Abstract
Typhoid fever is one of the most common enteric fever in low to middle income countries. In the pediatric population, it is a rare cause of acalculous cholecystitis in which one of the dreaded complication is gall bladder perforation. This was a case of a 15-year-old male with 1-month history of intermittent undocumented fever, anorexia and weight loss. The patient presented with signs of pancytopenia and abdominal examination revealed acute abdomen. Patient was optimized and prepared for surgery. Intraoperative findings revealed Type II gall bladder perforation with bile peritonitis, and patient underwent exploratory laparotomy, cholecystectomy, lavage, Jackson-Pratt drain. The sepsis eventually resolved postoperatively, and the patient was discharged. Preoperative diagnosis in patients with gall bladder perforation is often challenging and sophisticated, due to its rarity. However, it should be considered as one of the differential diagnoses in pediatric patients presenting with atypical history of abdominal pain. At present, there are no specific guidelines in the management of complications such as gall bladder perforation in patients with typhoid fever. Therefore, early diagnosis and immediate surgical intervention of gall bladder perforation are of prime importance in the successful outcomes of these patients, given the high morbidity and mortality associated with this condition.
Highlights
Typhoid fever is a global burden, and is one of the most common enteric infection especially in low- to middleincome countries, which is mainly caused by Salmonella typhi, that is usually found in an environment with poor sanitation and limited supply of clean drinking water
CASE DISCUSSION Gallbladder perforation is a rare and potentially lifethreatening complication of cholecystitis, especially in patients with typhoid fever, which is caused by Salmonella typhii, a gram-negative bacteria, which may cause an acute acalculous cholecystitis (1, 4)
Ischemia of the gall bladder wall due to severe inflammation and acalculous cholecystitis can lead to spontaneous Gallbladder perforation (GBP), which is seen in this case
Summary
Typhoid fever is a global burden, and is one of the most common enteric infection especially in low- to middleincome countries, which is mainly caused by Salmonella typhi, that is usually found in an environment with poor sanitation and limited supply of clean drinking water. It accounts for nearly 27 million cases worldwide and 200,000 deaths per year (1). Gallbladder perforation (GBP) is a rare but a dreaded complication of acalculous cholecystitis, especially in patients with typhoid fever, with an incidence rate of 2-
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