Outcome of acalculous cholecystitis from typhoid in Nigerian children.

BACKGROUND: Gallbladder perforation and gangrene ordinarily follow obstructive (calculous) cholecystitis with a higher frequency among immunocompromised patients or patients with intense inflammation of the gallbladder. The occurrence of typhoid intestinal perforation is common in the tropics, but GBP and gangrene have been reported sparingly. We report management challenges of 6 children with complications of acalculous cholecystitis from typhoid seen at our center.

PATIENTS AND METHODS: The patients were retrospectively sorted from the pediatric surgery unit and theater records of January 2000 to December 2006. Information studied included the patients' biodata, presenting features, operative findings, and outcome of management.

RESULTS: There were 6 patients, including 5 boys and a girl, ages ranging 3 to 15 years. The general presentation was that of septicemia. Three had multiple gallbladder perforations, and 3 others had gallbladder gangrene with inflamed Payer's patches on the terminal ileum. All patients underwent open cholecystectomy. There was a case each of postoperative fecal fistula and biliary fistula. All patients survived.

CONCLUSION: Acalculous typhoid gallbladder perforation, though rare, presents with management challenges.