Conservative Management of Acalculous Cholecystitis in a Seven-year-old Child

Acute acalculous cholecystitis is an uncommon disease in children and is usually associated with trauma, burns, and infections. Whereas acute acalculous cholecystitis is only seen in 10% of cholecystitis in adults, it is uncommon in the paediatric population. A seven-year-old male presented to the emergency department of a regional hospital with a 36-hour history of right-upper-quadrant abdominal pain. He had associated symptoms of anorexia, nausea, and vomiting. He was septic with raised white cell count and inflammatory markers. Diffuse gallbladder wall thickening without intraluminal sludge or calculi was seen on abdominal ultrasound. He was found to have a concurrent right-upper lobe pneumonia on further investigation. The patient was treated with antibiotics and responded well to supportive and conservative management with close radiological monitoring. Acute acalculous cholecystitis is associated with a high mortality rate (30%) and significant complications such as gangrene, empyema, and perforation in 40% of adult cases. Acute surgical management has been traditionally advocated, however, surgery is not without risks; studies have suggested that non-operative intervention may be appropriate for selected critically ill children with an underlying cause. Herein, we discuss the safe and effective conservative treatment of acute acalculous cholecystitis in lieu of operative management and highlight the importance of recognising this disease in paediatric patients with acute abdominal pain and coexisting infection.