Acute Acalculous Cholecystitis in a Patient With Pancolitis: A Case Report

TL;DR

A 65-year-old man with pancolitis caused by Salmonella developed acute acalculous cholecystitis, which was successfully treated with antibiotics instead of surgery.

Contribution

Highlights a rare case of Salmonella-induced AAC in a non-critically ill patient successfully managed with antibiotics.

Findings

Salmonella infection was identified as the cause of pancolitis and acute acalculous cholecystitis in a non-critically ill patient.

Antibiotic treatment with ceftriaxone resolved symptoms without the need for surgery.

The case emphasizes the importance of determining the etiology of AAC to avoid unnecessary surgical interventions.

Abstract

Salmonella is an infectious bacterial organism found in many food products. In this case, there is an investigation into salmonella infection leading to acute acalculous cholecystitis (AAC). Pancolitis, although mostly caused by ulcerative colitis, can also be caused by infections. A 65-year-old male with a past medical history of benign hyperplastic prostate, lung nodule, and hyperlipidemia presented to general surgery for colitis and cholecystitis. The patient had presented to the emergency department before for abdominal pain, but it worsened this time. Ultrasound showed a confirmed distended gallbladder without stones. Originally, the patient was supposed to undergo laparoscopic cholecystectomy for acute cholecystitis. However, based on worsening diarrhea symptoms, a CT scan was ordered and showed diffuse colonic wall thickening. The patient was then treated with IV ceftriaxone with resolution of symptoms. The patient was discharged with a plan to follow up in the clinic in two weeks. AAC has traditionally been associated with critically ill patients, with the treatment of percutaneous cholecystostomy. However, there is an increase in incidence in healthy patients, with nonsurgical treatment involving antibiotics that led to the resolution of inflammation. It is important to ascertain the etiology of AAC in non-critically ill patients before treatment, as it can prevent unnecessary surgeries.

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