Acute acalculous cholecystitis caused by Salmonella typhi in an 11-year-old

Abstract

Gallbladder disease in children is an uncommon cause of abdominal pain. Gibson1 in 1734 has provided us with the earliest recorded case of cholecystitis in a child whereupon he removed “three Scotch pints of water of a greenish hue” via aspiration of a distended gallbladder in a 13-year-old who subsequently died. As quoted by Thomas,2 as early as 1829 Lewis recognized the possibility of cholecystitis complicating typhoid fever remarking that “changes in the bile and gallbladder are much more frequent in the course of typhoid fever than in any other acute disease.” According to Arnspiger et al.,3 in 1835 Husson described the first pediatric patient with acute acalculous cholecystitis associated with typhoid. Most of the reports in the literature have concerned the adult population and in this regard Da Costa4 in 1898 stated “from the frequency, it might be said constancy, with which infection of the gallbladder happens in typhoid fever, it would be supposed that symptoms referable to it are very common. But it is just the reverse.” The largest collection in the literature is that by Thomas2 in 1907 who reported 154 patients with typhoidal cholecystitis of whom 5 were younger than 10 years old and 33 were between 11 and 33 years. A comprehensive review of gallbladder disease in young subjects under 15 years was retrospectively prepared by Potter5 in 1928. Twenty-five of 226 (11%) cases resulted from acute typhoidal cholecystitis. Since that era acute cholecystitis resulting from typhoid has become a rare disease. Rubenstein6 in 1943 presented 4 patients all older than 25 years of age and Glenn and Hill7 in their 20-year study in 1951 specified a single 9-year-old patient who succumbed to the illness. The incidence of this as an acute complication of typhoid has been noted to be between 0.5 and 2% in all age groups8,9; the precise estimation of this event in children is not known. Presented herein is an 11-year-old girl who recovered from acute acalculous typhoid cholecystitis following medical therapy.