Surgical complications of typhoid fever present commonly as gut perforation and very rarely as gall bladder gangrene or gall bladder perforation. Gall bladder complications are rare in children and when they occur they are often the result of an infective condition. Occasionally, typhoid fever causes concomitant gall bladder complications and gut perforation. The coexistence of both conditions accentuates morbidity and mortality. We present two cases of typhoid fever with gall bladder perforation and gall bladder gangrene, respectively. Challenges of diagnosis and treatment are highlighted. The need for surgeons in endemic areas to consider these conditions while evaluating children with peritonitis is emphasized. Ultrasound detection of thickened distended gall bladder with pericholecystic fluid in a child with typhoid fever may be a sign of impending gall bladder perforation. To reduce the high morbidity and mortality from surgical complications of typhoid fever, the implementation of proven preventive measures must be encouraged. In addition, public enlightenment of this scourge must be pursued with vigor.

Gall bladder perforation as a sequel of typhoid-induced acalculous cholecystitis is a rare clinical encounter, reported sparsely in literature. Here, we discuss a case wherein successful laparoscopic management of typhoid-induced gall bladder perforation was performed. A 24-year-old female presented with a history of 5 days of fever and acute pain in the abdomen for 2 days. Computed tomography scan suggested gall bladder perforation which was confirmed on diagnostic laparoscopy. Laparoscopic cholecystectomy with peritoneal lavage was performed. The patient did well postoperatively and was discharged on post-operative day 4 after drain removal. One should be aware about the possibility of gall bladder perforation as a sequel of acalculous cholecystitis in typhoid fever. Minimal access surgery techniques can be applied for confirming the diagnosis as well as the definitive treatment.

Gallstone disease is one of the most common surgical diseases. Complications associated with cholelithiasis is not uncommon, but gallbladder perforation is a rare complication of acute cholecystitis with cholelithiasis. This gallbladder perforation may present in different ways like free perforation inside peritoneal cavity causing generalized peritonitis, localized collection around gallbladder fossa after perforation and in chronic cases cholecystoenteric fistula. Here we present our experience of this condition with a review of literature for a different presentation of this condition.

This study was done for 2 years, and patients who were diagnosed with gallbladder perforation either preoperatively or intraoperatively were included.

There was a total of 16 patient included in the study during this period which were either diagnosed preoperatively or intraoperatively of gallbladder perforation (GBP).

GBP, though a rare complication of cholecystitis with high morbidity and mortality, has no specific pathognomic feature and is often misdiagnosed or late diagnosed. Nowadays most cases can be managed with improved diagnostic means and therapeutic modalities (endoscopic, laparoscopic, endostaplers).

Patel G, Jain A, et al. Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management. Euroasian J Hepatogastroenterol 2019;9(1):14-19.

Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.

We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.

Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation.

Acute biliary tract disease is a common condition in adults. Apart from bile duct perforation, spontaneous perforation of the gallbladder itself is very rare in all age groups; to date, all recorded cases are secondary to coexistent disease. We present the case report of a 60-year-old adult having an idiopathic gallbladder perforation. In our case, an unusual presentation was situs inversus totalis and fundal gas shadow was considered as free air under the right dome of the diaphragm by mistake. The patient underwent laparotomy and emergency cholecystectomy was performed in the perforated gallbladder. To date, no case has been described in the literature.

Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database.

This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database.

LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients.

We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.

Atypical manifestations of acute hepatitis A virus (HAV) infection include ascites, pleural effusion, acute renal failure, aplastic anemia, and neurological manifestations. Although association of HAV and acute cholecystitis is known, presentation of hepatitis A infection with acute cholecystitis has not been reported in pediatric emergency medicine literature. Primary acute acalculous cholecystitis in children is rare and commonly attributed to systemic infections. We report a case of a child developing acute viral cholecystitis as a presenting feature of sporadic HAV infection and review HAV-associated cholecystitis in children. The article provides a brief illustration of evaluating acute abdominal pain in older children in the emergency department in a developing country.