Necrotic acalculous cholecystitis in an 8-year-old boy: a case report

TL;DR

An 8-year-old boy with necrotic acalculous cholecystitis was successfully treated with laparoscopic surgery despite a lack of typical infection signs.

Contribution

Highlights the importance of laparoscopic exploration in diagnosing acalculous cholecystitis without clear infectious causes in children.

Findings

The patient had necrotic acute acalculous cholecystitis without evidence of infection.

Laparoscopic cholecystectomy improved the patient's health rapidly.

Laparoscopic exploration proved vital for diagnosis and outcome in this atypical case.

Abstract

Although its incidence has increased in recent years, gallbladder inflammation in childhood is generally a rare condition. Acute acalculous cholecystitis accounts for about 50–70% of gallbladder inflammation in childhood, mostly in previously healthy children. The onset is strongly associated with viral, bacterial, or parasitic infections.

We present the case of a healthy 8-year-old boy of German descent diagnosed with necrotic acute acalculous cholecystitis, exhibiting only mild inflammatory signs and an unspecific clinical presentation of abdominal pain. There was no evidence of viral, bacterial, or parasitic infection. According to his unclear clinical presentation with 2-day history of vomiting, we performed an explorative laparoscopy and detected a necrotic gallbladder. After laparoscopic cholecystectomy, the patient’s health status improved immediately. He was discharged from the hospital on the third day after the operation.

Unlike our patient, almost all cases of acute acalculous cholecystitis originate from viral or bacterial infections, with clinical evidence of gallbladder inflammation shown on diagnostic imaging. An exploration of the abdominal cavity during a laparoscopic procedure was vital to our patient’s mortality and could be for others as well.

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