Enterically transmitted non-A, non-B hepatitis mimicking acute cholecystitis

To study the significance of cholecystitis-like presentation and increased gallbladder wall thickness (GBWT) in patients with acute viral hepatitis (AVH).

Sixty-seven consecutive patients with acute viral hepatitis (hepatitis A:3, hepatitis B:13, and enterically transmitted non-A, non-B hepatitis: 51) were included in this prospective study. Clinical assessment and sonographic evaluation of the GBWT were carried out every week until recovery from acute hepatitis.

The clinical presentation in 16 patients with hepatitis A and B and in 29 patients with enterically transmitted non-A, non-B hepatitis (ET-NANB hepatitis) was typical of AVH, and the mean GBWT in these patients was 6.16 +/- 2.23 mm and 7.28 +/- 2.93 mm, respectively. The remaining 22 patients with ET-NANB hepatitis presented with features suggestive of acute cholecystitis (fever, severe pain, and tenderness right hypochondrium), and the mean GBWT in these patients (10.18 +/- 2.58 mm) was significantly higher compared with the rest of the patients with AVH (p < 0.001). The mean GBWT in patients with AVH (7.31 +/- 0.97 mm) was significantly higher compared with controls (1.76 +/- 2.17 mm) (p < 0.001). All patients with acute cholecystitis-like presentation recovered with conservative medical management. A time-dependent normalization of the thickened gallbladder wall was observed in all the patients within 6 wk.

A proportion of our patients with ET-NANB hepatitis presented with acute cholecystitis-like picture and had markedly thickened gallbladder wall on ultrasonography. These patients made an uneventful recovery, and the sonographic abnormalities disappeared within 6 wk.