Disclosures: Nahyun Kim, MD: No financial relationships or conflicts of interest

Case Diagnosis: 78-year-old female and 84-year-old male admitted with acute right middle cerebral artery infarct

Case Description: Two patients were admitted after acute stroke with hemiparesis and percutaneous endoscopic gastrostomy (PEG) tube placed for significant dysphagia. During their inpatient rehabilitation stay, they developed low grade fever, vague abdominal discomfort and were found to have acute cholecystitis (AC). The first patient, a 78-year-old female, was treated with intravenous antibiotics, followed by oral antibiotics. After the course of antibiotics, she developed mild abdominal discomfort and the necessity of surgical intervention was explored, but not recommended. The second patient, a 84-year-old male, had a percutaneous cholecystostomy placed and also received a course of antibiotics.

Setting: Acute inpatient rehabilitationAssessment/

Results: Both patients stayed stable after appropriate treatment of AC and were able to participate in multidisciplinary rehabilitation. Enteral feeding was restarted and advanced as tolerated.

Discussion: Extant literature suggests that AC is frequently observed in patients with acute stroke. This trend was more common among patients who had severe hemiparesis and those who fasted. The proposed mechanism to this link was compromised circulation to the gallbladder and biliary obstruction as a result of bedridden status. Another contributor to cholecystitis was fasting, which leads to hyposecretion of gastrointestinal hormones, and results in contractile dysfunction of the gallbladder. In our case series, both patients were placed on PEG tube which may have contributed to less secretion of gastrointestinal hormones compared to oral feeding. Further, the autonomic dysfunction in stroke patients may cause contractile dysfunction of the gallbladder.

Conclusion: When stroke patients develop a fever, and abdominal tenderness, AC should be in the differentials, especially if they are bedridden with significant disability, fasting or placed on a PEG tube. Proper antibiotics treatment, as well as surgical intervention as needed, and achieving early ambulation with therapies and resumption of oral intake through rehabilitation treatment are critical.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-cholecystitis-during-inpatient-rehabilitation-in-acute-stroke-patients-coincidence-or-consequence-a-case-report/