The Enormous Size of the Gallblader - A Reason for Conversion to Open Surgery in Acute Cholecystitis

Abstract

Laparascopic cholecystectomy is considered the treatment of choice for cholelithiasis. Laparosopic cholecystectomy can be safely performed in patients with acute cholecystitis, but there is a difference between conversion rates in patients operated within 72 hours from the onset of the symptoms and those after. The main reason for conversion on early laparoscopic cholecystectomy is the inflammation that interferes and makes the anatomy of the Calot's triangle less visible, while other factors for the conversion of laparoscopic cholecystectomy in acute cholecystitis are the timing of the operation, age, BMI, CRP, white blood cell count (WBC), fever, tenderness in the right upper abdomen and ultrasonographic finding of extremely thickened gallbladder wall, close relation of the Hartmann's pouch with hepaticoduodenal ligament, the gallbladder size and the number and size of stones. Case presentation: Here we present a case of 74 year old female patient, who presented at our institution with 6 day history of abdominal pain, nausea and fever, with physical, laboratory and ultrasound signs of acute cholecystitis. She underwent an laparoscopic exploration of abdominal cavity in order to perform laparoscopic cholecystectomy. Because of extremely large and thickened gallbladder wall and short xyphoid- umbilicus distance, conversion was mandated. Conclusion: The enormous size of gallbladder in patients with acute cholecystitis, accompanied with short xyphoid-umbilicus distance can be a reason for conversion to open surgery during laparoscopic cholecystectomy.