ALITHIASIC HYDROPS OF THE GALLBLADDER CAUSED BY CYSTIC DUCT SPASM IN COCAINE ADDICTION

Cocaine addiction is an important public health problem, especially in developed countries; the number of users worldwide ranges from 14 million to 21 million (0.3 – 0.5% of the population aged 15 – 64 years)1. The primary effects of cocaine on the nervous system are related to a blockade of the reuptake of monoamines, including dopamine, serotonin and norepinephrine 2. As a consequence of the blockade of amines reuptake, cocaine abuse is a major cause of life threatening cardiovascular emergencies and hypertensive crisis 3, but also of severe damages on other districts (alithiasic cholecystitis, ischemic colitis, pulmonary interstitial fibrosis, testicular and renal damages), always mediated by the thrombosis and destruction of small blood vessels 4. Cocaine is also recognised to cause an important reduction in production of Nitric Oxide, that is an important concause of microvascular damages and consequent ischemic processes, but can also cause smooth muscular tissue spasms in several anatomic districts 4. We report the case of a Caucasian 22 years old female patient, who has been admitted to our Institution because of worsening abdominal pain localized in right hypochondrium, associated with nausea and vomiting; clinical history of the patient revealed daily intake of cocaine by sniffing from at least 3 years. Blood exams did not show leukocytosis nor cholestasis, but a moderate increasing of protein C reactive (7.24 mg / dL); chronic consumption of alcohol or other drugs addictions have been excluded; consumption of cocaine was confirmed by urinary test. Abdominal ultrasonography showed hydrops of the gallbladder without evidence of gallstones; the patient underwent laparoscopic cholecystectomy; postoperative stay was uneventful, with discharge in I day P.O. Histological examination demonstrated a macroscopic distension of the gallbladder that did not contain stones; at microscopy, a moderate flogosis of the walls was visible, without signs of fibrosis, walls thickening or microvascular thrombosis. Cocaine addiction is a rare cause of alithiasic acute cholecystitis ; small vessels thrombosis and destruction have in fact always been demonstrated in the few cases described in Literature 5. The case we have reported, in which no specific vascular occlusion or gallbladder walls fibrotic degeneration have been recognized at histological examination, demonstrates that in very rare cases, cocaine can be the responsible of acute visceral events without ischemic implications; in particular, the acute obstructive cholecystitis that we have observed, seems to have been caused by a continuous spastic obstruction of cystic duct, whose smooth muscular tissue has been affected by the reduced production of Nitric Oxide directly caused by cocaine.