Frontiers in surgery · 2026
Case Report: Acute acalculous cholecystitis due to Salmonella Typhi: a case of conservative treatment failure and review of the literature.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Pasquale Alessio, Brolese Marco, Marinelli Laura, Valcanover Stefano, Marcucci Stefano, Beltempo Paolo, Prezzi Cristina, Frisini Marco, Brolese Alberto
Аннотация
BACKGROUND: Acute acalculous cholecystitis (AAC) is an uncommon but potentially life-threatening inflammation of the gallbladder in the absence of gallstones, accounting for 5-10% of all cases of acute cholecystitis. While most cases occur in critically ill or postoperative patients, infectious etiologies-particularly Salmonella Typhi-are increasingly recognized. Typhoid-related AAC is well described in children from endemic regions but remains rare in adults, with limited evidence to guide management.
CASE PRESENTATION: We report the case of a 67-year-old man presenting with fever, chills, and epigastric pain following a self-limited diarrheal illness. Laboratory findings showed marked leukocytosis, elevated transaminases, and hyper-bilirubinemia with mild pain in the right upper quadrant. Blood cultures showed an infection of Salmonella Typhi sensitive to ceftriaxone. Despite 72 h of targeted antibiotic therapy, the patient remained febrile with rising inflammatory markers. Laparoscopic cholecystectomy was performed, revealing a gangrenous, necrotic gallbladder. Histopathology confirmed AAC with wall necrosis and abscesses. The postoperative course was uneventful.
CONCLUSION: This case highlights the importance of recognizing Salmonella-associated AAC as a rare but severe complication of typhoid infection in adults. While initial conservative therapy is reasonable, persistent symptoms or lack of improvement after 48-72 h should prompt early surgical intervention to prevent gallbladder necrosis, perforation, and sepsis.
CASE PRESENTATION: We report the case of a 67-year-old man presenting with fever, chills, and epigastric pain following a self-limited diarrheal illness. Laboratory findings showed marked leukocytosis, elevated transaminases, and hyper-bilirubinemia with mild pain in the right upper quadrant. Blood cultures showed an infection of Salmonella Typhi sensitive to ceftriaxone. Despite 72 h of targeted antibiotic therapy, the patient remained febrile with rising inflammatory markers. Laparoscopic cholecystectomy was performed, revealing a gangrenous, necrotic gallbladder. Histopathology confirmed AAC with wall necrosis and abscesses. The postoperative course was uneventful.
CONCLUSION: This case highlights the importance of recognizing Salmonella-associated AAC as a rare but severe complication of typhoid infection in adults. While initial conservative therapy is reasonable, persistent symptoms or lack of improvement after 48-72 h should prompt early surgical intervention to prevent gallbladder necrosis, perforation, and sepsis.