Presentation and outcome of typhoid cholecystitis in children

Abstract

Background: Typhoid cholecystitis is an extra-intestinal manifestation of Salmonella typhi infection. It is rarely suspected even in environments where typhoid intestinal perforation is common. It poses a diagnostic challenge as history, physical examination and laboratory findings are not usually specific.

Materials and Method: This was retrospective review of 10 patients below 16 years of age managed for typhoid cholecystitis over a period of 7 years at Federal Medical Centre Lokoja, Kogi State. Information on presentation, treatment, and outcomes were retrieved from case notes of the patients.

Results: There were 7 males and 3 females with age range of 5-13 years, mean duration of symptoms was 10.5 ± 5.38 days, all presented with pyrexia, vomiting and generalized abdominal pain. Mean body temperature at presentation was 38.4 ± 0.56 ^oC, the abdomen was distended in 100% of the patients with associated generalized tenderness. A pre-op diagnosis of typhoid intestinal perforation was made in 50% of cases, ruptured appendix in 30% and acute cholecystitis in 20%. Eight had gallbladder gangrene with perforations, 2 had inflamed gall bladder without perforation. All patients (80%) with gangrenous gallbladder had cholecystectomy, 20% had aspiration of the gall bladder content. Nine patients were discharged home, 1 died. Mean duration of hospital stay was 12.4 ± 4.03 days.

Conclusion: A high index of suspicion is required in diagnosing typhoid cholecystitis in children. The outcome of typhoid cholecystitis is good with timely and appropriate surgical intervention.

Keywords: Acalculous cholecystitis, typhoid cholecystitis, typhoid peritonitis