Acute acalculous cholecystitis in children

Acute acalculous cholecystitis (AAC) is a rare disease in African children and usually occurs as a complication of some other diseases, such as systemic infections. AAC can, however, be the primary pathology but, because of its low incidence, it is difficult to establish definite mechanisms and causes.
The case histories of six children (mean age seven years) with AAC are presented. They were treated in Queen Elizabeth Central Hospital, Blantyre, Malawi and in Gweru Provincial Hospital in Zimbabwe between 1985 and 1996. In four children, pre-operative ultrasonography showed the typical signs of AAC.
Cholecsytectomy was performed on all seven children. One child died postoperatively from generalized sepsis and in two children a wound infection occurred.
In the tropics, where many children are seen with gastro-enteritis and other infections diseases, the possibility of AAC must be borne in mind when a child is admitted with right upper abdominal tenderness and fever. The role of ultrasonography is emphasized. It is a reliable, non-invasive and quick investigation, which helps to establish the diagnosis before surgery.
Cholecystectomy is the treatment of choice because of the high incidence of necrosis of the gallbladder wall.