P2023 - Acute Gangrenous Cholecystitis Following a Diagnostic Colonoscopy, Case Report, and Literature Review

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Kinan Obeidat, MD

University of Texas Medical Branch
Galveston, TX

Kinan Obeidat, MD, Yamam Al Saadi, MBBS, Kanana Aburayyan, MD, Anni Chowdhury, DO
University of Texas Medical Branch, Galveston, TX

Introduction: Colonoscopy is a low risk procedure. Although safe, it is associated with a range of complications, including bleeding and perforation. The most common adverse event is self-limiting abdominal pain with an incidence up to 11%. Very rarely, post colonoscopy pain is attributed to acute cholecystitis. This was first described in 2001. We herein present a case of post-colonoscopy acute cholecystitis.

Case Description/Methods: 66-year-old male with a history of hypertension and type 2 diabetes who presented for a screening colonoscopy. The patient tolerated the procedure without difficulties. A 5 mm ascending colon polyp and a 4 mm rectal polyp were resected using a cold snare. The following day, he presented with right upper quadrant (RUQ) pain radiating to the back, associated with nausea and vomiting. Vital signs were stable. Physical examination revealed moderate epigastric tenderness without guarding or rigidity. Murphy’s sign was positive. Blood workup significant for WBC count of 15. Liver chemistries were normal. CT scan showed cholelithiasis and a hydropic gallbladder, and RUQ ultrasound revealed gallbladder wall thickening, pericholecystic fluid, and gallstones consistent with acute cholecystitis. Laparoscopic cholecystectomy was performed. Intraoperative and pathologic findings showed acute gangrenous cholecystitis. He did well and was discharged the following day on antibiotics.

Discussion: Post colonoscopy Cholecystitis is rare, with a total of 11 cases reported in the literature. The precise mechanism behind the development of cholecystitis is not well established yet however, previous proposed mechanisms include, dislodgment of gallstones related to manipulation during colonoscopy, formation of a new stone caused by the biliary stasis as a result of preparation induced dehydration, bacterial translocation, and local inflammatory response to polypectomy.

Figure: A,B: RUQ US findings
C,D: Colonoscopy findings

Patient	Author	Gender	Indication	Bowel Prep	Polypectomy	Hospital encounter	Etiology
1	Madder et al	Male	Screening	Prebed-golytley	Yes	48 hrs	Calculus
2	Madder et al	Male	Screening	Prebed-golytley	Yes	72 hrs	Calculus
3	Madder et al	Female	Screening	Prebed-golytley	Yes	48 hrs	Calculus
4	Milman et al	Female	Screening	Prebed-Unknown	Yes	24 hrs	Calculus
5	Milman et al	Female	Diarrhea	Prebed-Unknown	no	8 hrs	Calculus
6	Gorgan et al	Male	Diarrhea	Prebed-golytley	Yes	12 hrs	Calculus
7	Campbell et al	Male	Positive FIT	Prebed-Unknown	Unknown	48 hrs	Calculus
8	Fernandez-Martinez et al	Male	Screening	Prebed-Unknown	Unknown	72 hrs	Calculus
9	Park et al	Male	Screening	Prebed-Unknown	Yes	48 hrs	Calculus
10	Aziz et al	Female	Rectal bleeding	Prebed-golytley	Yes	48 hrs	Calculus
11	Aziz et al	Male	Screening	Prebed-golytley	Yes	48 hrs	Calculus

Disclosures:

Kinan Obeidat indicated no relevant financial relationships.

Yamam Al Saadi indicated no relevant financial relationships.

Kanana Aburayyan indicated no relevant financial relationships.

Anni Chowdhury indicated no relevant financial relationships.

Kinan Obeidat, MD, Yamam Al Saadi, MBBS, Kanana Aburayyan, MD, Anni Chowdhury, DO. P2023 - Acute Gangrenous Cholecystitis Following a Diagnostic Colonoscopy, Case Report, and Literature Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.