POLYARTERITIS NODOSA OF THE GALLBLADDER PRESENTING AS ACUTE CHOLECYSTITIS

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Recently we had experienced a case with a diagnosis of polyarteritis nodosa (P.N.), which was first made by pathological examination of a gallbaldder surgically removed for acute cholecystitis. A 72-year-old male entered this hospital complaining of general fatigue, right hypochondralgia and fever, and a clinical diagnosis of possible acute cholecystitis was made by abdominal ultrasonography. The patient had also renal dysfunction and conservative therapy was not effective. Cholecystectomy was carried out. Operative findings revealed that there were two 3mm sized stones in the gallbladder and its mucosa was almost entirely intact. On histopathological examination, several arteries in the wall showed focal fibrinoid necrosis accompanied with inflammatory cells. A clinical diagnosis of P.N. was made and the patient markedly imporved with steroid treatment. Important points in diagnosing acute cholecystitis derived from P.N. were such as follows: 1) delayed inflammatory findings even by antibiotics regimen; 2) multiple organ dysfunction in addition to acute cholecystitis; and 3) acalculous cholecystitis.
日本臨床外科学会の論文