Acute acalculous cholecystitis - Salmonella

Case contributed by Liz Silverstone
Diagnosis almost certain


Presents to the emergency department with severe RUQ pain following several days generalized abdominal pain and diarrhea.

Patient Data

Age: 25 years
Gender: Female

Full gall bladder with edematous wall. No radiopaque calculi. Non-distended ducts. Trace ascites in the RUQ and pelvis (not shown).

Edematous, hyperemic, thick-walled gall bladder containing dependent sludge but no calculi. The cystic duct is clearly seen and is patent. The gall bladder is full but compressible. Maximum tenderness to transducer pressure over the gall bladder (positive Murphy’s sign). Minor peri-cholecystic fluid. Trace ascites near the inferior angle of the liver.

Case Discussion

Acalculous cholecystitis typically affects critically ill hospital patients and has a high morbidity and mortality: gall bladder stasis and ischemia often lead to perforation and/or secondary infection. Percutaneous cystostomy can be diagnostic and therapeutic.

This case is unusual: a fit 25 year old developed florid acalculous cholecystitis 10 days after developing severe diarrhea. Fecal cultures were 4+ for Salmonella. Disease is normally self-limiting and antibiotics are reserved for complications or for immunosuppressed patients.

Salmonella can spread through blood, bile or lymph. Extra-intestinal complications include endocarditis, vascular infections including aortitis, hepatic and splenic abscesses, urinary tract infections, pneumonia or empyema, meningitis, septic arthritis and osteomyelitis.

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