Eosinophilic cholecystitis: An infrequent cause of acute cholecystitis. Colecistitis eosinofílica: causa infrecuente de colecistitis aguda. María del-Moral-Martínez1, . Caso clínico. Chica de 18 años. AP: TDAH (Tto: lisdexanfetamina 70 mg/día) Colecistitis aguda alitiásica. Inflamación de la vesícula, sin. liar causa dolor y la interrupción refleja de la inspiración que es el signo de Murphy que es tidades tales como la colecistitis acalculosa, la USG ha. Figura 3.
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An infrequent cause of acute cholecystitis. Hospital Universitario San Cecilio. Eosinophilic cholecystitis EC is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and cauwas performed after analysis of the surgical specimen.
Meaning of “colecistitis” in the Spanish dictionary
We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed.
Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms acalcilosa found. Eosinophilic cholecystitis is an uncommon condition of the gallbladder. It is characterised by an inflammatory infiltrate constituted ccausas of eosinophils. Its aetiology is often unknown, although cases have been associated with hyper-eosinophilic syndrome, parasitosis, infections, drugs and medicinal herbs.
Clinically, it is indistinguishable from common cholecystitis, although peripheral eosinophilia is sometimes observed, as is the case in hyper-eosinophilic syndrome and parasitic disease. When the effect is limited to the bladder, the treatment of choice is cholecystectomy, and the prognosis is usually favourable.
A year-old woman presented to the emergency department complaining of abdominal pain, located in the epigastrium and radiating to the right upper quadrant, together with nausea, vomiting and fever of 39 o C for the past two days. The presence of choluria was also reported. The patient had no personal or family history of interest.
She smoked about five cigarettes per day and was a habitual consumer of oral contraceptives. Physical examination revealed good general condition, with cutaneous-mucous jaundice and tenderness in the right upper quadrant, and a positive Murphy sign. Other results of the examination were normal. Laboratory analysis revealed the following alterations: Thin-walled acalculous gallbladder; non-dilated bile duct; no evidence of pancreatic abnormalities.
In view of the clinical and laboratory findings, the patient was admitted to monitor the evolution of the condition and for further study.
Colecistitis eosinofílica: causa infrecuente de colecistitis aguda
During admission, abdominal and caussa MRI were performed to assess the bile duct, obtaining the following results: Further analyses were performed, which revealed increased total bilirubin, decreased direct bilirubin, increased leukocytosis, increased C-reactive protein, and normal levels of amylase, transaminases and cholestatic enzymes.
The patient had malaise, with increased pain despite analgesia, and painful abdominal tenderness, with a tightening in the epigastric right upper quadrant. There were no colecistitus suggestive of perforation or pancreatitis. The patient’s clinical condition was worsening and presence of cholecystitis was suspected, and so an urgent cholecystectomy was performed, which revealed a thickened gallbladder wall with oedema on the rear surface.
The pathology examination revealed the presence of a transmural infiltration, and of a more intense infiltration in the muscular layer, by eosinophilic polynuclear leukocytes Fig.
After surgery, the patient was asymptomatic and was discharged a few days later. Eosinophilic cholecystitis EC is a rare and poorly understood disease of the gallbladder, which was first described in It can be considered an inflammatory condition of the gallbladder, in which the inflammatory infiltrate consists primarily of eosinophils 1.
The aetiology of EC is unknown. In patients with eosinophilic infiltrate affecting other organs and tissues, it has been suggested that these lesions could be due to a local allergic reaction to substances released at sites of inflammation within the target organ or tissue.
It has also been hypothesised that EC may be caused by hypersensitivity to bile acids 2,3. Cases have also been reported secondary to infections, parasitosis, allergies, hyper-eosinophilic syndrome, eosinophilia-myalgia syndrome, eosinophilic gastroenteritis, drugs and acalculowa medicines 4,5. In the absence of evident causes, we consider the present cauas to be an idiopathic EC 6.
EC is three times more common in patients with acalculous cholecystitis than in patients with cholelithiasis 6. EC does not present any clinical or laboratory manifestation to colecistitiz it from common cholecystitis, and so it is difficult to detect prior to cholecystectomy and histological examination of the surgical specimen.
Peripheral eosinophilia may or may not be present; when it is, it has been associated with hyper-eosinophilic syndrome, eosinophilic gastroenteritis and parasitosis. In addition, symptoms secondary to the eosinophilic infiltration of other organs have been described 8. In imaging tests, ultrasound results may be normal or show signs suggestive of cholecystitis gallbladder distension, wall thickening, perivesicular liquid or sonographic Murphy sign.
A CT scan may reveal similar features, with perivesicular oedema or decreased attenuation in the adjacent liver, indicative of perihepatitis EC prognosis is favourable. When the disease is confined to the bladder, the treatment of choice is cholecystectomy, preferably performed laparoscopically. Treatment with corticosteroids can be effective when the bile ducts are affected, or when the condition is associated with eosinophilic gastroenteritis.
It is generally accepted that EC should not be considered a separate entity, because the clinical and laboratory manifestations are indistinguishable from those of common cholecystitis, and therefore it is considered more a histological finding than a pathology in itself. The importance of EC lies in the fact that it can be associated with other diseases, and therefore, when it is observed, possible associated syndromes should be investigated. Eosinophil inflammatory reaction in isolated organs.
Eosinophilic cholecystitis associated with rupture of hepatic hydatid cyst aclculosa the bile ducts. Rev Esp Enferm Dig ; Acalculous eosinophilic cholecystitis from herbal medicine: Eosinophilic cholecystitis as a possible late manifestation of the eosinophilia-myalgia syndrome. An infrequent cause of cholecystectomy. Idiopathic eosinophilic cholecystitis with cholelithiasis: A case report and review of literature. The Internet Journal of Surgery. Eosinophilic cholecystitis, with a review of the literature.
Ann Clin Lab Sc ; Eosinophilic and lympho-eosinophilic cholecystitis. Indian J Gastroenterol ; Multidetector CT of emergent biliary pathologic conditions.
Digestive Diseases Clinical Management Unit. Introduction Eosinophilic cholecystitis is an uncommon condition of the gallbladder. Case report A year-old woman presented to the emergency department complaining of abdominal pain, located in the epigastrium and radiating to the right upper quadrant, together with nausea, vomiting and fever of 39 o C for the past two days. Discussion Eosinophilic cholecystitis EC is a rare and poorly understood disease of the gallbladder, which was first described in