Pielaciński Konrad, Ejduk Anna, Wróblewski Tadeusz, Szczepanik Andrzej B
Department of General and Hematological Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):468-72. doi: 10.5114/wiitm.2014.45397. Epub 2014 Sep 26.
Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy.
急性非结石性胆囊炎（ACC）最常见于败血症、广泛损伤或手术后的重症患者。作为化疗引起的并发症相当罕见，在接受骨髓抑制治疗的中性粒细胞减少患者中通常危及生命。一名23岁的急性淋巴细胞白血病患者接受了骨髓抑制化疗（环磷酰胺、阿糖胞苷、聚乙二醇天冬酰胺酶）。在第一个化疗周期后，患者出现中性粒细胞减少和发热；她伴有呕吐和右上腹疼痛。超声显示胆囊无结石，胆囊壁增厚至14毫米。诊断为ACC。药物治疗包括广谱抗生素方案和粒细胞集落刺激因子。ACC诊断后第二天，患者的一般状况恶化。进行了腹腔镜胆囊切除术。切除的胆囊未显示细菌或白血病浸润迹象。术后过程顺利。在中性粒细胞减少的ACC患者的治疗中，手术治疗与药物治疗同样重要。
