Enterically Transmitted Non-A, Non-B Hepatitis Mimicking Acute Cholecystitis

Objectives : To study the significance of cholecystitislike presentation and increased gallbladder wall thickness (GBWT) in patients with acute viral hepatitis (AVH). Methods : Sixty-seven consecutive patients with acute viral hepatitis (hepatitis A:3, hepatitis B:13, and enterically transmitted non-A, non-B hepatitis: 51) were included in this prospective study. Clinical assessment and sonographic evaluation of the GBWT were carried out every week until recovery from acute hepatitis. Results : The clinical presentation in 16 patients with hepatitis A and B and in 29 patients with enlerically transmitted non-A, non-B hepatitis (ET-NANB hepatitis) was typical of AVH, and the mean GBWT in these patients was 6.16 ± 2.23 mm and 7.28 ± 2.93 mm, respectively. The remaining 22 patients with ET-NANB hepatitis presented with features suggestive of acute cholecystitis (fever, severe pain, and tenderness right hypoehondrium), and the mean GBWT in these patients (10.18 ± 2.58 mm) was significantly higher compared with the rest of the patients with AVH ( p < 0.001). The mean GBWT in patients with AVH (7.31 ± 0.97 mm) was significantly higher compared with controls (1.76 ± 2.17 mm) ( p < 0.001). All patients with acute cholecystitis-like presentation recovered with conservative medical management. A time-dependent normalization of the thickened gallbladder wall was observed in all the patients within 6 wk. Conclusion : A proportion of our patients with ET-NANB hepatitis presented with acute cholecystitislike picture and had markedly thickened gallbladder wall on ultrasonography. These patients made an uneventful recovery, and the sonographic abnormalities disappeared within 6 wk.