Acute Calculous Cholecystitis in a Young Male Patient: An Atypical Presentation with Significant Inflammatory Findings

Abstract

Acute calculous cholecystitis is a common cause of acute abdominal pain; however, it predominantly affects older individuals and females, making its occurrence in young male patients without traditional risk factors relatively uncommon and clinically significant. We report the case of a 23-year-old male with no relevant medical history who presented with a 48-hour history of right upper quadrant abdominal pain associated with nausea, vomiting, and fever. Physical examination revealed a positive Murphy’s sign without signs of peritoneal irritation. Laboratory studies demonstrated mild leukocytosis and markedly elevated C-reactive protein, with normal liver function tests and pancreatic enzymes. Abdominal ultrasound confirmed cholelithiasis and significant gallbladder wall thickening (12 mm), consistent with acute cholecystitis. According to Tokyo Guidelines 2018 criteria, the patient met diagnostic and severity parameters suggestive of moderate disease. The patient underwent urgent open cholecystectomy as the primary surgical approach due to intraoperative findings of a tense and distended gallbladder, with an uneventful postoperative course. Histopathological analysis confirmed chronic calculous cholecystitis. This case highlights the importance of recognizing acute cholecystitis in atypical populations such as young male patients, who may present with significant inflammatory changes and require prompt surgical management to prevent complications.