Gallbladder Wall Thickening associated with Dengue Shock Syndrome in a German traveller – no indication for surgical therapy – a case report

Abstract Background With the increasing number of dengue virus infections imported into Germany, knowledge about the different phases of the disease and possible complications is essential for the treatment of patients. The virus is endemic in the tropics and subtropics and up to 2.5 billion people are at risk of infection. Case presentation Here we present a German traveller with dengue shock syndrome after returning from Thailand. After hospitalization the patient developed acute upper abdominal pain. The ultrasound findings were consistent with an acute acalculous cholecystitis, but were interpreted as dengue associated gallbladder wall thickening (GBWT). Therefore a surgical intervention was not indicated and would have been associated with an higher risk of complications in this situation. Under supportive care spontaneous regression of GBWT could be documented by sonography four days later as well as complete resolution of clinical symptoms. Conclusion GBWT in dengue virus infection mimicking acute cholecystitis is a differential diagnosis one should take into consideration in travellers returning from endemic areas and should be managed conservatively because of an high risk of bleeding and increased mortality under surgical therapy.

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Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

Critical Care Research and Practice ◽

10.1155/2012/565617 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Pavlos Myrianthefs ◽

Efimia Evodia ◽

Ioanna Vlachou ◽

Glykeria Petrocheilou ◽

Alexandra Gavala ◽

...

Keyword(s):

Ultrasound Examination ◽

Imaging Finding ◽

Acalculous Cholecystitis ◽

Gallbladder Wall ◽

Apache Ii Score ◽

Wall Thickening ◽

Acute Acalculous Cholecystitis ◽

Laboratory Findings ◽

Ultrasound Monitoring ◽

Gallbladder Wall Thickening

Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU).Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy’s sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria.Measurements and Results. We included 53 patients (42 males; mean age57.6±2.8years; APACHE II score21.3±0.9; mean ICU stay35.9±4.8days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings.Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

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Involvement of the gallbladder in the course of viral hepatitis A in childhood

Tropical Doctor ◽

10.1177/0049475519858893 ◽

2019 ◽

Vol 49 (4) ◽

pp. 271-273

Author(s):

Valeri Velev ◽

Metodi Popov ◽

Latchezar Tomov ◽

Branimir Golemanov

Keyword(s):

Significant Relationship ◽

Hepatitis A ◽

Acalculous Cholecystitis ◽

Gallbladder Wall ◽

Laboratory Evaluation ◽

Wall Thickening ◽

Acute Acalculous Cholecystitis ◽

Acute Hepatitis A ◽

Viral Hepatitis A

The course of acute hepatitis A (AHA) in childhood is most often benign. There are relatively few reports of gallbladder involvement during such infection and its consequences. We discuss the cases of 75 children (mean age = 4.5 years) with confirmed AHA. Clinical and laboratory evaluation upon admission were classical for AHA. Only two children had normal bilirubin levels and 38.7% had visible involvement of the gallbladder with wall thickening of >3 mm, while six met criteria for acute acalculous cholecystitis. There appears to be no clear relationship between thickening of the gallbladder wall and transaminase levels, but a significant relationship with total and direct bilirubin levels ( P < 0.05). Ultrasonographic examination should therefore be carried out in each case of AHA and follow-up should be performed with greater caution, if there are changes in the gallbladder wall.

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