2023 Volume 59 Issue 5 Pages 905-911
An 8-year-old boy was treated for hemolytic uremic syndrome (HUS) with intravenous fluids and transfusions. He started oral intake 13 days after the onset of HUS, but 19 days after the onset of HUS, he developed abdominal pain and vomited. A blood test revealed elevated levels of liver enzymes with conjugated hyperbilirubinemia. An abdominal ultrasound demonstrated vesicular sludge. Although fasting and ursodeoxycholic acid relieved him of colic attacks, similar attacks occurred three times whenever oral feeding was attempted. An operation was planned because conservative therapy was considered ineffective. During the waiting period for the operation, fever, right epigastric pain, and vomiting occurred. The blood test showed leukocytosis and CT showed thickening of the gallbladder wall. He was diagnosed as having acute cholecystitis and underwent cholecystectomy. A large amount of highly viscous sludge was found inside the gallbladder, but no stones were found. His postoperative course was uneventful, and he was discharged on the fifth postoperative day. Since the accumulation of gallbladder sludge after HUS is a transient event that can be resolved by conservative therapy, cholecystectomy is rarely used as a treatment option. However, long-term conservative therapy may result in prolonged illness and adhesion during surgery; therefore, early cholecystectomy is recommended.
