompt operative intervention, it should be considered in patients presenting with right upper quadrant (RUQ) pain following a colonoscopy once perforation has been excluded.…”