Abstract Introduction: Gallbladder (GB) wall edema is a common, often non-surgical, finding characterized by fluid accumulation and thickening of the gallbladder wall (>3 mm) on imaging. While associated with acute cholecystitis, it is frequently caused by non-primary diseases like congestive heart failure, hepatitis, renal failure, or hypoalbuminemia. It is generally a transient, secondary condition, often resolving when the underlying illness is treated. Case Series: Our department is model treatment centre for free treatment of hepatitis B & C under National viral hepatitis control program (NVHCP). It is high flow center where on daily basis 70-80 patients of hepatitis B and C come for consultation. Out of them 15-20 are new and rest 55-60 are old patients. We frequently see many acute hepatitis B patients and till date, 700 acute hepatitis B patients and 100 acute HCV patients have been enrolled. In addition, till date 300 patients of acute hepatitis A & E have been enrolled. In addition, our department of medical gastroenterology commonly encounter alcoholic hepatitis, dengue, malarial, enteric and autoimmune hepatitis patients. Approximately, more than 2000 patients in total of acute hepatitis, including all aetiology have been seen and followed up clinically. In half of them (around) 1000 patients, they had gall bladder wall edema but none was advised for cholecystectomy and every body recovered once baseline aetiological factor of hepatitis was resolved. All of them were symptomatically treated with ursodeoxycholic acid, proton pump inhibitors, prokinetics, anti-allergic, multivitamin and antiviral therapy where indicated. In last fifteen years, we encountered five patients of acute hepatitis with gall bladder wall edema who underwent laparoscopic cholecystectomy at private hospitals, thinking it to be acalculous cholecystitis. Normally, in acute viral hepatitis, the serum transaminases (AST & ALT) are raised to ten times i.e. more than 400 IU/ml and serum bilirubin level are also significantly raised but in cholecystitis, the increase in transaminases and serum bilirubin level is lesser than acute viral hepatitis. Moreover, pain abdomen in acute viral hepatitis is usually dull ache due to stretching of liver capsule which is in contrast of pain of acute cholecystitis which is very severe and radiating to right shoulder. The fever in acute cholecystitis is persistent in comparison to acute viral hepatitis in which it occurs only in initial phase. In cases of alcoholic hepatitis, dengue, malarial, enteric and autoimmune hepatitis patients, they all can be separated on basis of clinical history and other supportive biochemical and serological investigations which are specific to particular disease. Conclusion: Any patient with gall bladder edema, especially in absence of cholelithiasis should be evaluated for causes unrelated to gall bladder like hepatitis, so as to avoid unwarranted cholecystectomies and decrease associated morbidity and mortality. In our large study pool of 1000 patients of acute hepatitis were saved from unwarranted laparoscopic cholecystectomy. Keywords: Gall bladder wall edema, Ultrasonogram, Computed tomography scan, Endoscopic ultrasonogram, Cholecystectomy
Malhotra et al. (Mon,) studied this question.