Acute Gangrenous Acalculous Cholecystitis In An Adolescent: A Case Report

Abstract

Introduction: Acute Acalculous cholecystitis (AAC) represents a severe complicated variant of acute gallbladder (GB) disease. AAC most often occurs in old age, critically ill patients, especially related to trauma, surgery, shock, burns, sepsis, total parenteral nutrition, diabetes, immunosupression and/or prolonged fasting. The presentation of acalculous cholecystitis is similar to that of calculous disease. Case Report: An 18 year old male patient presented with severe abdominal pain associated with tenderness and guarding in right hypochondrium and epigastric region. Radiological investigations were suggestive of acute acalculous cholecystitis. Cholecystectomy was performed subsequently. Discussion: AAC is defined as an acute necroinflammatory disease of the gallbladder in the absence of cholelithiasis. The etiology of AAC is multifactorial and likely results from bile stasis or ischemia or both. Ultrasonography (USG) is considered as first modality to evaluate suspected AAC and diagnostic triad is GB wall thickness, sludge, and hydrops. Computed Tomography (CT) scan can be performed if other abdominal pathology is considered more likely. Treatment options for AAC are cholecystostomy and cholecystectomy. Cholecystectomy generally is considered the definitive therapy. Cholecystostomy can be a lifesaving alternative in the patient considered too unstable to undergo definitive surgery. Conclusion: The possibility of AAC, especially in a younger patient with symptoms of acute cholecystitis should always be considered, in spite of the absence of any medical co morbid condition and risk factors. Proper clinical assessment and interpretation of investigation with high index of suspicion with timely intervention can reduce mortality and morbidity associated with AAC. Key word: Acute Acalculous cholecystitis (AAC), Adolescent, risk factor.