Acute lithiasic cholecystitis in Rett syndrome: Discussion on a complication

BACKGROUND: The laparoscopic cholecystectomy becoming the gold standard in the treatment of lithiasic cholecystitis. At present, the complications range between 0.25% and 0.74% for the major lesions and between 0.28% and 1.7% for the minor lesions. In this study, we describe a clinical picture of biliary peritonitis in a RTT patient after laparoscopic cholecystectomy. The cause of lesion is not always easily identifiable and the multiple factors promoting a lesion can be involved, such as those ones related to anatomy of hepatic pedicle, abnormalities of cystic duct, inflammatory alterations and finally factors related to the expertise of surgical teams. In addition, the factors related to patients, such as obesity, cirrhosis, precedent surgeries and anatomical abnormalities, should always be considered. METHODS: Among the 250 patients operated on for acute lithiasic cholecystitis from January 2009 to February 2014 at the "Istituto di Chirugia II" of the Siena University Hospital, we have observed 12 cases (circa 5% of the population) of RTT patients (mean age: 29.0±years, range 22-36, all female). RESULTS: After twenty days the patients were released, of note, one RTT patient showed a clinical picture of biliary peritonitis.The presence of subhepatic fluid collection and extravasated contrast medium near the cystic duct stump and the common hepatic duct. The abdominal computerized tomography (CT) with contrast agent confirmed the biliary peritonitis. On an emergency laparotomy, bile duct injuries at the level of the right hepatic duct and cystic duct have been revealed. CONCLUSIONS: Our experience suggests that these risks are increased in RTT patients and therefore necessitate a more accurate pre-and postoperative assessment, both in terms clinical-Anaesthesiological and instrumental, in order to make early diagnosis and thereby prevent possible complications.