Incidence and management of acalculus cholecystitis in dengue fever - A retrospective study

Abstract

Objectives: To investigate the frequency, clinical features, prognosis and clinical response of acute acalculous cholecystitis in dengue fever. Materials and Methods: Study setting included January 2010-December 2012 in RLJH hospital (Karnataka, India), where patients diagnosed with dengue fever (DF), both clinically and serologically (positive for IgM and IgG antibodies for dengue) were included in the study. Incidence of acute acalculous cholecystitis among these patients was studied, acalculous cholecystitis diagnosed with clinical presentation and supported by abdominal ultrasonography. Fever, right upper quadrant (RUQ) pain and tenderness, positive Murphy's sign being the clinical findings and thickened gallbladder wall (defined as wall thickness >3.5 mm), positive sonographic Murphy's sign (defined as maximum tenderness of the sonographically localized gallbladder), pericholecystic fluid collection, and no stone(s) in the gallbladder being the ultrasound findings. The patients satisfying the criteria were serially monitored for vital signs (i.e., pulse rate, blood pressure), with regular monitoring for development of any complication. Treatment with antibiotics, intravenous fluids and analgesics were also given. Results: Total no of patients with confirmed dengue fever by antibody testing was 955. Among these, number of patients who developed acute acalculous cholecystitis was 68 (7.12%). Mean period of stay for patients developing this complication at the hospital was 7.1 days as against 3.4 days who had no complication. All of these patients recovered fully with conservative management, with none requiring any surgical intervention. Conclusion: Acute acalculous cholecystitis is one of the common complication developing in patients with dengue fever. Conservative line of management with antibiotics, intravenous fluids, analgesics and regular monitoring is sufficient in managing this complication with no need for aggressive surgical intervention.