Acute Cholelithiasis with Calculous Cholecystitis and Impending Perforation: A Rare Presentation of Salmonella TyphiCholelithiasis is a common biliary condition with substantial morbidity, often progressing to acute calculous cholecystitis when complic

Abstract

Cholelithiasis is a common biliary condition with substantial morbidity, often progressing to acute calculous
cholecystitis when complicated by gallstone obstruction. While the typical pathogens implicated in biliary
infections are enteric Gram-negative bacilli, Salmonella enterica serovar Typhi (S. Typhi) is a rare etiological
agent, particularly in immunocompetent individuals, and can present without any systemic typhoid features.
Case Presentation: This case report describes a young female presenting with right upper quadrant pain and
radiological evidence of acute cholecystitis with impending gallbladder perforation. Intraoperative findings
included a phlegmon with pus, inflammation, and the presence of gallbladder perforation, with microbiological
culture of these fluids revealing the pathogen as S. Typhi resistant to ciprofloxacin, ampicillin, and tetracycline.
Histopathology confirmed the findings. The case underscores the emerging prevalence of drug-resistant S. Typhi
in endemic regions such as India and highlights the importance of routine culture in severe cholecystitis cases,
even in the absence of overt enteric fever. It also emphasizes the need for vigilance in endemic settings where
typhoid complications may present atypically