A Curious Case of Acute Acalculous Cholecystitis

Abstract

Acute acalculous cholecystitis is inflammation of the gallbladder without any evidence of gallstones. Although acalculous cholecystitis is less common than its calculous counterpart, it can be fatal if not treated. It is essential to rule out the cause of acalculous cholecystitis to aid in the treatment and management of the patient. We present a case of acalculous cholecystitis wherein a comprehensive workup found the etiology to be viral. Albeit rare, hepatitis A and cytomegalovirus can be causes of acute cholecystitis. Both viruses were observed simultaneously in this patient, proving it to be a unique case. This early diagnosis allowed conservative management of the patient, sparing him from unnecessary surgical intervention.

HAV-induced Acalculous cholecystitis: A case report and literature review

“…12,14,41 HAV-induced AAC is rare with only 29 reports from 1992 to 2022 consisted of a total 71 patients in the literature; of these patients, 44 (61.9%) were under 18 years old and 27 (31.8%) were over 18 years old (Table 3). The incidence of HAV-induced AAC in the adult population is less than pediatrics, and it is mostly seen in the developing and endemic areas of HAV; 22,45 We found that the youngest patient was 2.5-year-old and the most elderly was 81-year-old. 46,47 HAV-induced AAC can lead to gallbladder perforation, cholangitis, pleural effusion, ascites, acute pancreatitis, and co-infection with various microorganisms.…”

“…AAC was first reported in 1844 by Duncan J in a fatal case of AAC complicating an incarcerated hernia. 21 In fact, AAC is a type of acute cholecystitis which constitutes 5 -10% of all acute cholecystitis without presence of gallstones, 19,22 which occurs in the setting of gallbladder dysfunction and often occurs in criticallyill patients in the ICU. 19 AAC is a life-threatening state in which the critical complications include necrosis and perforation of the gallbladder.…”

“…16,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The main clinical features of AAC are fever, nausea and vomiting, icterus, abdominal pain (mostly in the right upper quadrant), and positive Murphy's sign. 22 Laboratory investigations may show increased ALT, AST, ALK, total and direct bilirubin; however, normal levels do not rule out the disease. 40 The initial AAC diagnosis is done clinically, which is confirmed with the help of abdominal ultrasound.…”

“…40 The initial AAC diagnosis is done clinically, which is confirmed with the help of abdominal ultrasound. 22 The five main ultrasonographic diagnostic criteria of AAC are: 1. Gallbladder distention; 2.…”

HAV‐induced acalculous cholecystitis: A case report and literature review

“… 45 The initial AAC diagnosis is made clinically, which is confirmed with the help of abdominal ultrasound. 27 The five main ultrasonographic diagnostic criteria of AAC are 1. gallbladder distention; 2. gallbladder wall thickening greater than 3.5 mm; 3. absence of stone (no acoustic shadow) or sludge in the gallbladder; 4. perivesical liquid collection; and 5. absence of intra‐ and extrahepatic bile duct dilatation with a sensitivity, specificity, and accuracy of 88.9%, 97.8%, and 96.1%, respectively. 45 , 46 Most AAC patients are candidates for percutaneous cholecystostomy, a definitive treatment option with a low mortality rate and following cholecystectomy (except in patients with gallbladder perforation or gangrene).…”