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There was no fever, vomiting or other clinical symptoms by system.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On examination he presented a soft, depressible abdomen with abdominal guarding in the right hypochondrium and a positive Murphy’s sign. The examination was supplemented with general blood tests, which showed leucocytosis with neutrophilia, elevated C-reactive protein and slightly elevated transaminases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The ultrasound revealed a distended gallbladder of some 15 × 6 cm, with abundant heterogeneous intravesicular content without dilation of the bile duct (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Given the persistence of pain in spite of analgesia and the suspicion of acute cholecystitis, the decision was made to perform a laparoscopic cholecystectomy, in which a necrohaemorrhagic gallbladder with intravesical clots was found (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Patients on haemodialysis have a higher risk of bleeding due to a deficiency in platelet aggregation secondary to uraemia and the use of anticoagulants and low-molecular-weight heparins in haemodialysis treatments.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> When they present with abdominal pain, we must consider various less common haemorrhagic processes in the differential diagnosis, such as haemobilia or necrohaemorrhagic cholecystitis,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as occurred in our case.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gomez Sanchez J, Garde Lecumberri C, Gonzalez Puga C, Miron Pozo B. Colecistitis necrohemorrágica tras terapia renal sustitutiva. Gastroenterol Hepatol. 2019;42:500–501.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 651 "Ancho" => 1740 "Tamanyo" => 96145 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound image showing a distended gallbladder of 15 × 6 cm, with abundant heterogeneous intravesicular content, with no clear image of cholelithiasis and without dilation of the bile duct.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1068 "Ancho" => 1740 "Tamanyo" => 365169 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Macroscopic appearance of the gallbladder during laparoscopic surgery and the extracted tissue, displaying thickened walls with a necrohaemorrhagic appearance and many clots in the lumen, matching the heterogeneous content described in the ultrasound.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Literature review and case series of haemorrhagic cholecystitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Tarazi" 1 => "F.T. Tomalieh" 2 => "A. Sweeney" 3 => "D. Sumner" 4 => "Y. Abdulaal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jscr/rjy360" "Revista" => array:3 [ "tituloSerie" => "J Surg Case Rep" "fecha" => "2019" "volumen" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de estudio español sobre anticoagulación en hemodiálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Herrero-Calvo" 1 => "E. González-Parra" 2 => "R. Pérez-García" 3 => "F. Tornero-Molina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2011.Nov.11106" "Revista" => array:5 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "143" "paginaFinal" => "152" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemorrhagic cholecystitis in a patient on maintenance dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Masayuki" 1 => "I. Masahiro" 2 => "K. Nozomi" 3 => "O. Kosuke" 4 => "T. Naofumi" 5 => "S. Manabu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000479497" "Revista" => array:6 [ "tituloSerie" => "Case Rep Gastroenterol" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "488" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29033767" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004200000008/v1_201910180727/S2444382419301889/v1_201910180727/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004200000008/v1_201910180727/S2444382419301889/v1_201910180727/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382419301889?idApp=UINPBA00004N" ]
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Necrohaemorrhagic cholecystitis after renal replacement therapy
Colecistitis necrohemorrágica tras terapia renal sustitutiva
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Javier Gomez Sanchez
, Carlos Garde Lecumberri, Cristina Gonzalez Puga, Benito Miron Pozo
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Hospital Clinico San Cecilio, Granada, Spain
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