A case report of acute gangrenous cholecystitis presenting as right lower quadrant abdominal pain

Rationale: Acute gangrenous cholecystitis (AGC) is a life-threatening complication of acute cholecystitis that is characterized by early diagnostic difficulties due to nonspecific imaging and laboratory findings. The clinical presentation is a critical diagnostic tool. Although the typical pain location in AGC is the right upper quadrant, a few patients exhibit atypical abdominal pain locations, posing additional challenges to an already difficult diagnosis. Patient concerns: This report describes the case of a 71-year-old female patient with pain in the right lower quadrant as the primary manifestation. Computed tomography revealed gallbladder wall edema, cholecystitis, and abdominopelvic effusion. Abdominal paracentesis revealed greenish fluid with significantly elevated amylase and lipase levels. Diagnoses: Laparoscopic examination, including histopathological findings, confirmed gangrenous cholecystitis. Interventions: Laparoscopic cholecystectomy was performed, and postoperative antibiotic therapy and wound care were administered. Outcomes: The patient recovered uneventfully and was discharged on postoperative day 6. The follow-up showed no complications. Lessons: This rare case highlights that AGC should be considered in patients with right lower quadrant pain, even in those without the classic right upper quadrant symptoms. Timely imaging (ultrasound, computed tomography), paracentesis with fluid amylase/lipase testing, and early laparoscopic exploration are essential for early diagnosis and intervention to improve the outcomes. This case aims to enhance the awareness of atypical presentations of AGC and aid early diagnosis.