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.

Severe complications in the induction phase of therapy in a pediatric patient with T-cell acute lymphoblastic leukemia: A case report

“…In the literature, most pediatric cases describe the occurrence of acute acalculous cholecystitis during chemotherapy. [17][18][19] However, in George J. single-center, retrospective study on a cohort of immunocompromised patients, 65.83% had acute calculous and US calculous lesions during diagnosis. In this study group, 80.80% (n = 97) of patients had leukemia or had received a recent bone marrow transplantation.…”

“…Percutaneous cholecystostomy is the treatment option of choice for critically ill patients with acute cholecystitis, while more stable patients may undergo definitive laparoscopic cholecystectomy. [19][20][21] Xin et al [22] presented a case study of an 11-year-old patient with B-ALL who developed intracranial hemorrhage and cholecystitis after completing high-dose methotrexate chemotherapy.…”

Acalculous Perforated Hemorrhagic Emphysematous Cholecystitis Caused byClostridium perfringensin a Patient with Myeloma Taking Daratumumab

“…Whereas acalculous cholecystitis has been described in patients with immunodeficiency caused by human immunodeficiency virus (HIV), there are few case reports in patients immunosuppressed as a result of other causes. Kassar et al [4] and Pielacinski et al [5] describe acalculous cholecystitis arising during chemotherapy for acute myeloblastic and lymphoblastic leukemia, respectively; both patients were neutropenic at the time of diagnosis. Interestingly, there are also reports of acalculous cholecystitis without associated neutropenia in patients receiving small molecule inhibitors for solid organ tumors, such as sunitinib and sorafenib [6,7].…”