Acute acalculous cholecystitis after blunt abdominal trauma

Abstract

Severe trauma is a recognised risk factor for developing acute acalculous cholecystitis (AAC), which is associated with a high mortality rate. The sonographic features of AAC have been well described in the literature and debate continues over its definitive management. We present the case of a 52-year old man who presented with right upper quadrant pain three days after sustaining blunt abdominal trauma. Leucocytosis with neutrophilia and an elevated CRP level were noted on haematological investigation. The liver function tests and amylase were within normal limits. Radiological investigations using ultrasound scan and computed tomography demonstrated gallbladder features suggestive of AAC. The patient was managed with intravenous antibiotics and simple analgesia and did not require any surgical or radiological intervention. Follow-up ultrasound scan, performed three months after the initial presentation, demonstrated a tortuous acalculous gallbladder. Despite a delayed presentation and a low Injury Severity Score, a high index of clinical suspicion for AAC should be maintained given the history of significant trauma.