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• W2100408023 abstract "A 15-year-old boy presented with a progressive abdominal fullness sensation, nausea, vomiting, and intermittent right flank pain for 1 week. The patient did not have the associated symptoms of fever, diarrhea, and hematuria. The right flank pain was not exacerbated with body or bowel movement. No drug allergies and no illicit drug use history were reported. He had visited his primary care physician and had been diagnosed as having gastroenteritis. After 1 week, he presented to our emergency department because of persistent symptoms after antispasmodic medication use. Clinical examination of the patient was unremarkable except for mild right upper-quadrant abdominal tenderness on deep palpation and equivocal Murphy's sign. The laboratory data were within the appropriate reference range for serum C-reactive protein, lipase, electrolytes, liver function, and urine routine analysis, except for a mildly increased amylase level (162 U/L; normal, 28–100 U/L) and white cell count (10,450/μL; normal, 4000–10,000/μL).The abdomen plain film (kidneys, ureters, and bladder x-ray) revealed scattered large- and small-bowel air without obstruction and 1 soft-tissue opacity at the right upper quadrant. A computed tomography scan was performed and showed an enlarged gallbladder (GB) with a marked thickened and edematous wall. The mucosal surface and its adjacent GB wall were strongly enhanced (Figure A, arrow). During exploratory laparotomy, a huge GB with wall thickening and adhesion to the liver was discovered. No GB stone was discovered and the provisional diagnosis was in favor of stromal tumor at surgery (Figure B). Pathologic examination showed more than 90% eosinophilic infiltration in the GB wall without evidence of parasitic infection, as illustrated in Figure C (arrows), and confirmed the diagnosis of eosinophilic cholecystitis (EC) with clinical presentation of hydrops of gallbladder. The patient's complaints disappeared significantly after the surgery was performed, compared with the previous period, and no complications were observed during a 12-month follow-up period.The etiology of EC is unclear and it occurs 3 times more commonly in patients with acalculous cholecystitis than in patients with cholelithiasis.1Dabbs D.J. Eosinophilic and lymphoeosinophilic cholecystitis.Am J Surg Pathol. 1993; 17: 497-501Crossref PubMed Scopus (42) Google Scholar The possible causes include allergies, parasitic infection, hypereosinophilic syndromes, and eosinophilic gastroenteritis.2Shakov R. Simoni G. Villacin A. et al.Eosinophilic cholecystitis, with a review of the literature.Ann Clin Lab Sci. 2007; 37: 182-185PubMed Google Scholar This case is interesting for several reasons. First, we present a patient with cholecystitis with clinical symptoms such as right flank pain, nausea, and vomiting without fever. That reminds us to keep GB disease in mind as a differential diagnosis even though the symptoms are subtle or relatively common. Second, peripheral esosinophilia should be ruled out before idiopathic EC is diagnosed. The underlying etiology should be defined because if other systemic disease is found, the treatment may be different and involve more than only cholecystectomy. In this case, this patient had no peripheral eosinophilia. Without any apparent precipitating etiology, the case described is considered idiopathic EC. A 15-year-old boy presented with a progressive abdominal fullness sensation, nausea, vomiting, and intermittent right flank pain for 1 week. The patient did not have the associated symptoms of fever, diarrhea, and hematuria. The right flank pain was not exacerbated with body or bowel movement. No drug allergies and no illicit drug use history were reported. He had visited his primary care physician and had been diagnosed as having gastroenteritis. After 1 week, he presented to our emergency department because of persistent symptoms after antispasmodic medication use. Clinical examination of the patient was unremarkable except for mild right upper-quadrant abdominal tenderness on deep palpation and equivocal Murphy's sign. The laboratory data were within the appropriate reference range for serum C-reactive protein, lipase, electrolytes, liver function, and urine routine analysis, except for a mildly increased amylase level (162 U/L; normal, 28–100 U/L) and white cell count (10,450/μL; normal, 4000–10,000/μL). The abdomen plain film (kidneys, ureters, and bladder x-ray) revealed scattered large- and small-bowel air without obstruction and 1 soft-tissue opacity at the right upper quadrant. A computed tomography scan was performed and showed an enlarged gallbladder (GB) with a marked thickened and edematous wall. The mucosal surface and its adjacent GB wall were strongly enhanced (Figure A, arrow). During exploratory laparotomy, a huge GB with wall thickening and adhesion to the liver was discovered. No GB stone was discovered and the provisional diagnosis was in favor of stromal tumor at surgery (Figure B). Pathologic examination showed more than 90% eosinophilic infiltration in the GB wall without evidence of parasitic infection, as illustrated in Figure C (arrows), and confirmed the diagnosis of eosinophilic cholecystitis (EC) with clinical presentation of hydrops of gallbladder. The patient's complaints disappeared significantly after the surgery was performed, compared with the previous period, and no complications were observed during a 12-month follow-up period. The etiology of EC is unclear and it occurs 3 times more commonly in patients with acalculous cholecystitis than in patients with cholelithiasis.1Dabbs D.J. Eosinophilic and lymphoeosinophilic cholecystitis.Am J Surg Pathol. 1993; 17: 497-501Crossref PubMed Scopus (42) Google Scholar The possible causes include allergies, parasitic infection, hypereosinophilic syndromes, and eosinophilic gastroenteritis.2Shakov R. Simoni G. Villacin A. et al.Eosinophilic cholecystitis, with a review of the literature.Ann Clin Lab Sci. 2007; 37: 182-185PubMed Google Scholar This case is interesting for several reasons. First, we present a patient with cholecystitis with clinical symptoms such as right flank pain, nausea, and vomiting without fever. That reminds us to keep GB disease in mind as a differential diagnosis even though the symptoms are subtle or relatively common. Second, peripheral esosinophilia should be ruled out before idiopathic EC is diagnosed. The underlying etiology should be defined because if other systemic disease is found, the treatment may be different and involve more than only cholecystectomy. In this case, this patient had no peripheral eosinophilia. Without any apparent precipitating etiology, the case described is considered idiopathic EC." @default.
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• W2100408023 title "Idiopathic Eosinophilic Cholecystitis: A Cause of Hydrops of Gallbladder in a Young Adolescent" @default.
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