Fatal Pulmonary Bile Embolism Following Acute Acalculous Cholecystitis

Proia, Alan D.; Fetter, Bernard F.; Woodard, Brett H.; Stickel, Delford L.; Meyers, William C.

doi:10.1001/archsurg.1986.01400100118022

Cited by 13 publications

(4 citation statements)

References 8 publications

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“…Perforation into the liver or biliary tract is extremely rare [93,94], as is perforation into the retroperitoneum with iliopsoas abscess [95]. Unusual causes of death from gallbladder perforation in acute acalculous cholecystitis include hemorrhage from the liver [96] and pulmonary bile embolism [97]. Serious complications of gallbladder gangrene without perforation include acute pancreatitis [98], colon perforation [99], and obstruction of the common hepatic duct [100].…”

Section: Complicationsmentioning

confidence: 99%

Acute acalculous cholecystitis

Barie

Eachempati

2003

Curr Gastroenterol Rep

135

104

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Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered.

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Section: Complicationsmentioning

confidence: 99%

Acute acalculous cholecystitis

Barie

Eachempati

2003

Curr Gastroenterol Rep

135

104

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“…Gangrene is either focal or diffuse, when it can cause bizarre complications such as bleeding into the colon37 or pulmonary bile embolism. 38 The diagnosis of acute acalculous cholecystitis requires a high index of clinical suspicion. There is usually a leucocytosis, and serum concentrations of bilirubin, liver enzymes and amylase may be increased;39 indeed patients can be mildly jaundiced.…”

Section: Acute Acalculous Cholecystitismentioning

confidence: 99%

Acalculous disease of the gall bladder.

Williamson¹

1988

Gut

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“…A variety of underlying causes of BPE have been reported (Table I). These include abdominal trauma [2,[6][7][8], liver metastases [9], liver abscesses [9,10], cholecystitis [11,12], and a variety of iatrogenic procedures associated with pancreatic, hepatic, and biliary pathology [1,[13][14][15][16][17][18][19][20][21][22][23][24]. To the best of our knowledge, this is the first case of BPE in a patient with ERCP-treated acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary bile embolism associated with acute pancreatitis – a case report and review of the literature

Knapik,

Okoń,

Ulatowska-Białas

2024

pjp

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A 27-year-old woman with jaundice and abdominal pain was admitted to an emergency ward. The diagnostic process showed that gallstones were causing her symptoms. The patient was treated via endoscopic retrograde cholangiopancreatography (ERCP), and during the procedure she suffered a cardiac arrest. Autopsy findings included multiple pulmonary bile emboli as well as features of disseminated intravascular coagulation. Among 22 thus far described cases of bile pulmonary embolism, 13 were associated with medical procedures involving the liver and biliary tract. We present the case report of a pulmonary bile embolism associated with acute pancreatitis treated via ERCP in a woman with gallbladder bile stones.

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Fatal Pulmonary Bile Embolism Following Acute Acalculous Cholecystitis

Cited by 13 publications

References 8 publications

Acute acalculous cholecystitis

Acute acalculous cholecystitis

Acalculous disease of the gall bladder.

Fatal pulmonary bile embolism associated with acute pancreatitis – a case report and review of the literature

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