Cholelithiasis Case


A 60-year-old man with cirrhosis and a remote history of colon cancer, for which he had undergone a hemicolectomy, presented to the emergency department with a fever. He reported no diarrhea, vomiting, or abdominal pain. His temperature was 38.5°C. There was no tenderness to palpation across his abdomen. Laboratory studies revealed a white-cell count of 12,300 per cubic millimeter (normal range, 3600 to 11,000) and a total bilirubin level of 2.0 mg per deciliter (34.2 μmol per liter) (normal range, 0.2 to 1.3 mg per deciliter [3.4 to 22.2 μmol per liter]), although his baseline total bilirubin level was 2.0 mg per deciliter owing to his liver disease. The aminotransferase levels, alkaline phosphatase levels, and urinalysis results were within the normal range. Two sets of blood cultures obtained on admission grew Escherichia coli. Computed tomography, which was performed to determine possible intraabdominal sources of infection, revealed no abscess, ascites, or colitis but did show multiple small, round, calcified gallstones (Panels A and B). Although no definitive source of the bacteremia was found, the patient became afebrile within the first 48 hours after antibiotic treatment was initiated. Cholecystectomy was considered but not pursued because of the patient’s high operative risk owing to cirrhosis. He completed a course of antibiotics and was doing well at a follow-up visit 11 months after his discharge from the hospital. Ongoing surveillance has not identified a recurrence of colon cancer.

Interferon-free therapy for hepatitis C ‘cured’ 90% of patients

Currently, doctors treating hepatitis C patients with cirrhosis (liver scarring) can only offer treatments that rely on the drug interferon, which unfortunately, only works for less than half of patients. Now, a new study found that an interferon-free combination of drugs was safe, well tolerated and cured over 90% of …

What is cirrhosis of the liver?

Cirrhosis of the liver describes a condition where scar tissue gradually replaces healthy liver cells. The main causes are sustained, excessive alcohol consumption, viral hepatitis B and C, and fatty liver disease – however, there are other possible causes. People with cirrhosis may develop jaundice (yellowing of the skin, eyes, …

Hepatitis A

Hepatitis A is a virus that causes infection and inflammation of the liver. It rarely results in serious liver damage or death and does not develop chronic liver disease. Unlike hepatitis B or C, it does not lead to chronic liver disease, but it can result in significant loss of income and …

Show Buttons
Hide Buttons