A 70 year-old diabetic male patient with an acute abdominal pain for hours enters the emergency room of Medic Center. His history are gallstone, controlled glycemia and coronary arterial 2 stents for over 10 years. His EKG shows a life-rhythmic extrasystolic. WBC: 11.4H, CRP:0.4.
Ultrasound represents a 17 mm stone in a # 98x31 mm gallbladder with thickened wall of GB # 5-7mm. SonoMurphy sign positive and no fluid exist around the GB.
The cholecystitis pain reduces rapidly with taken Voltaren, No-Spa after 20 minutes. But a cholecystectomy via endoscopy is planned in regarding his Clopidogrel, diabetic status and the life-rhythmic extrasystolic EKG.
Endoscopic surgery removes a 17 mm pigmented stone within a thicken gallbladder which GB mucosa is in necrosis and hemorrhage. Thicken GB wall leads to cut it into small pieces for removing the gallstone and the inflamed gallbladder.
In reviewing the gallbladder, the gross specimen of GB shows a cholecystitis image more interesting than the ultrasound view. So it makes alert when facing a painful gallstone than a silent stone of gallbladder.
Furthermore there is a proposal that should think about acute cholecystitis while seeing a gallstone in a RUQ painful patient.