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GALL BLADDER INVOLVEMENT DURING ENTERIC FEVER (SALMONELLA INFECTION)
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Picture of typhoid (enteric) has changed over the last few years. What was taught to the doctors 50 years back has been forgotten by the GPs. They have forgotten that in this illness the lymphoid peyer's patches of the small intestines are affected but during septicaemia many other organs can also be affected.
One of the important organs which can be involved is the gall bladder. For years, it has been stressed that the gall bladder stores salmonella organisms even if the patient is cured. A good sonologist like Dr. Nitin Chaubal has already demonstrated in a dozen children suffering from typhoid a huge enlarged gall bladder, which at times reaches up to the right iliac fossa! These enlarged gall bladders disappear with medical line of treatment.
But then, Dr. Jehangir Sorabjee a leading Physician, while treating a case of pyrexia, (where the cause of the fever was not confirmed), one day detected a rupture of gall bladder which had become gangrenous.
Finally, we have all forgotten that if a patient of typhoid recovers, you need some treatment to "sterilise the gall bladder" which is the storehouse of salmonella.
It is time for the family physicians to wake up and look out for gall bladder involvement in patients who are diagnosed as typhoid.
ACKNOWLEDGEMENT
I am thankful to Dr. Nitin Chaubal and Dr. Jehangir Sorabjee for having shared their experiences with me.
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