# Hepatitis A virus induced acute acalculous cholecystitis diagnosed postoperatively: Case report

## TL;DR

A 41-year-old patient with no gallstones had gallbladder inflammation caused by Hepatitis A virus, showing that surgery may not always be needed in such rare cases.

## Contribution

This case report highlights the rare occurrence of Hepatitis A virus-induced acute acalculous cholecystitis and suggests conservative management as a possible treatment.

## Key findings

- Hepatitis A virus can cause acute acalculous cholecystitis without gallstones.
- Cholecystectomy may not be necessary for HAV-induced cholecystitis if symptoms resolve.
- More case studies are needed to better understand and manage HAV-induced cholecystitis.

## Abstract

acute acalculous cholecystitis (AAC) is defined as gallbladder inflammation without the presence of stones. Contrary, hepatitis A virus (HAV) can present with different symptoms; however, HAV causing and presenting as AAC is rare.

41-year-old previously healthy patient presented with right upper quadrant abdominal pain. The pain was persistent and associated with vomiting and laboratory tests showed elevated bilirubin. Laparoscopic cholecystectomy showed inflamed gallbladder with no stones and intraoperative cholangiography showed no abnormalities. Day one post-operation, while the pain resolved, labs showed elevated liver function tests and hepatitis workup showed acute HAV infection attributing her presentation to HAV induced AAC.

AAC is usually caused by stasis of the gallbladder due to different causes; however, HAV induced AAC has been rarely reported. While cholecystectomy is the mainstay treatment for AAC, this might not be the case for HAV induced AAC. For instance, unless there is necrotic gallbladder or persistence of symptoms, AAC can be managed conservatively in this case. Even though our diagnosis was cleared post-operatively, had we knew the diagnosis of HAV induced AAC before, we would have still opt for surgery due to the severity and persistence of pain.

More cases should be reported and more studies should be done to further define the presentation and management of HAV induced AAC.

•Hepatitis A virus as acute acalculous cholecytitis cause has been rarely reported.•Cholecystectomy might not be the treatment when cholecytitis is caused by hepatitis A virus.•Hepatitis A induced acute acalculous cholecystitis can be managed conservatively.•More cases should be reportedto further define the management of hepatitis A induced acute acalculous cholecystitis.

Hepatitis A virus as acute acalculous cholecytitis cause has been rarely reported.

Cholecystectomy might not be the treatment when cholecytitis is caused by hepatitis A virus.

Hepatitis A induced acute acalculous cholecystitis can be managed conservatively.

More cases should be reportedto further define the management of hepatitis A induced acute acalculous cholecystitis.