During my year of fellowhip in Cordele, GA, I took out 82 gallbladders. 81 laparoscopically and 1 open. Since I have been in Nalerigu, I have taken out only a handful, but none in the past couple years until recently. In a span of less than 4 weeks, I have taken out 5 gallbladders. All kids! Typhoid Fever strikes again. Interestingly, I have been picking it up with my new portable ultrasound.
The first case was a 9 year old girl. I took her to the operating room believing she had a perforation of her intestines, but I couldn’t find a hole! I inspected the small bowel from start to finish 3 times, I looked at the colon and appendix and saw no problems. Finally, I saw her gallbladder.
Instead of a nice robin’s egg blue, it was inflamed with patches of green gangrene and a hole through which purulent bile was draining. Thankfully, a seasoned scrub tech was there to help me as my technique felt a bit rusty.
Two more of my young typhoid patients had holes in both the gallbladder and the intestines! For two boys, I was able to see the thickened gallbladder on ultrasound and direct my surgical efforts there alone.
Salmonella Typhi is known to be harbored in the gallbladder (remember Typhoid Mary?) and it replicates well there. In the past I have taken out some gallbladders due to Typhoid, but never at such a frequency. Many times, I have seen children with severely dilated gallbladders without any other signs of gangrene nor any signs of intestinal perforation. These children were successfully treated with antibiotics alone.
I have not yet figured out why the gallbladder has been the target of late (although the small bowel is still the main victim in most of my typhoid patients), but I am much more aware of the possibility now.