Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
Question: cholecystitis, no stones
|flora - Tue Mar 18, 2003 12:25 am||
During a liver core biopsy because of elevated liver enzyme tests (asymptomatic and not related to any known drug, medication or alcohol use(result: normal) 4 months ago, I had a severe vaso-vagal reaction which took 5-6 hours in emerg. to recover from. I also had severe abdominal and back pain. The next a.m. I had severe upper abdominal pain, nausea , vomiting, and slight fever, again to emerg. No diagnosis. Pain, fever, nausea subsided within a week but milder symptoms have persisted. Ultrasound 5 days after biopsy = markedly thickened gbladder walls with some edema and fluid, no stones. MRI 3 weeks later showed same. Told by Radiologist, G.I. Spec. and family Dr. that gall bladder would need removal. No satisfactory explanation of reason for sudden condition: In the 5-6 years of investigation of liver, I had several ultrasounds which showed a normal gall bladder, the last one 3 months previous to biopsy.
Finally 3 months after biopsy saw
Surgeon who requested repeat ultrasound. Result = "normal GB". Recommendation from surgeon: surgery not indicated. Thinks my symptoms (such as mild pain and tenderness over gall bladder, twinges in upper back and abdomen,spells of severe bloating, itching and irritation in upper abdomen,) not related to GB.
My Questions are:
1. Am I right in thinking that some event at the biopsy could have traumatized my gall bladder? I'm not looking for a villain, just an explanation!
2. If "no" to above, how common is such inflammation with no stones? What can cause it?
2. Can a gall bladder like mine "heal" itself, what are the chances of that happening.
3. Is it risky to neglect surgery in chronic cholecystitis when there are symptoms, even quite mild ones?
|Dr. N. Haider - Wed Jan 11, 2006 8:57 am||
1. The biopsy needle may inadvertently pierce organs that are adjacent to the liver eg gall bladder. This does not usually cause a serious problem. However, perforation of the gallbladder may cause leaking of the bile into abdomen which is severely irritant and causes a condition called ' bile peritonitis.' While this is a known complication of a liver biopsy, your symptoms were not consistent with a gall bladder perforation and peritonitis.
2. A disease exists called "acalculous cholecystitis" meaning inflammation of gall bladder and no stone. It is mostly found in patients in ICU setting having food injected into veins. BUT trauma is a predisposing factor to cause it. When diagnosed, an emergency removal of gall bladder is recommended, as it almost always perforates.
3. Body has unique abilities to heal itself. Through experience, medical people have come up with evidence that indicates what diseases are better off treated, medically or surgically. The answer is 'may be yes', but let a medical opinion guide you, as it is based on countless patients treated one way or the other. The final opinion was the one with most favourable response.
4. Chronic cholecystitis and surgery: Surgery is done to alleviate patient symptoms. There is no special 'risk' if surgery is not done.
However, chronic irritation is known to cause cancer, and cancer of gall bladder in chronic cholecystitis is a known thing.
Najaf Haider MBBS
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