Gallbladder Perforation Secondary to Enteric Fever: An Interesting Case of Acute Abdomen

Abstract

Enteric fever is a common infectious disease, especially in countries with poor sanitation and in the tropics. It is caused mainly by Salmonella typhi and accounts for nearly 27 million cases worldwide and 200,000 deaths annually. Enteric fever involves the reticuloendothelial system such as bone marrow, spleen, and liver. As it mostly involves the Peyer’s patches of the terminal ileum, enteric perforation occurs commonly. However, gallbladder perforation can also occur, though not very often. Ultrasound as well as computerized tomography (CT) abdomen and pelvis lack specificity for detecting gallbladder perforations in enteric fever. Diagnosis is usually confirmed intraoperatively when the gallbladder is visualized and perforation is seen. Gallbladder perforation is usually seen in acute cholecystitis when the gallbladder becomes necrotic and gangrenous. In acalculous cholecystitis, perforation is rare. Enteric fever is one of the rarest causes of acalculous cholecystitis, leading to perforation. Here, we present the case of a 20-year-old man who presented with fever for 10 days along with loose stools, vomiting, and acute abdomen. Labs showed leukopenia, positive Typhidot test but X-ray erect abdomen and ultrasound abdomen and pelvis were nonspecific. Only after resuscitation and exploration of the abdomen was it found that the gallbladder had multiple perforations. The patient was improved after eight days of postoperative intravenous antibiotics. This is a unique and rare presentation of such a common infectious disease.

Rare Case of Gallbladder Perforation in Pediatric Patient: A Pitfall in Generalized Peritonitis in Late Presented Typhoid Fever

“…Acute acalculous cholecystitis which causes the gallbladder perforation in pediatric typhoid fever is not extremely rare, but late presentation in patient may become a pitfall in preoperative diagnosis because of the sign of peritonitis mimicking other causes of peritonitis, such as perforation caused by appendicitis which is the most cause of acute abdominal pain in children [4,6]. In this patient, we found type 2 perforated gallbladder based on Niemeier's classification (Table 1).…”

“…It accounts for nearly 27 million cases worldwide and 200000 deaths per year, while in Indonesia the prevalence is 0.3-3%, with highest incidence found in East Java based on 2007. Indonesian Health Research [4,5].…”

“…Even though, cholecystectomy in type 3 gallbladder perforation may be difficult. In this case, we preferred thiamphenicol (group of chloramphenicol) because based on the research done in Malang, East Java by Ni Made Diah et al showed that chloramphenicol was the most cost-effective antibiotic for typhoid fever, compared to ceftriaxone and cefixime both in pediatric patients [4,7].…”

Empyema of Gall Bladder- Typhoid

“…In a study titled gallbladder perforation secondary to enteric fever by N Malik et al (1) concluded that patients with signs and symptoms of typhoid fever along with enteric perforation, gall bladder perforation should be carefully looked for. Typhoid was diagnosed based on IgG and IgM Typhoid tests and the patient did not have bacteraemia.…”

“…Enteric fever is a common in tropical countries. It is caused mainly by Salmonella typhi and accounts for nearly 27 million cases worldwide and 200,000 deaths annually (1) . Enteric fever involves the reticuloendothelial system such as bone marrow, spleen, and liver.…”