EUS to the Rescue: Endoscopic Ultrasound-Guided Transgastric Cholecystostomy in Acute Cholecystitis
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Case Presentation and Evolution
A 58-year-old African-American man with recently diagnosed pancreatic adenocarcinoma was initially evaluated in the Emergency Department with severe upper abdominal pain. Significant tenderness and guarding were elicited in the right upper quadrant. Laboratory data were unremarkable. A computed tomography (CT) scan of the abdomen revealed a large pancreatic head mass encasing the celiac, common hepatic, and splenic arteries. The wall of the markedly distended gallbladder was ulcerated, consistent with a diagnosis of acute gangrenous cholecystitis. Multiple liver metastases were also noted.
The patient had developed obstructive jaundice a few weeks prior to evaluation; a fully covered metal stent was placed across a malignant-appearing distal common bile duct (CBD) stricture via endoscopic retrograde cholangiopancreatography (ERCP) performed at an outside facility after which the patient’s jaundice resolved; bile duct brushings were non-diagnostic. The...
KeywordsAcute Cholecystitis Bile Leak Percutaneous Cholecystostomy Tokyo Guideline Gallbladder Drainage
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