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Gangrenous acalculous cholecystitis in a premature infant
E T Fernandes1, R S Hollabaugh, T F Boulden
1Department of Pediatric Surgery, LeBonheur Children's Hospital, Memphis, TN 38107.
Insights
Acute acalculous cholecystitis is rare in infants but can occur. This case highlights a premature infant initially diagnosed with necrotizing enterocolitis who actually had acute gangrenous cholecystitis requiring surgery.
Area of Science:
- Pediatric Surgery
- Neonatology
- Gastroenterology
Background:
- Acute acalculous cholecystitis is an uncommon condition, with a higher prevalence in pediatric populations compared to adults.
- Premature infants are particularly susceptible to abdominal pathologies that can mimic other serious conditions.
Observation:
- A case report details a 1,100-gram premature infant girl diagnosed with acute gangrenous acalculous cholecystitis.
- The infant's initial clinical and radiographic presentation suggested necrotizing enterocolitis.
Findings:
- Exploratory laparotomy revealed acute gangrenous acalculous cholecystitis.
- A cholecystectomy was performed, and this represents one of the smallest patients reported with this condition.
- This is the first reported case where acute gangrenous acalculous cholecystitis was initially misdiagnosed as necrotizing enterocolitis.
Implications:
- Recognizing acute gangrenous acalculous cholecystitis in premature infants is crucial for appropriate management.
- Distinguishing between necrotizing enterocolitis and acute gangrenous cholecystitis is vital, as treatment strategies differ significantly (nonoperative vs. surgical).
Abstract:
Acute acalculous cholecystitis is uncommon, although children are more likely to have this condition than adults. A 1,100-g premature baby girl with a gangrenous acalculous cholecystitis is reported. She presented with clinical and radiographic findings that were initially interpreted as necrotizing enterocolitis. An exploratory laparotomy demonstrated the presence of an acute gangrenous acalculous cholecystitis, and a cholecystectomy was performed. To our knowledge, this one of the smallest patients reported with this entity, and the first whose condition was initially diagnosed as necrotizing enterocolitis. It is important to recognize this entity and consider it in the differential diagnosis of premature infants, because in patients with necrotizing enterocolitis nonoperative management should be attempted initially, and patients with acute gangrenous cholecystitis most likely will require a laparotomy and cholecystectomy.