Refractory abdominal pain resistant to medical management as the main manifestation of ischemic gallbladder

In the present paper, we discuss the importance of clinical evaluation by presenting three cases whose diagnosis was acute cholecystitis.Their clinical presentation was characterized by abdominal ischemic pain, with no data of acute complicated cholecystitis in imaging or laboratory studies.However, during surgical procedures, the gallbladders of all three patients were found in an ischemic phase.We observe that conventional studies are not able to identify gallbladder ischemia before the surgery.Contrasting computed tomography must be used, but we emphasize that clinical suspicion must be obtained.