A patient with polyarterhitis nodosa (PAN) may develop cholecystitis.
The diagnosis can be challenging if the patient is not known to have polyarterities nodosa or suspected of a vasculitic disorder.
The diagnosis may depend on the histologic exam of the resected gallbladder. Additional scrutiny of vessels may be indicated if
(1) there are no stones (acalculous) and no cholesterolosis.
(2) the patient is known to be HBsAg positive.
The possibility of a vasculitis should be considered when making the decision to perform laparoscopic surgery in a patient without gallstones. A delay in surgery increases the risk for gangrenous cholecystitis.
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