CASE REPORT   

Chirurgia 2021 April;34(2):97-100

DOI: 10.23736/S0394-9508.20.05118-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

When diagnosis of abdominal upper right quadrant pain remains difficult and treatment even worse

Sara COPPOLA ✉, Maria MASUTTI, Giorgio CASTELLO, Davide FERRARA, Mauro LONGONI

Unit of Visceral Surgery, Department of Surgery, Bassini Hospital, ASST Nord Milano, Cinisello Balsamo, Milan, Italy

Acute cholecystitis can mask gallbladder cancer because signs and symptoms are often similar; early-stage gallbladder cancer is usually unsuspected and asymptomatic, while advanced stage presents unspecific clinical behavior. We presented the case of a middle age female who presented at our Emergency Department for right upper quadrant abdominal pain. Laboratory tests were normal; abdominal CT scan revealed a non-thickened, distended gallbladder containing small stones and multiple small hypodense hepatic lesions. MRI showed a focal mural thickening of the fundus, with a gallbladder body that was scarcely differentiable from the surrounding liver. Considering acute cholecystitis, a simple cholecystectomy was performed with wedge resection at S3 in correspondence of one of the several hepatic lesions. Postoperatively the patient worsened and became septic; in attendance of pathological exam result, a non-operative management was decided suspecting a locally advanced neoplastic lesion. Pathological exam revealed a rare case of gallbladder carcinosarcoma with hepatic metastases and the patient died two months later. This case report showed how in presence of acute cholecystitis with unclear clinical, biochemical or radiological behavior, a neoplastic gallbladder disease must always be suspected.

KEY WORDS: Gallbladder; Carcinosarcoma; Cholecystitis, acute; Diagnosis, differential; Prognosis