Gangrenous Cholecystitis in a 54-Year-Old Male With Schizophrenia and Other Barriers to Care: A Case Report.

Schizophrenia is a chronic psychiatric condition that can contribute to delays in the diagnosis and treatment of health conditions. Factors like poor judgment, decreased medical literacy, cognitive barriers, and delayed seeking of therapy can result in worse outcomes of the disease. Acute gangrenous cholecystitis is a severe complication of acute cholecystitis, requiring immediate surgical intervention. We present the case of a 54-year-old Spanish-speaking male with schizophrenia who presented with seven days of progressively worsening right upper quadrant (RUQ) pain, as well as associated nausea and postprandial emesis. The patient also reported having been recently discharged from an Emergency Department (ED) on an antibiotic regimen after presenting with the same chief complaint. Further evaluation showed laboratory findings of leukocytosis (22.3 × 10³ cells/µL) and a computed tomography (CT) of the abdomen and pelvis with findings consistent with acute cholecystitis, with a possible gangrenous component. This case sheds light on the impact of psychiatric disorders on the treatment of disease. Stigmatized psychiatric comorbidities, including schizophrenia, can lead to worsened outcomes and an increased risk of life-threatening complications due to delayed initiation of proper treatment protocols. Increased awareness, identification of biases, and practiced protocols for disease management should be upheld in patients with mental illness to prevent complications.