Asymptomatic Gangrenous Acute Cholecystitis: A Life-Threatening Condition

Gangrenous gallbladder (GGB) is a life-threatening complication of acute cholecystitis, which happens due to gallbladder (GB) wall ischemia and necrosis. Delaying the diagnosis of GGB is life-threatening and may happen in asymptomatic patients. We present a case of an elderly male patient with a history of gastric carcinoid tumor, with partial gastric resection, who presented with generalized weakness and jaundice. His total bilirubin was elevated and an ultrasonography and computed tomography (CT) scan of the abdomen showed evidence of acute cholecystitis. An endoscopic retrograde cholangiopancreatography (ERCP) the day after admission showed no evidence of choledocholithiasis or cholangitis. It was during laparoscopic cholecystectomy three days later that the diagnosis of GGB was made as the GB was found to be necrotic with extensive adhesions. The patient also required intravenous antibiotics prior to discharge. This case illustrates risk factors for the development of gangrenous cholecystitis, physical findings in asymptomatic patients, and the importance of early diagnosis in order to reduce morbidity in this patient population.