Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 888 


 
LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 14  |  Issue : 4  |  Page : 213
Gall bladder perforation as a complication of typhoid fever


Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, U.P, India

Click here for correspondence address and email
 

How to cite this article:
Pandey A, Gangopadhyay AN, Kumar V. Gall bladder perforation as a complication of typhoid fever. Saudi J Gastroenterol 2008;14:213

How to cite this URL:
Pandey A, Gangopadhyay AN, Kumar V. Gall bladder perforation as a complication of typhoid fever. Saudi J Gastroenterol [serial online] 2008 [cited 2019 Sep 19];14:213. Available from: http://www.saudijgastro.com/text.asp?2008/14/4/213/43282


Sir,

Among various described complications of typhoid fever, acute cholecystitis is a rare one, [1] while perforation of the gallbladder is extremely uncommon. We share our experience of gall bladder perforation-this rare complication of typhoid. A 10-year-old boy presented to us with fever of 10 days' duration, distension of the abdomen, and an inability to pass flatus and feces for two days. Clinical examination demonstrated the presence of guarding, rigidity, and rebound tenderness. An X-ray of the abdomen showed multiple air fluid levels, but no free air. The Widal test was strongly positive for  Salmonella More Details typhi 'O' and S. typhi 'H' but negative for S. paratyphi.

After initial resuscitation, the patient was operated; exploratory laparotomy revealed a bile-stained abdomen with matted bowel loops. There was no bowel perforation, but a large perforation in its fundus was noticed on exploring the gall bladder. Cholecystectomy was preformed; the postoperative period was uneventful, and the patient was discharged on the 10th postoperative day.

Acute cholecystitis is a rare complication of typhoid, [1] presenting mostly in the first week of illness. Characteristic findings include fever, abdominal pain, diarrhea, vomiting, jaundice, and a palpable mass. [1] The clinical features suggestive of gall bladder perforation are nonspecific. Paracentesis may reveal bile-stained ascitic fluid. [2] Abdominal X-rays may not show pneumoperitoneum as seen in our patient, and hence, they are not always helpful. Ultrasonography and computerized tomography may demonstrate abdominal fluid but lack specificity to diagnose gall bladder perforation, which can be easily detected on hepatobiliary scanning. [3] A high index of suspicion is needed to diagnose the condition. Surgical options include cholecystostomy or cholecystectomy. [1] However, we believe that cholecystectomy may be desirable to prevent the carrier state of typhoid fever.

Perforation of the gall bladder may be caused by an inflammatory reaction and weakness of its wall in the course of the disease. Histology shows inflammatory changes in the gall bladder [2] that were also noticed in our patient.

Gall bladder perforation after typhoid cholecystitis is an uncommon occurrence in a pediatric population. A simple literature search revealed fewer than 10 cases in children, and all these reports were very old.

Gall bladder perforation in the setting of typhoid requires a high degree of clinical suspicion, especially in the pediatric population. Hence, surgeons must bear in mind the possibility of this complication while treating any pediatric patient presenting with a history of prolonged fever and signs of peritonitis. Cholecystectomy is the treatment of choice with a reasonable outcome.

 
   References Top

1.Jaramillo Samaniego JG. Acalculous acute cholecystitis during the course of typhoid fever in children. Rev Gastroenterol Peru 2001;21:36-41.  Back to cited text no. 1    
2.Sharma SB, Gupta V, Sharma V. Spontaneous gall bladder perforation: A rare entity in infants. Indian J Gastroenterol 2004;23:75-6.  Back to cited text no. 2  [PUBMED]  Medknow Journal
3.Estevao-Costa J, Soares-Oliveira M, Lopes JM, Carvalho JL. Idiopathic Perforation of the Gallbladder: A novel differential diagnosis of acute abdomen. J Pediatr Gastroenterol Nutr 2002;35:88-9.  Back to cited text no. 3    

Top
Correspondence Address:
Anand Pandey
Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, U.P
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.43282

Rights and Permissions



This article has been cited by
1 Spontaneous gall bladder perforation: a rare condition in the differential diagnosis of acute abdomen in children
Ram Mohan Shukla,Dipankar Roy,Partha Pratik Mukherjee,Kaushik Saha,Biswanath Mukhopadhyay,Kartik Chandra Mandal,Kalyani SahaBasu,Shib Sankar Barman
Journal of Pediatric Surgery. 2011; 46(1): 241
[Pubmed] | [DOI]
2 Spontaneous gall bladder perforation: A rare condition in the differential diagnosis of acute abdomen in children
Shukla, R.M., Roy, D., Mukherjee, P.P., Saha, K., Mukhopadhyay, B., Mandal, K.C., Sahabasu, K., Barman, S.S.
Journal of Pediatric Surgery. 2011; 46(1): 241-243
[Pubmed]
3 Acute acalculous cholecystitis causing gall bladder perforation in children
Karkera, P., Sandlas, G., Ranjan, R., Gupta, A., Kothari, P.
Journal of Indian Association of Pediatric Surgeons. 2010; 15(4): 139-141
[Pubmed]
4 Management of biliary perforation in children
Mirza, B., Ijaz, L., Saleem, M., Iqbal, S., Sharif, M., Sheikh, A.
African Journal of Paediatric Surgery. 2010; 7(3): 147-150
[Pubmed]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed2479    
    Printed72    
    Emailed3    
    PDF Downloaded397    
    Comments [Add]    
    Cited by others 4    

Recommend this journal