Food-borne infection vs. dietary factors

I was recently hospitalized with a gall bladder infection. The source of the infection was enterococcus, caused by an ill-fated trip to a sushi-laden buffet. I and another were affected by the germ, but I was not so lucky as it had found its way into my gall bladder.  My symptoms were consistent with acute cholecystitus, and a catheter was inserted to drain the infection.

The infections (including our old friend e.coli) were eradicated with a combination of Zyvox, metronidazole, and levaquin. The gall bladder is functioning normally again, but the surgeon still wishes to remove it. I am not convinced this is the best long-term solution. I am 36 yrs old and very healthy, with balanced diet and frequent exercise. I am concerned about long-term effects, but the doctors can only speak in "maybes" and "possiblies". At the very least, I want to remove the catheter immediately but I don't know what if anything else is required to seal the puncture.

So the question is, must a gall bladder be removed under all circumstances of infection, including those that are inflicted rather than developed?

[Kevin Pho, MD]

In most cases of cholangitis (80%) is treated with conservative therapy, including antibiotics and supportive therapy.  Bile duct decompression with a stent may be performed (as it sounds like in your case).  

Emergent surgery for acute cholangitis has largely been replaced by nonoperative biliary drainage. Once the acute cholangitis is controlled, patients with difficult ductal stones may undergo surgical exploration of the CBD for stone removal (if the stone has caused the infection).

If there is no evidence of stones causing the cholangitis, then there is a possibility that surgery to remove the gallbladder may not be needed.  I would suggest a second surgical opinion to see whether this elective procedure is needed.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Afdhal.  Acute cholangitis.  UptoDate, 2004.

[othello]

I must also add that since the infection cleared, I have absolutely no pain from the gall bladder. The only discomfort I am experiencing comes from the presence of the catheter.

[othello]

And a final note. I did not have gallstones, nor any symptoms of gall bladder disease prior to this episode. I exercise vigorously and regularly, I avoid junk food, and I want to maintain peak efficiency. What the doctors are speculating is contrary to common sense. I need to know quickly what will happen if only the catheter is removed; if a small amount of bile leakage is acceptable, how long it would take for the puncture in the gall bladder to close, what changes in my diet can I make to hasten its recovery.