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Necrotic acalculous cholecystitis in an 8-year-old boy: a case report
Fanny Mueller1, Amy McDonald2, Vera S Schellerer3
1Department of Pediatric Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany. fanny.mueller@med.uni-greifswald.de.
Insights
Acute acalculous cholecystitis is rare in children, often linked to infections. This case highlights a necrotic gallbladder in a healthy child without infection, emphasizing the importance of exploratory laparoscopy for diagnosis and survival.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Case Reports
Background:
- Gallbladder inflammation in children, while increasing, remains rare.
- Acute acalculous cholecystitis comprises 50-70% of childhood gallbladder inflammation, typically in healthy children.
- Infections (viral, bacterial, parasitic) are the usual cause of acute acalculous cholecystitis onset.
Purpose of the Study:
- To report a unique case of necrotic acute acalculous cholecystitis in a healthy child.
- To highlight the diagnostic challenges and management of this rare condition.
- To emphasize the critical role of surgical exploration in potentially life-threatening cases.
Main Methods:
- Case presentation of an 8-year-old boy with non-specific abdominal pain and vomiting.
- Diagnostic workup revealed no evidence of infection.
- Exploratory laparoscopy was performed due to unclear clinical presentation, revealing a necrotic gallbladder.
Main Results:
- The patient was diagnosed with necrotic acute acalculous cholecystitis.
- Laparoscopic cholecystectomy was successfully performed.
- Immediate improvement in health status and discharge on the third postoperative day.
Conclusions:
- This case differs from typical acute acalculous cholecystitis, lacking infectious etiology and clear imaging signs of inflammation.
- Exploratory laparoscopy proved crucial for diagnosis and preventing mortality in this patient.
- Surgical exploration is vital for managing atypical cases of pediatric acute acalculous cholecystitis.
Background:
Although its incidence has increased in recent years, gallbladder inflammation in childhood is generally a rare condition. Acute acalculous cholecystitis accounts for about 50-70% of gallbladder inflammation in childhood, mostly in previously healthy children. The onset is strongly associated with viral, bacterial, or parasitic infections.
Case Presentation:
We present the case of a healthy 8-year-old boy of German descent diagnosed with necrotic acute acalculous cholecystitis, exhibiting only mild inflammatory signs and an unspecific clinical presentation of abdominal pain. There was no evidence of viral, bacterial, or parasitic infection. According to his unclear clinical presentation with 2-day history of vomiting, we performed an explorative laparoscopy and detected a necrotic gallbladder. After laparoscopic cholecystectomy, the patient's health status improved immediately. He was discharged from the hospital on the third day after the operation.
Conclusion:
Unlike our patient, almost all cases of acute acalculous cholecystitis originate from viral or bacterial infections, with clinical evidence of gallbladder inflammation shown on diagnostic imaging. An exploration of the abdominal cavity during a laparoscopic procedure was vital to our patient's mortality and could be for others as well.
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