An Unexpected Case of Perforated Acalculous Cholecystitis Caused by a Fish Bone

Abstract

Gallbladder inflammation is most often determined by the presence of gallstones. Acalculous cholecystitisusually occurs in patients with multiple comorbidities or with an immunosuppressed status, and therefore itsevolution is faster and more severe compared to acute calculous cholecystitis. The presence of a fish bone intothe peritoneal cavity, through a gastrointestinal fistula is not very rare, but acute cholecystitis caused by a fishbone is unexpected. Here, we present the case of a 75-year old woman who had eaten fish two months beforeand presented at the Emergency Room with perforated acalculous cholecystitis and a right subphrenic abscess.The laparoscopic approach permitted the evacuation of the subphrenic abscess, bipolar cholecystectomy andremoval of a fish bone from nearby the cystic duct. Postoperative evolution was uneventful, with hospitaldischarge after five days. The patient was in good clinical condition at two months follow-up.