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 cholecystitis
usually occurs in patients with multiple comorbidities or with an immunosuppressed status, and therefore its
evolution is faster and more severe compared to acute calculous cholecystitis. The presence of a fish bone into
the peritoneal cavity, through a gastrointestinal fistula is not very rare, but acute cholecystitis caused by a fish
bone is unexpected. Here, we present the case of a 75-year old woman who had eaten fish two months before
and 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 and
removal of a fish bone from nearby the cystic duct. Postoperative evolution was uneventful, with hospital
discharge after five days. The patient was in good clinical condition at two months follow-up.