Stroke of luck | Figure 1

forderit

Emergency Medicine

Stroke of luck

I was asked to help with an elderly female patient with dementia who had had 4 or 5 episodes of vomiting. General abdominal discomfort was reported by her husband, but her abdomen was soft and non-tender on examination. No localized discomfort whatsoever. White cell count was 14 with neutrophil count of 12, CRP 1, she was apyrexial. I dragged my ultrasound with me as I walked into the cubicle, not knowing exactly what I was going to scan. I swept the probe over the abdomen and immediately noted gallstones and what appeared to be a thickened gallbladder wall. CT abdomen confirmed acute cholecystitis.

Bottom line, cholecystitis can be a very atypical presentation in the elderly, sometimes there is absolutely no inflammatory response, abdominal discomfort may be vague and not localized, with no peritonism.