Dengue and Cholecystitis: An Association to Consider in Epidemic Outbreak

Aim: to examine the association between dengue infection and cholecystitis, particularly acute acalculous cholecystitis.

Key points. Evidence from 34 studies, including case reports, series, and observational cohorts, shows that acute acalculous cholecystitis is the most frequent gallbladder manifestation linked to dengue infection. This complication is characterized by gallbladder wall thickening on ultrasonography and is frequently accompanied by systemic alterations such as vascular leak, ascites, pleural effusion, and hepatic dysfunction. Pathophysiologically, mechanisms such as viral-induced endothelial dysfunction, immune-mediated inflammation, and capillary hyperpermeability are believed to contribute to gallbladder wall edema. These changes can mimic surgical acute abdomen, complicating clinical decisions in endemic areas. Management in most cases is conservative, with supportive measures including hydration, electrolyte monitoring, and careful clinical observation. However, surgical intervention — such as cholecystectomy or percutaneous drainage — is indicated when complications arise, including perforation, gangrene, or persistent sepsis unresponsive to conservative treatment. Multidisciplinary collaboration between infectious disease specialists, gastroenterologists, and surgeons is essential, especially in severe dengue or when diagnostic uncertainty exists. Importantly, early ultrasonography is a valuable tool to confirm the diagnosis and avoid unnecessary invasive procedures.

Conclusion. Dengue-associated acute acalculous cholecystitis represents a clinically significant but often reversible complication during epidemic outbreaks. Recognizing this association is crucial, as it allows timely diagnosis, tailored management, and the prevention of unnecessary surgeries. While supportive care is sufficient in the majority of cases, careful monitoring is required to promptly identify complications that warrant surgical intervention. Future prospective studies should focus on determining the incidence, identifying predictors of adverse outcomes, and establishing standardized protocols for the management of dengue-related acute acalculous cholecystitis.

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