Acute Acalculous Cholecystitis in a Previously Healthy Infant
The incidence of gallbladder disease in children is relatively rare. We recently encountered a 6-month-old child who was found to have an acalculous cholecystitis post vaccination, a rare diagnosis in a previously healthy child. Although recognized for more than 150 years, there is a paucity of review literature describing acute acalculous cholecystitis (ACC) in paediatrics1. The two largest retrospective review articles, by Tsakayannis and İmamoğlu, have cohorts of 25 and 12 patients respectively2,3. As a result, the majority of literature pertaining to AAC in paediatrics is in the form of individual case reports. From our review of the literature, there is no current evidence of AAC occurring post vaccination.
İmamoğlu describe the most recent case series of ACC in paediatrics3. A number of similarities between this case series and our patient were identified including pyrexia, vomiting, transaminitis and ultrasound findings. The differences noted in our case were the absence of leucocytosis, abdominal tenderness or RUQ mass. Our case also presented with a coagulopathy, reversed with IV vitamin K, a feature which we did not note in previous studies. Whereas Imamoglu report that a number of their series had an underlying/intercurrent infection which may have predisposed to the presentation of cholecystits, our patient was free from any underlying issues. Interestingly, our patient had recently received his 6-month vaccination as part of the normal immunisation schedule in the Republic of Ireland.
Published literature would suggest that the incidence of AAC is on the rise3. Our case demonstrates the changing epidemiology of AAC from critically ill patients to include young healthy infants4. It also shows the presentation is similar to calculous cholecystitis and that the prognosis is positive if diagnosed and treated early. Therefore it should be considered in the infant with non-specific abdominal symptomology. In addition, we propose the theory that vaccination was a precipitating in the presentation. Further retrospective review of same will have to be carried out to validate this.
BST SHO General Paediatrics.
Dr. Jean Donnelly, Department of General Paediatrics OLCHC, Crumlin Road, Crumlin, Dublin.
1.Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2010;8(1):15-22.
2.Tsakayannis DE, Kozakewich HPW, Lillehei CW. Acalculous cholecystitis in children. Journal of Pediatric Surgery.31(1):127-31.
3.Imamoglu M, Sarihan H, Sari A, Ahmetoglu A. Acute acalculous cholecystitis in children: Diagnosis and treatment. J Pediatr Surg. 2002;37(1):36-9.
4.Shridhar Ganpathi I, Diddapur RK, Eugene H, Karim M. Acute acalculous cholecystitis: challenging the myths. HPB : The Official Journal of the International Hepato Pancreato Biliary Association. 2007;9(2):131-4.