Complicated cholecystitis in pediatric typhoid fever: A case series

Acute cholecystitis is relatively uncommon in the pediatric population, with complicated cases being even more infrequent. Among the different forms, acute acalculous cholecystitis is the most prevalent type seen in children. Infections are a major contributing factor, with Salmonella Typhi playing a significant role. This is particularly relevant in countries including Indonesia, where typhoid fever is endemic. A total of 3 complicated pediatric cholecystitis cases at Dr. Soetomo General Academic Hospital and Dr. Ramelan Naval Hospital Surabaya were evaluated for clinical presentation, diagnostic challenges, and responses to treatment and surgical intervention. Infectious acute acalculous cholecystitis has been associated with typhoid fever. While the exact pathophysiology continues to be investigated, it is well-established that Salmonella Typhi tends to invade and colonize the gallbladder epithelium. The clinical presentation of complicated cholecystitis often overlaps with that of uncomplicated cases, making early recognition challenging. Delayed diagnosis can significantly increase both morbidity and mortality. In our three cases, vague symptoms and nonspecific physical examination findings hindered accurate diagnosis without the aid of emergent exploratory laparotomy. Without overt signs such as peritonitis, acalculous cholecystitis may be easily overlooked, delaying critical treatment. Complicated cholecystitis is a life-threatening clinical condition that requires prompt diagnosis and treatment and should always be suspected in pediatric patients with an acute abdomen. It is important to consider the possibility of this condition in typhoid patients, especially in typhoid-endemic regions such as Indonesia.