Acute acalculous cholecystitis in children: Diagnosis and treatment

Abstract

Purpose: In this study, 12 patients with acute acalculous cholecystitis (AAC) who underwent diagnosis and treatment at the authors' clinic were discussed. Methods: Nine of these patients were boys, and 3 were girls. The mean age was 7.8 years. Almost all had fever, abdominal pain, and tenderness. Other manifestations included vomiting (75%) and jaundice (41%). Results of laboratory tests showed leucocytosis (83%) and abnormal liver function (66%). Three patients (25%) had previous operations (2 perforated appendicitis and 1 osteomylitis), and 4 (33%) had a previous blunt abdominal trauma. Five patients (41%) had underlying infectious disease. Diagnosis was suspected clinically and confirmed by ultrasonography (USG). USG criteria for AAC consisted of gallbladder (GB) distension, GB wall thickness (>3.5 mm), nonshadowing echogenic materials or sludge, and pericholecystic fluid collections. All patients were treated initially nonoperatively with nasogastric suction, intravenous fluids and antibiotics. They were followed by daily USG examinations, clinical condition, physical examinations, and laboratory findings for determining the timing of operative intervention. Results: GB distension was found in 50% of patients, a thickened GB wall in 100%, nonshadowing echogenic materials or sludge in 50%, and pericholecystic fluid in 41% at first USG examinations of patients. The combination of the least 2 USG criteria was noticed in all patients. Daily USG examinations also were helpful in confirming the diagnosis in our series. In contrast to the other 9 patients, daily USG examinations found a progressive increasing GB wall thickness and distension, or a persistent appearance of the nonshadowing echogenic materials or sludge and pericholecystic fluid in 3 (25%). Cholecystectomy was performed in these patients. In the other 9 patients (75%), daily USG examinations found a progressive improvement in the previous USG findings. They recovered fully and complete resolution of symptoms and signs related to AAC with nonoperative treatment resulted. Conclusions: USG is the most reliable method of early diagnosis of AAC. In addition, follow-up USG criteria are earlier and much more reliable in determining the most favorable time for operative intervention than those of clinical and laboratory criteria used conventionally in AAC patients who had underlying diseases. So, the authors suggest that initially nonoperative treatment of AAC is safe and effective in most cases. J Pediatr Surg 37:36-39. Copyright © 2002 by W.B. Saunders Company.