An 81-year-old woman presented to our emergency department with days of severe back pain. She had a history of congestive heart failure and end-stage kidney disease undergoing peritoneal dialysis for 2 years. She fell 1 day prior and developed an L2 compression fracture. Greenish discoloration of peritoneal dialysate was found, without abdominal discomfort, fever or guarding of the abdomen (Figure 1). Hemogram revealed leukocytosis (11,210/ mm3) without left shift, but dialysate leukocyte contained only 1 OO/jjlL with 76% lymphocytes. An abdominal computed tomography revealed distended gallbladder with uneven wall and focal bulging. Emergent cholecystectomy on the same day disclosed a focal hematoma over gallbladder wall with swelling and bulging but without gross gallbladder rupture. Histopathologic examination demonstrated severe wall ulcer-ation with necrosis, confirming gangrenous changes. She was subsequently transferred to subacute ward for respiratory rehabilitation.
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