View Article PDF

Campylobacter jejuni is commonly associated with gastroenteritis,1-3 but extremely few reports link it with acute cholecystitis.4-8 These infectious complications can assume menacing proportions in the immunocompromised, and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.CaseA 65-year-old gentleman having non-Hodgkins lymphoma Stage 4 was started on Rituximab, cyclophosphamide, vincristine and prednisolone (RCHOP). On Day 11 of his second cycle of chemotherapy, he presented to the emergency department with a three-day history of severe right upper-abdominal pain, vomiting, high-grade fever and diarrhea. The diarrhea was florid 16-18 episodes in a day, occasionally bloody, but mostly watery and associated with tenesmus. He had cooked chicken stew approximately 36 hours prior to the onset of symptoms. On examination, he was dehydrated. He had a temperature of 39\u00b0C, associated with mild chills, and right upper-quadrant tenderness with positive Murphys sign.He was initially started on piperacillin-tazobactam 4.5g and metronidazole 500mg intravenously every 8 hours for presumed febrile neutropenia. The patient had received peg-filgrastim, post chemotherapy and had an elevated neutrophil count of 14.72x109/L. Abdominal ultrasound reported features of acute cholecystitis, with gall bladder wall thickening and enlargement, mobile gallstones and small amounts of pericholecystic fluid. The region was tender to probe pressure (sonographic Murphys sign positive). Hepatic steatosis was also present. The common bile duct was not dilated, nor the biliary tree. There was no biliary sludge. The stool microscopic examination revealed pus cells and red blood cells, suggesting infectious colitis. A surgical consult was taken, but owing to his weak general condition, the patient was deemed unfit for any surgical intervention by the surgeons and was managed conservatively.He was managed conservatively with intravenous fluids and small amounts of clear fluid orally for the first 72 hours, followed by institution of a low-fat, semisolid diet and oral rehydration therapy.On the fifth day, the stool culture was reported positive for Campylobacter jejuni. Parenteral antibiotics were stopped and oral ciprofloxacin 750mg twice daily was started. Following this, his condition improved, and his clinical symptoms resolved over the next one week. His right upper-quadrant pain also subsided, coinciding with the resolution of his diarrhea.The patient was discharged home on ciprofloxacin for a total of two weeks of oral therapy. An ultrasound, repeated 10 days later, demonstrated complete resolution of the acute cholecystitis.Campylobacters are common commensals in the gastrointestinal tract of animals, especially poultry. Campylobacter jejuni is known to cause gastroenteritis, colitis, septicemia, peritonitis, pancreatitis and gastrointestinal hemorrhage besides many extra-intestinal complications.1-3 However, association with acute cholecystitis is exceedingly rare.4-8There have been 16 reported cases4-8 (15 published and 1 unpublished poster report6) worldwide (none from Australia/Oceania) that have linked Campylobacter infection with cholecystitis. The clinical presentation included abdominal pain in all, fever in nine, vomiting in eight, jaundice in two, septic shock with hypotension in two and mortality in one case with advanced hepatocellular carcinoma. Diarrhea and pre-existing gall stones, as seen in our case, were described in six and seven cases, respectively.4-8Three of the cases were treated conservatively only with antibiotics, while the rest were managed with cholecystectomy. For Campylobacter infections, ciprofloxacin or macrolides are antibiotics of choice. Most notably, in one of the cases, the clinical condition of the patient continued to deteriorate after cholecystectomy and resolved only upon institution of specific targeted antibiotic treatment against C.jejuni.7We do believe that successful conservative management is possible in patients deemed unfit for surgery owing to poor general condition. Another alternative is percutaneous cholecystostomy.Percutaneous cholecystostomy is usually indicated in patients who fail an initial trial of antibiotic therapy. However, gallbladder drainage by percutaneous cholecystostomy in conjunction with antibiotics may be used as initial treatment for very ill patients (ie, intensive care unit). The procedure is not without risk and in one retrospective review that included 1,918 patients, 30-day mortality after percutaneous cholecystostomy was 15.4 %, but only 4.5 % for cholecystectomy,9 the difference being likely due to patient selection bias. Minor complications of percutaneous drainage include bleeding, catheter blockage and dislodgement (10-15%), and failure to resolve the acute cholecystitis (10%). 10 However, our patient responded promptly to change of therapy to ciprofloxacin, thus obviating the need for such a procedure.Mobile gall stones were present in our case, but the liver function tests were normal. There was no biliary sludge or bile duct dilatation on ultrasound. There was an extremely strong temporal relationship between both the onset and the resolution of cholecystitis and gastroenteritis. As mentioned above, there was rapid and simultaneous resolution of cholecystitis, along with the gastroenteritis upon institution of C.jejuni specific antimicrobial therapy with ciprofloxacin. Diarrhea and pre-existing gall stones, as seen in our case, have been described in Campylobacter cholecystitis, as detailed in the review of literature above. Also, at least in one reported case, the diagnosis of Campylobacter infection was based on initial stool culture rather than bile cultures post cholecystectomy.8 All these facts, taken together, strongly argue for both conditions having a common etiology in the form of Campylobacter jejuni.In patients with lymphoma, use of Rituximab a monoclonal antibody against CD 20 positive B cells, adds to the immunosuppression and may have contributed to the severe manifestations seen in our case.Studies suggest strong association between fatal outcome and prescription of a third-generation cephalosporin for patients with Campylobacter (except C.fetus) bacteremia, especially in the immunocompromised.2,3 Thus, it would be prudent to provide anti-Campylobacter anti-microbial coverage presumptively in such situations, rather than wait for confirmatory investigations so as to avoid serious complications especially in the immunocompromised, in whom there is greater likelihood of being deemed unfit for surgical interventions.

Summary

Abstract

Campylobacter jejuni is commonly associated with gastroenteritis, but extremely few reports worldwide link it acute cholecystitis. These infectious complications can assume menacing proportions in the immunocompromised and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.

Aim

Method

Results

Conclusion

Author Information

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia; Louise Teo, Medical Oncology, Hervey Bay Hospital, Queensland, Australia.

Acknowledgements

Correspondence

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia

Correspondence Email

ajayajaygupta2002@rediffmail.com

Competing Interests

Nil

- - Kapperud G, Lassen J, Ostroff SM, Aasen S. Clinical features of sporadic Campylobacter infections in Norway. Scand J Infect Dis 1992; 24:741. Skirrow MB, Blaser MJ. Clinical aspects of Campylobacter infection. In: Campylobacter, 2nd ed, Nachamkin I, Blaser MJ (Eds), ASM Press, Washington DC 2000. p.69. Pacanowski J1, Lalande V, Lacombe K, etal. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. 2008 ;47:790-6. Dakdouki GK, Araj GF, Hussein M. Campylobacter jejuni: unusual cause of cholecystitis with lithiasis. Case report and literature review. Clin Microbiol Infect 2003; 9: 970-2 Takatsu M, Ichiyama S, Nada T, et al. Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinoma. Scand J Infect Dis 1997; 29: 197-8. Verzotti G, Muradbegovic M, Schneider R. Acalculous cholecystitis due to Campylobacter jejuni: should we operate? http://www.chirurgiekongress-poster.ch/fileadmin/files/documents/pdfs-2015/3759.pdf Vaughan-Shaw PG, Rees JR, White D. Campylobacter jejuni cholecystitis: a rare but significant clinical entity. BMJ Case Rep. 2010;2010:bcr1020092365. doi: 10.1136/bcr.10.2009.2365. Udayakumar D, Sanaullah M. Campylobacter cholecystitis. Int J Med Sci. 2009 :6:374-5. Abi-Haidar Y, Sanchez V, Williams SA, Itani KM. Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg 2012; 147:416-422. Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197:206-11.- -

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

Campylobacter jejuni is commonly associated with gastroenteritis,1-3 but extremely few reports link it with acute cholecystitis.4-8 These infectious complications can assume menacing proportions in the immunocompromised, and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.CaseA 65-year-old gentleman having non-Hodgkins lymphoma Stage 4 was started on Rituximab, cyclophosphamide, vincristine and prednisolone (RCHOP). On Day 11 of his second cycle of chemotherapy, he presented to the emergency department with a three-day history of severe right upper-abdominal pain, vomiting, high-grade fever and diarrhea. The diarrhea was florid 16-18 episodes in a day, occasionally bloody, but mostly watery and associated with tenesmus. He had cooked chicken stew approximately 36 hours prior to the onset of symptoms. On examination, he was dehydrated. He had a temperature of 39\u00b0C, associated with mild chills, and right upper-quadrant tenderness with positive Murphys sign.He was initially started on piperacillin-tazobactam 4.5g and metronidazole 500mg intravenously every 8 hours for presumed febrile neutropenia. The patient had received peg-filgrastim, post chemotherapy and had an elevated neutrophil count of 14.72x109/L. Abdominal ultrasound reported features of acute cholecystitis, with gall bladder wall thickening and enlargement, mobile gallstones and small amounts of pericholecystic fluid. The region was tender to probe pressure (sonographic Murphys sign positive). Hepatic steatosis was also present. The common bile duct was not dilated, nor the biliary tree. There was no biliary sludge. The stool microscopic examination revealed pus cells and red blood cells, suggesting infectious colitis. A surgical consult was taken, but owing to his weak general condition, the patient was deemed unfit for any surgical intervention by the surgeons and was managed conservatively.He was managed conservatively with intravenous fluids and small amounts of clear fluid orally for the first 72 hours, followed by institution of a low-fat, semisolid diet and oral rehydration therapy.On the fifth day, the stool culture was reported positive for Campylobacter jejuni. Parenteral antibiotics were stopped and oral ciprofloxacin 750mg twice daily was started. Following this, his condition improved, and his clinical symptoms resolved over the next one week. His right upper-quadrant pain also subsided, coinciding with the resolution of his diarrhea.The patient was discharged home on ciprofloxacin for a total of two weeks of oral therapy. An ultrasound, repeated 10 days later, demonstrated complete resolution of the acute cholecystitis.Campylobacters are common commensals in the gastrointestinal tract of animals, especially poultry. Campylobacter jejuni is known to cause gastroenteritis, colitis, septicemia, peritonitis, pancreatitis and gastrointestinal hemorrhage besides many extra-intestinal complications.1-3 However, association with acute cholecystitis is exceedingly rare.4-8There have been 16 reported cases4-8 (15 published and 1 unpublished poster report6) worldwide (none from Australia/Oceania) that have linked Campylobacter infection with cholecystitis. The clinical presentation included abdominal pain in all, fever in nine, vomiting in eight, jaundice in two, septic shock with hypotension in two and mortality in one case with advanced hepatocellular carcinoma. Diarrhea and pre-existing gall stones, as seen in our case, were described in six and seven cases, respectively.4-8Three of the cases were treated conservatively only with antibiotics, while the rest were managed with cholecystectomy. For Campylobacter infections, ciprofloxacin or macrolides are antibiotics of choice. Most notably, in one of the cases, the clinical condition of the patient continued to deteriorate after cholecystectomy and resolved only upon institution of specific targeted antibiotic treatment against C.jejuni.7We do believe that successful conservative management is possible in patients deemed unfit for surgery owing to poor general condition. Another alternative is percutaneous cholecystostomy.Percutaneous cholecystostomy is usually indicated in patients who fail an initial trial of antibiotic therapy. However, gallbladder drainage by percutaneous cholecystostomy in conjunction with antibiotics may be used as initial treatment for very ill patients (ie, intensive care unit). The procedure is not without risk and in one retrospective review that included 1,918 patients, 30-day mortality after percutaneous cholecystostomy was 15.4 %, but only 4.5 % for cholecystectomy,9 the difference being likely due to patient selection bias. Minor complications of percutaneous drainage include bleeding, catheter blockage and dislodgement (10-15%), and failure to resolve the acute cholecystitis (10%). 10 However, our patient responded promptly to change of therapy to ciprofloxacin, thus obviating the need for such a procedure.Mobile gall stones were present in our case, but the liver function tests were normal. There was no biliary sludge or bile duct dilatation on ultrasound. There was an extremely strong temporal relationship between both the onset and the resolution of cholecystitis and gastroenteritis. As mentioned above, there was rapid and simultaneous resolution of cholecystitis, along with the gastroenteritis upon institution of C.jejuni specific antimicrobial therapy with ciprofloxacin. Diarrhea and pre-existing gall stones, as seen in our case, have been described in Campylobacter cholecystitis, as detailed in the review of literature above. Also, at least in one reported case, the diagnosis of Campylobacter infection was based on initial stool culture rather than bile cultures post cholecystectomy.8 All these facts, taken together, strongly argue for both conditions having a common etiology in the form of Campylobacter jejuni.In patients with lymphoma, use of Rituximab a monoclonal antibody against CD 20 positive B cells, adds to the immunosuppression and may have contributed to the severe manifestations seen in our case.Studies suggest strong association between fatal outcome and prescription of a third-generation cephalosporin for patients with Campylobacter (except C.fetus) bacteremia, especially in the immunocompromised.2,3 Thus, it would be prudent to provide anti-Campylobacter anti-microbial coverage presumptively in such situations, rather than wait for confirmatory investigations so as to avoid serious complications especially in the immunocompromised, in whom there is greater likelihood of being deemed unfit for surgical interventions.

Summary

Abstract

Campylobacter jejuni is commonly associated with gastroenteritis, but extremely few reports worldwide link it acute cholecystitis. These infectious complications can assume menacing proportions in the immunocompromised and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.

Aim

Method

Results

Conclusion

Author Information

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia; Louise Teo, Medical Oncology, Hervey Bay Hospital, Queensland, Australia.

Acknowledgements

Correspondence

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia

Correspondence Email

ajayajaygupta2002@rediffmail.com

Competing Interests

Nil

- - Kapperud G, Lassen J, Ostroff SM, Aasen S. Clinical features of sporadic Campylobacter infections in Norway. Scand J Infect Dis 1992; 24:741. Skirrow MB, Blaser MJ. Clinical aspects of Campylobacter infection. In: Campylobacter, 2nd ed, Nachamkin I, Blaser MJ (Eds), ASM Press, Washington DC 2000. p.69. Pacanowski J1, Lalande V, Lacombe K, etal. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. 2008 ;47:790-6. Dakdouki GK, Araj GF, Hussein M. Campylobacter jejuni: unusual cause of cholecystitis with lithiasis. Case report and literature review. Clin Microbiol Infect 2003; 9: 970-2 Takatsu M, Ichiyama S, Nada T, et al. Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinoma. Scand J Infect Dis 1997; 29: 197-8. Verzotti G, Muradbegovic M, Schneider R. Acalculous cholecystitis due to Campylobacter jejuni: should we operate? http://www.chirurgiekongress-poster.ch/fileadmin/files/documents/pdfs-2015/3759.pdf Vaughan-Shaw PG, Rees JR, White D. Campylobacter jejuni cholecystitis: a rare but significant clinical entity. BMJ Case Rep. 2010;2010:bcr1020092365. doi: 10.1136/bcr.10.2009.2365. Udayakumar D, Sanaullah M. Campylobacter cholecystitis. Int J Med Sci. 2009 :6:374-5. Abi-Haidar Y, Sanchez V, Williams SA, Itani KM. Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg 2012; 147:416-422. Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197:206-11.- -

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

Campylobacter jejuni is commonly associated with gastroenteritis,1-3 but extremely few reports link it with acute cholecystitis.4-8 These infectious complications can assume menacing proportions in the immunocompromised, and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.CaseA 65-year-old gentleman having non-Hodgkins lymphoma Stage 4 was started on Rituximab, cyclophosphamide, vincristine and prednisolone (RCHOP). On Day 11 of his second cycle of chemotherapy, he presented to the emergency department with a three-day history of severe right upper-abdominal pain, vomiting, high-grade fever and diarrhea. The diarrhea was florid 16-18 episodes in a day, occasionally bloody, but mostly watery and associated with tenesmus. He had cooked chicken stew approximately 36 hours prior to the onset of symptoms. On examination, he was dehydrated. He had a temperature of 39\u00b0C, associated with mild chills, and right upper-quadrant tenderness with positive Murphys sign.He was initially started on piperacillin-tazobactam 4.5g and metronidazole 500mg intravenously every 8 hours for presumed febrile neutropenia. The patient had received peg-filgrastim, post chemotherapy and had an elevated neutrophil count of 14.72x109/L. Abdominal ultrasound reported features of acute cholecystitis, with gall bladder wall thickening and enlargement, mobile gallstones and small amounts of pericholecystic fluid. The region was tender to probe pressure (sonographic Murphys sign positive). Hepatic steatosis was also present. The common bile duct was not dilated, nor the biliary tree. There was no biliary sludge. The stool microscopic examination revealed pus cells and red blood cells, suggesting infectious colitis. A surgical consult was taken, but owing to his weak general condition, the patient was deemed unfit for any surgical intervention by the surgeons and was managed conservatively.He was managed conservatively with intravenous fluids and small amounts of clear fluid orally for the first 72 hours, followed by institution of a low-fat, semisolid diet and oral rehydration therapy.On the fifth day, the stool culture was reported positive for Campylobacter jejuni. Parenteral antibiotics were stopped and oral ciprofloxacin 750mg twice daily was started. Following this, his condition improved, and his clinical symptoms resolved over the next one week. His right upper-quadrant pain also subsided, coinciding with the resolution of his diarrhea.The patient was discharged home on ciprofloxacin for a total of two weeks of oral therapy. An ultrasound, repeated 10 days later, demonstrated complete resolution of the acute cholecystitis.Campylobacters are common commensals in the gastrointestinal tract of animals, especially poultry. Campylobacter jejuni is known to cause gastroenteritis, colitis, septicemia, peritonitis, pancreatitis and gastrointestinal hemorrhage besides many extra-intestinal complications.1-3 However, association with acute cholecystitis is exceedingly rare.4-8There have been 16 reported cases4-8 (15 published and 1 unpublished poster report6) worldwide (none from Australia/Oceania) that have linked Campylobacter infection with cholecystitis. The clinical presentation included abdominal pain in all, fever in nine, vomiting in eight, jaundice in two, septic shock with hypotension in two and mortality in one case with advanced hepatocellular carcinoma. Diarrhea and pre-existing gall stones, as seen in our case, were described in six and seven cases, respectively.4-8Three of the cases were treated conservatively only with antibiotics, while the rest were managed with cholecystectomy. For Campylobacter infections, ciprofloxacin or macrolides are antibiotics of choice. Most notably, in one of the cases, the clinical condition of the patient continued to deteriorate after cholecystectomy and resolved only upon institution of specific targeted antibiotic treatment against C.jejuni.7We do believe that successful conservative management is possible in patients deemed unfit for surgery owing to poor general condition. Another alternative is percutaneous cholecystostomy.Percutaneous cholecystostomy is usually indicated in patients who fail an initial trial of antibiotic therapy. However, gallbladder drainage by percutaneous cholecystostomy in conjunction with antibiotics may be used as initial treatment for very ill patients (ie, intensive care unit). The procedure is not without risk and in one retrospective review that included 1,918 patients, 30-day mortality after percutaneous cholecystostomy was 15.4 %, but only 4.5 % for cholecystectomy,9 the difference being likely due to patient selection bias. Minor complications of percutaneous drainage include bleeding, catheter blockage and dislodgement (10-15%), and failure to resolve the acute cholecystitis (10%). 10 However, our patient responded promptly to change of therapy to ciprofloxacin, thus obviating the need for such a procedure.Mobile gall stones were present in our case, but the liver function tests were normal. There was no biliary sludge or bile duct dilatation on ultrasound. There was an extremely strong temporal relationship between both the onset and the resolution of cholecystitis and gastroenteritis. As mentioned above, there was rapid and simultaneous resolution of cholecystitis, along with the gastroenteritis upon institution of C.jejuni specific antimicrobial therapy with ciprofloxacin. Diarrhea and pre-existing gall stones, as seen in our case, have been described in Campylobacter cholecystitis, as detailed in the review of literature above. Also, at least in one reported case, the diagnosis of Campylobacter infection was based on initial stool culture rather than bile cultures post cholecystectomy.8 All these facts, taken together, strongly argue for both conditions having a common etiology in the form of Campylobacter jejuni.In patients with lymphoma, use of Rituximab a monoclonal antibody against CD 20 positive B cells, adds to the immunosuppression and may have contributed to the severe manifestations seen in our case.Studies suggest strong association between fatal outcome and prescription of a third-generation cephalosporin for patients with Campylobacter (except C.fetus) bacteremia, especially in the immunocompromised.2,3 Thus, it would be prudent to provide anti-Campylobacter anti-microbial coverage presumptively in such situations, rather than wait for confirmatory investigations so as to avoid serious complications especially in the immunocompromised, in whom there is greater likelihood of being deemed unfit for surgical interventions.

Summary

Abstract

Campylobacter jejuni is commonly associated with gastroenteritis, but extremely few reports worldwide link it acute cholecystitis. These infectious complications can assume menacing proportions in the immunocompromised and need careful management. We present a report of such a case from Australia, successfully managed conservatively, without surgery.

Aim

Method

Results

Conclusion

Author Information

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia; Louise Teo, Medical Oncology, Hervey Bay Hospital, Queensland, Australia.

Acknowledgements

Correspondence

Ajay Gupta, Department of Medical Oncology, Asian Cancer Center and Ex Consultant, Medical Oncology, Hervey Bay, Queensland, Australia

Correspondence Email

ajayajaygupta2002@rediffmail.com

Competing Interests

Nil

- - Kapperud G, Lassen J, Ostroff SM, Aasen S. Clinical features of sporadic Campylobacter infections in Norway. Scand J Infect Dis 1992; 24:741. Skirrow MB, Blaser MJ. Clinical aspects of Campylobacter infection. In: Campylobacter, 2nd ed, Nachamkin I, Blaser MJ (Eds), ASM Press, Washington DC 2000. p.69. Pacanowski J1, Lalande V, Lacombe K, etal. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. 2008 ;47:790-6. Dakdouki GK, Araj GF, Hussein M. Campylobacter jejuni: unusual cause of cholecystitis with lithiasis. Case report and literature review. Clin Microbiol Infect 2003; 9: 970-2 Takatsu M, Ichiyama S, Nada T, et al. Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinoma. Scand J Infect Dis 1997; 29: 197-8. Verzotti G, Muradbegovic M, Schneider R. Acalculous cholecystitis due to Campylobacter jejuni: should we operate? http://www.chirurgiekongress-poster.ch/fileadmin/files/documents/pdfs-2015/3759.pdf Vaughan-Shaw PG, Rees JR, White D. Campylobacter jejuni cholecystitis: a rare but significant clinical entity. BMJ Case Rep. 2010;2010:bcr1020092365. doi: 10.1136/bcr.10.2009.2365. Udayakumar D, Sanaullah M. Campylobacter cholecystitis. Int J Med Sci. 2009 :6:374-5. Abi-Haidar Y, Sanchez V, Williams SA, Itani KM. Revisiting percutaneous cholecystostomy for acute cholecystitis based on a 10-year experience. Arch Surg 2012; 147:416-422. Byrne MF, Suhocki P, Mitchell RM, et al. Percutaneous cholecystostomy in patients with acute cholecystitis: experience of 45 patients at a US referral center. J Am Coll Surg 2003; 197:206-11.- -

Contact diana@nzma.org.nz
for the PDF of this article

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