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Year : 2011  |  Volume : 16  |  Issue : 3  |  Page : 118-119

Acute acalculous cholecystitis causing gall bladder perforation in children

Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

Date of Web Publication4-Aug-2011

Correspondence Address:
Syed Ahmed Zaki
Room No. 509, New RMO Quarters, Sion, Mumbai - 400 022
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-9261.83489

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How to cite this article:
Zaki SA. Acute acalculous cholecystitis causing gall bladder perforation in children. J Indian Assoc Pediatr Surg 2011;16:118-9

How to cite this URL:
Zaki SA. Acute acalculous cholecystitis causing gall bladder perforation in children. J Indian Assoc Pediatr Surg [serial online] 2011 [cited 2023 Jun 2];16:118-9. Available from: https://www.jiaps.com/text.asp?2011/16/3/118/83489


I read with interest the article by Karkera et al. [1] on "Acute acalculous cholecystitis causing gall bladder perforation in children" and have the following comments to offer:

  1. In the introduction the authors have stated "Gall bladder perforations after cholecystitis are usually seen in elderly patients (>60 years) and are rare in children." The reference quoted is from an article by Ong et al. [2] However, in the study by Ong et al., the mean age of presentation of patients was 47 years. In their article, Ong et al., have quoted a study by Roslyn et al.,[3] which found that acute acalculous cholecystitis was found in elderly patients >60 years. The authors should have given the reference for their statement from the study by Roslyn et al. The authors have also stated "Sensitivity of CT in the detection of gallbladder perforation and biliary calculi has been reported to be 88% and 89%, respectively." The reference quoted is from a study by Alvi et al. [4] In the article, Alvi et al. have quoted a study by Morris et al.,[5] who found that that the sensitivity of computed tomography in the detection of gallbladder perforation and biliary calculi was 88 and 89%, respectively. I would like to bring to the notice of our readers that one should always quote the original study in support of their statement. Otherwise it can amount to even plagiarism. Plagiarism is taking over ideas, methods, or results of another without acknowledging them. In scientific writing, plagiarism is regarded as a serious breach of ethics. [6] It is the responsibility of the authors to ensure that they make due acknowledgment every time they use the results of others.
  2. "Only 5-10% of the patients with acute cholecystitis are associated with acalculous cholecystitis." After checking the reference quoted for the statement, it was found that no such information is given in the article. The authors have also stated that "The mortality rate of gall bladder perforation is in the range of 12-16%." The reference quoted for this statement is a study by Roslyn et al. [7] However, if one reads the article it is found that the mortality in their study was 17%. Authors should not give wrong information to the readers.
  3. "GBP is a well known, although unusual complication, in enteric fever." How can an unusual complication be well known? The authors have failed to deliver the message properly to the readers.
  4. "The 'HOLE' sign, in which the defect in the gall bladder is visualized, is the only reliable sign of GBP." The authors have quoted the study by Derici et al., [8] supporting their statement. However, Derici et al., had not found the 'HOLE' sign in any of their patients. I would like the authors to clarify their statement with proper reference.
  5. Acute acalculous cholecystitis can be caused by hepatitis A virus, taenia saginata, leptospirosis, dengue fever, malaria, ascaris lumbricoides, and many other causes. [9],[10],[11],[12],[13],[14] The authors have only excluded typhoid fever in their patients. They should have at least ruled out common endemic diseases such as malaria, dengue fever, and leptospirosis which are easily done in the hospital. I would like to emphasize to our readers that acute acalculous cholecystitis can be caused by several conditions other than typhoid fever and one has to specifically look for them.
  6. The authors have stated that they believe that interval cholecystectomy in all diagnosed cases of acalculous cholecystitis should be a viable option to consider preventing future complications. Thus, if we go by the authors' suggestion, then acalculous cholecystitis due to typhoid fever, dengue fever, malaria, and leptospirosis should also undergo cholecystectomy. I would like to know whether this is author's personal opinion or they have any support of literature.

   References Top

1.Karkera PJ, Sandlas G, Ranjan R, Gupta A, Kothari P. Acute acalculous cholecystitis causing gall bladder perforation in children. J Indian Assoc Pediatr Surg 2010;15:139-41.  Back to cited text no. 1
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2.Ong CL, Wong HT, Rauff A. Acute gall bladder perforation - A dilemma in early diagnosis. Gut 1991;32:956-8.  Back to cited text no. 2
3.Roslyn JJ, Thompson JE Jr, Darvin H, DenBesten L. Risk factors for gallbladder perforation. Am J Gastroenterol 1987;82:636-40.  Back to cited text no. 3
4.Alvi AR, Ajmal S, Saleem T. Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: A case report. Cases J 2009;2:166.  Back to cited text no. 4
5.Morris BS, Balpande PR, Morani AC, Chaudhary RK, Maheshwari M, Raut AA. The CT appearances of gallbladder perforation. Br J Radiol 2007;80:898-901.  Back to cited text no. 5
6.Afifi M. PubMed-indexed duplicate publications in the last decade, 1996-2006. Ann Saudi Med 2007;27:302-4.  Back to cited text no. 6
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7.Roslyn JJ, Bussutil RW. Perforation of the gallbladder: A frequently mismanaged condition. Am J Surg 1979;137:307-12.  Back to cited text no. 7
8.Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E. Diagnosis and treatment of gallbladder perforation. World J Gastroenterol 2006;12:7832-6.  Back to cited text no. 8
9.Malik AA, Wani RA, Bari S. Acute acalculous cholecystitis due to Taenia saginata. Ann Saudi Med 2008;28:388-9.  Back to cited text no. 9
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10.Madhusudhan KS, Gamanagatti S. An uncommon cause of right hypochondriac pain. Acute acalculous cholecystitis due to Ascaris lumbricoides with intestinal ascariasis was diagnosed. Saudi J Gastroenterol 2009;15:70-1.  Back to cited text no. 10
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11.Bhatty S, Shaikh NA, Fatima M, Sumbhuani AK. Acute acalculous cholecystitis in dengue fever. J Pak Med Assoc 2009;59:519-21.  Back to cited text no. 11
12.Souza LJ, Braga LC, Rocha Nde S, Tavares RR. Acute acalculous cholecystitis in a teenager with hepatitis a virus infection: A case report. Braz J Infect Dis 2009;13:74-6.  Back to cited text no. 12
13.Kumar A, Taksande AM, Vilhekar KY. Acalculous cholecystitis by P. falciparum in a 3-year-old child. J Vector Borne Dis 2008;45:76-7.  Back to cited text no. 13
14.Suchy FJ. Diseases of the gall bladder. In: Behrman RE, Kliegman RM, Jenson HB, Stanton FB, editors. Nelson Textbook of Pediatrics. 18 th ed. Philadelphia: WB Saunders; 2008. p. 1707-9.  Back to cited text no. 14

This article has been cited by
1 Authorsę reply
Karkera, P.J., Sandlas, G., Ranjan, R., Gupta, A., Kothari, P.
Journal of Indian Association of Pediatric Surgeons. 2011; 16(3): 119-120


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