LETTER TO THE EDITOR
Year : 2011  |  Volume : 16  |  Issue : 3  |  Page : 119-120

Authors' reply

Parag J Karkera, Gursev Sandlas, Ritesh Ranjan, Abhaya Gupta, Paras Kothari
Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India

Correspondence Address:
Parag J Karkera
Department of Paediatric Surgery, Okmanya Tilak Municipal General Hospital, Sion, Mumbai - 400 022, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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PMID: 21897578

1. The statement that "Gall bladder perforations after cholecystitis are usually seen in elderly patients (>60 years) and are rare in children" has been cited from the article by Ong et al., and the statement 'Sensitivity of CT in the detection of gallbladder perforation and biliary calculi has been reported to be 88% and 89%, respectively" has been cited from the article from Alvi et al. by us. These references have been offered as counter references to the articles by Roslyn et al. and Morris et al., respectively.
2. The statement "Only 5-10% of the patients with acute cholecystitis are associated with acalculous cholecystitis" is cited from the article by Wang et al. ^[3] which is reference no. 10 in my article. It was inadvertently marked as reference no. 2 (article by Alvi et al.).
   
   The statement "The mortality rate of gall bladder perforation is in the range of 12-16%" has been cited from the articles by Ong et al. (reference no.1) and Derici et al. (reference no. 4) who in turn have cited it from the articles by Lennon et al. and Roslyn et al. (reference no. 5 and 6 respectively). Hence, I have cited the articles by Lennon et al. and Roslyn et al. as references for the statement.
3. Enteric fever is a well-known cause for GBP, but GBP is an uncommon complication seen in cases of Enteric fever; hence the statement "GBP is a well known, although unusual complication, in enteric fever."
4. The statement "The "HOLE" sign, in which the defect in the gall bladder is visualized, is the only reliable sign of GBP" has been cited from the article by Derici et al. Derici et al. have in turn cited the statement from the article by Sood et al. ^[4]
5. Acute acalculous cholecystitis can be caused by a variety of medical diseases. We do not refute this statement; in fact we support this statement. We would like to only reiterate our article where we have mentioned that both the patients presented to us as cases of "Acute Perforative Peritonitis." Neither of the two children had any history of preceding medical illness for a prolonged course of time and both of them had an acute presentation in the form of acute abdomen.
6. As for this point, we are not making any sweeping statement for cholecystectomy for all cases of acute cholecystitis. Medical diseases presenting with acalculous cholecystitis have been treated conservatively by us and will be conserved in future as well. We were referring only to healthy children who presented with acalculous cholecystitis without any exacerbating factors. It is our personal opinion and is in no way binding to the readers.

References

1.	Zaki SA. Acute acalculous cholecystitis causing gall bladder perforation in children J Indian Assoc Pediatr Surg 2011;16:118.
2.	Karkera PJ, Sandlas G, Ranjan R, Gupta A, Kothari P. Acute acalculous cholecystitis causing gall bladder perforation in children. J Indian Assoc Pediatr Surg 2010;15:139-41.   [PUBMED]
3.	Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003;9:2821-3.   [PUBMED]  [FULLTEXT]
4.	Sood BP, Kalra N, Gupta S, Sidhu R, Gulati M, Khandelwal N, et al. Role of sonography in the diagnosis of gallbladder perforation. J Clin Ultrasound 2002;30:270-4.   [PUBMED]  [FULLTEXT]