# A case of acute acalculous cholecystitis after pulmonary vein isolation—novel phenotype of perioesophageal vagal nerve injury: a case report

## TL;DR

A patient developed acute cholecystitis after a heart procedure, suggesting a new symptom of nerve injury from the treatment.

## Contribution

This case report identifies acute acalculous cholecystitis as a novel phenotype of perioesophageal vagal nerve injury.

## Key findings

- A 64-year-old man developed acute acalculous cholecystitis 27 hours after pulmonary vein isolation.
- The condition is speculated to be a result of perioesophageal vagal nerve injury from the procedure.
- This case adds to the rare reports of cholecystitis following such ablation procedures.

## Abstract

Perioesophageal vagal nerve injury related to pulmonary vein isolation using radiofrequency catheter ablation sometimes causes somatic symptoms including gastric dilation and motility disorder. However, reports of acute acalculous cholecystitis after pulmonary vein isolation are rare.

We report a case of a 64-year-old man diagnosed with paroxysmal atrial fibrillation. No acute complications occurred on the day of the procedure, but he complained of epigastric pain 27 h after the ablation procedure. He was diagnosed with mild acute acalculous cholecystitis and underwent laparoscopic cholecystectomy.

Vagal nerve injury appears to be related to the development of acute acalculous cholecystitis because many patients with acute cholecystitis after abdominal surgery along with resection of vagal nerve have acute acalculous cholecystitis. We speculate that acute acalculous cholecystitis after pulmonary vein isolation is one phenotype of perioesophageal vagal nerve injury.