Acute abdomen resulting in cholecystectomy in a healthy young woman

Abstract

A 22-year-old woman with no significant medical history preented to an Australian hospital in 2014 with a 24-h history of acute ight upper quadrant pain, fever and rigors. The pain was acute, aking her from sleep, rated 10/10 in severity and radiated to her ight shoulder tip. There were no neurological, respiratory, genital, rinary or bowel complaints. Initial observations were normal apart from fever of 39 ◦C. xamination revealed tenderness in the right upper quadrant nd a positive Murphy’s sign but was otherwise unremarkble. Blood tests showed a normal total white cell count of .43 × 109[reference range [RR] 4.0–11.0 × 109/L] with moderate ymphopenia of 0.58 × 109[RR 1.5–3.5 × 109/L]. C-reactive protein as modestly elevated at 33 mg/L [RR < 8.0 mg/L]. She had noral electrolytes, liver transaminases and lipase. Pregnancy was xcluded. Blood cultures collected prior to antibiotics were negtive. Chest X-ray demonstrated clear lung fields and no free gas. bdominal ultrasound showed a minimally thickened but tender allbladder without calculi. A sexual history was obtained and she reported having a single egular partner with whom she used condoms. She did not comlain of localized vaginal discomfort or discharge. Her pelvic and aginal examination was normal. The patient was diagnosed with acalculous cholecystitis and as charted analgesia and antibiotics. The following day a aparoscopic cholecystectomy was performed without complicaion. Histopathology of the gallbladder showed serositis with an nflammatory infiltrate composed mainly of neutrophils within he subserosal adipose tissue. There was only scant mucosal