jkstn The Journal of the Korean Society for Transplantation J Korean Soc Transplant 1598-1711 The Korean Society for Transplantation 10.4285/jkstn.2013.27.2.57 jkstn-27-57 Case Report Acalculous Gallbladder Perforation and Coronary Artery Aneurysm after Kidney Transplantation ParkBo Rha M.D. KangJung Hyun M.D. ShinSung Joon M.D. KimKyung Soo M.D. Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea Correspondence：Kyung Soo Kim, Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 410-773, Korea Tel: +82-31-961-7123, Fax: +82-31-961-7153 E-mail: kskimmd@dumc.or.kr 62013 1162013 272 5761 31122012 13052013 20052013 Copyright © 2013 The Korean Society for Transplantation 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Although gallbladder (GB) perforation due to acalculous cholecystitis after kidney transplantation is rarely observed, it can be life threatening and result in cholecystectomy. Coronary artery aneurysm (CAA) is also rare and may require invasive therapy depending on its diameter. We report herein the case of a 69-year-old female who developed GB perforation due to acalculous cholecystitis after kidney transplantation and underwent cholecystectomy. The patient was later invasively treated when CCA was detected by coronary angiography.

 Kidney transplantation Acalculous cholecystitis Coronary artery aneurysm REFERENCES Lowell JA Stratta RJ Taylor RJ Bynon JS Larsen JL Nelson NL Cholelithiasis in pancreas and kidney transplant recipients with diabetes Surgery 199311485863 Hopkinson GB Crowson MC Barnes AD Perforation of the acalculous gallbladder following renal transplantation Transplant Proc 19851720145 Syed M Lesch M Coronary artery aneurysm: a review Prog Cardiovasc Dis 1997407784 Banerjee P Houghton T Walters M Kaye GC Giant right coronary artery aneurysm presenting as a media-stinal mass Heart 200490e50 Becker CG Dubin T Glenn F Induction of acute cholecystitis by activation of factor XII J Exp Med 1980151 8190 Barie PS Eachempati SR Acute acalculous cholecystitis Gastroenterol Clin North Am 20103934357 Lorber MI Van Buren CT Flechner SM Williams C Kahan BD Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients Transplantation 1987433540 Satran A Bart BA Henry CR Murad MB Talukdar S Satran D Increased prevalence of coronary artery aneurysms among cocaine users Circulation 2005111 24249 Wan S LeClerc JL Vachiery JL Vincent JL Cardiac tamponade due to spontaneous rupture of right coronary artery aneurysm Ann Thorac Surg 1996625756 Chia HM Tan KH Jackson G Non-atherosclerotic cor-onary artery aneurysms: two case reports Heart 199778 6136 Figures

Abdomen and pelvic com-puted tomography findings of the patient. (A) Cross section image revealing the irregular mucosa of gallbladder (GB) with suspicious wall defects and distended GB without definite radiopaque stone in GB. (B) Coronal section image showing a small amount of ascites in the perihepatic space and bowel ileus.

This gallbladder (GB) specimen consists of a previously opened GB measuring 10 cm in length and 4.5 cm in diameter. The serosa is dull gray tan and the mucosa is diffusely necrotic in appearance. There is no tumorous appearance and no gall-stones, GB sludge nor GB polyps in this specimen.

Coronary angiographic findings of the patient. (A) The short arrow indicates saccular aneurysmal change in the distal part of the obtuse marginal branch of the left circumflex artery. (B) The long arrow indicates the 3.0 mm×2.0 cm-sized tornado coil located in the aneurysmal sac. After this em-bolization, no more contrast agent filling the aneurysmal sac was observed and distal flow below aneurysmal sac disappeared.