case_images: PMC11697797_01
case_images: Acute chronic cholecystitis. (A) Mucosal erosion and hemorrhage (hematoxylin and eosin 40X). (B) Acute inflammatory cells (hematoxylin and eosin 200X).
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case_images: F1
case_images: Pathological microscopic examination of the gallbladder revealed examination showed mucosal erosion, hemorrhage and acute inflammatory cells infiltrate, consistent with acute on top of chronic cholecystitis and cholelithiasis (Figures 1A and B).
case_images: Acute Appendicitis. (A) Mucosal erosion (hematoxylin and eosin 40X). (B) Acute inflammatory cells in the wall (hematoxylin and eosin 600X).
case_images: LS-JSLS240023F002.jpg
case_images: PMC11697797_01_LS-JSLS240023F002.jpg
case_images: F2
case_images: Microscopic examination of the appendix revealed mucosal erosion and acute inflammatory cells in the muscularis propria were seen, consistent with AA (Figures 2A and B).
case_images: (A and B) Focused US of the gallbladder: showed distended gallbladder with two echogenic intraluminal nonshadowing echogenicities, the largest measure 0.57 cm. Slightly thickened gallbladder wall measuring 0.38 cm with minimal surrounding pericholecystic fluid. Differential Diagnoses: polyps Other or nonshadowing gallstone.
case_images: LS-JSLS240023F003.jpg
case_images: PMC11697797_01_LS-JSLS240023F003.jpg
case_images: F3
case_images: Slightly thickened gallbladder wall measuring 0.38 cm with minimum surrounding pericholecystic fluid (Figures 3A and 3B).
case_images: (A and B) Axial and coronal views of the CT showed: appendix in a subhepatic position the tip of the appendix is slightly dilated measuring maximum diameter of 0.9 cm; however, no adjacent fat stranding noted. The gallbladder was distended surrounded by fat stranding without obvious stones.
case_images: LS-JSLS240023F004.jpg
case_images: PMC11697797_01_LS-JSLS240023F004.jpg
case_images: F4
case_images: There was no surrounding fat stranding, and minimal free pelvic fluid was noticed (Figures 4A and 4B).
case_images: Four ports were inserted: subxiphoid port 11 mm, right upper quadrant midclavicular line 5 mm port, right upper quadrant anterior axillary line 5 mm, and supraumbilical 11 mm port.
case_images: LS-JSLS240023F005.jpg
case_images: PMC11697797_01_LS-JSLS240023F005.jpg
case_images: F5
case_images: Four ports were inserted like in any classical laparoscopic cholecystectomy (Figure 5), one 11 mm port in the supraumbilical area, one 11 mm port in the epigastric area, and two 5 mm ports in the right lateral side.