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

Abstract

Objectives: To investigate the frequency, clinical features, prognosis, clinical response of acute acalculous cholecystitis in dengue fevers. Materials and Methods: A study period from Jan 2010 to Dec 2012 in RLJH hospital, where patients diagnosed with dengue fever (DF), both clinically and with lab reports validating diagnosis with IgM antibody and IgG antibody positive for dengue antigen were included in the study. The incidence of acute acalculus cholecystitis among these patients was studied, acalculus cholecystitis diagnosed with clinical presentation and supported by USG abdomen. Fever, right upper quadrant (RUQ) pain and tenderness , positive murphys sign being the clinical findings and thickened gallbladder wall (defined as wall thickness > 3.5 mm), positive sonographic Murphys sign (defined as maximum tenderness of the sonographically localized gallbladder), pericholecystic fluid collection, and no stone(s) in the gallbladder being the USG findings. The patients satisfying the criteria were serially monitored for vitals pulse rate and blood pressure with regular monitoring for development of any complication done. Treatment given with antibiotics, intravenous fluids, analgesics. Results: Total no of patients with confirmed dengue fever by antibody testing - 955. Among these, number of patients who developed the complication of acute acalculus cholecystitis were 68. The incidence observed was 7.12%. Mean period of stay for patients developing this complication at hospital was 7.1 days as against 3.4 days who had no complication. All of these patients recovered fully with conservative line of management with none requiring any surgical intervention. Conclusion: Acute acalculus cholecystitis is one of the common complications developing in patients with dengue fever. Conservative line of management with antibiotics, intravenous fluids, analgesics, regular monitoring is sufficient in managing this complication with no need for aggressive surgical intervention.