Diagnostic Challenges of Acute Cholecystitis in Pediatric Sickle Cell Disease: A Case Report and Discussion

ABSTRACT Background: In sickle cell disease (SCD), acute abdominal pain is frequently attributed to vaso-occlusive crises (VOC). However, hepatobiliary complications such as acute cholecystitis may mimic VOC and require different management. Case: This report details a 10-year-old male with sickle cell disease (SCD) presenting with a 4-day history of epigastric pain, fever, and severe anemia, initially suggestive of vaso-occlusive crisis (VOC) but diagnosed as acute cholecystitis with biliary sludge via abdominal ultrasound. He was treated with blood transfusions, intravenous antibiotics (amoxicillin–clavulanate plus metronidazole), hydroxyurea, and analgesics, with full recovery by day 8. The diagnostic overlap between acute cholecystitis and vaso-occlusive crises (VOC) posed significant challenges, necessitating imaging for confirmation. Discussion: Literature highlights that hepatobiliary complications in SCD, such as acute cholecystitis, frequently mimic VOC due to shared symptoms like abdominal pain and systemic inflammation. Conclusion: This case underscores the need for routine abdominal ultrasound in SCD patients with abdominal pain to distinguish acute cholecystitis from VOC. Nutritional interventions, informed by regional studies, could mitigate anemia-related complications. Recommendations: We recommend mandatory abdominal ultrasound for all SCD patients presenting with abdominal pain, regardless of circumstances, to ensure accurate diagnosis. Enhanced nutritional support and patient education are also advised to improve outcomes in low-resource settings. Keywords: Sickle cell disease, acute cholecystitis, vaso-occlusive crisis, abdominal ultrasound, hepato-biliary system