Abstract
Enteric fever is a common infectious disease, especially in countries with poor sanitation and in the tropics. It is caused mainly by Salmonella typhi and accounts for nearly 27 million cases worldwide and 200,000 deaths annually. Enteric fever involves the reticuloendothelial system such as bone marrow, spleen, and liver. As it mostly involves the Peyer’s patches of the terminal ileum, enteric perforation occurs commonly. However, gallbladder perforation can also occur, though not very often. Ultrasound as well as computerized tomography (CT) abdomen and pelvis lack specificity for detecting gallbladder perforations in enteric fever. Diagnosis is usually confirmed intraoperatively when the gallbladder is visualized and perforation is seen. Gallbladder perforation is usually seen in acute cholecystitis when the gallbladder becomes necrotic and gangrenous. In acalculous cholecystitis, perforation is rare. Enteric fever is one of the rarest causes of acalculous cholecystitis, leading to perforation. Here, we present the case of a 20-year-old man who presented with fever for 10 days along with loose stools, vomiting, and acute abdomen. Labs showed leukopenia, positive Typhidot test but X-ray erect abdomen and ultrasound abdomen and pelvis were nonspecific. Only after resuscitation and exploration of the abdomen was it found that the gallbladder had multiple perforations. The patient was improved after eight days of postoperative intravenous antibiotics. This is a unique and rare presentation of such a common infectious disease.
Highlights
In many developing countries with little supply of clean drinking water and poor sanitation, typhoid fever is a common infection [1]
Gallbladder perforation is extremely rare when it occurs as a complication of enteric fever [2]
Salmonella, the causative agent of typhoid fever, has the ability to invade gallbladder epithelial cells, causing damage to the gallbladder wall, which leads to perforation [4]
Summary
In many developing countries with little supply of clean drinking water and poor sanitation, typhoid fever is a common infection [1]. Gallbladder perforation is extremely rare when it occurs as a complication of enteric fever [2]. The incidence of gallbladder perforation in enteric fever is around 3%-10% [3]. We report the case of a 20-year old man with perforation of the gallbladder, who presented with an acute abdomen and improved after surgical intervention. How to cite this article Malik M N, Mahmood T, Tameez Ud Din A, et al (April 22, 2019) Gallbladder Perforation Secondary to Enteric Fever: An Interesting Case of Acute Abdomen. A 20-year-old male presented with a history of abdominal pain, diarrhea, and vomiting for six days along with fever for 10 days. The fever was high grade, documented up to 1030 F, occurred 10 days before presentation, and followed a step-ladder pattern. There was uneventful recovery, and the patient was discharged on the eighth postoperative day
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