title: Dual pathology-An unreported case.
abstract: BACKGROUND
  Symptomatic biliary disease in children and young adults requiring surgical intervention are uncommon. However even rarer is the occurrence of a spontaneous gallbladder necrosis in a child. We report a case of spontaneous necrosis in a child with no apparent causative factors.
  
  
  METHODS
  Fit and well 16 year-old boy presented with acute generalized lower abdominal pain. Examination revealed mild epigastric pain with rebound tenderness and guarding of the right iliac fossa. Diagnostic laparoscopy showed a necrotic gallbladder and incidental finding of a Meckel's diverticulum. He had a cholecystectomy and Meckel's diverticulum resection. Patient recovered uneventfully and was discharged home. He was reviewed 2 months later and recovered well with no evidence of any post-operative complication. He was discharged without any further follow up.
  
  
  CONCLUSIONS
  Gall bladder necrosis is a rare cause of an acute abdomen. We present the first reported case of a spontaneous gallbladder necrosis with no apparent cause. Literature review showed various causes of gall bladder necrosis including trauma, acalculous cholecystitis, gallbladder torsion, gangrenous cholecystitis and etc.
  
  
  CONCLUSIONS
  We report a case of spontaneous gallbladder necrosis in a young healthy male with no family history of thrombotic disorders or any history of sepsis, intervention, trauma and no obvious underlying anatomical or histological abnormalities. This is an exceedingly rare pathology and one would be forgiven for not including it on the list of a differential diagnosis in such circumstance. However it is important to send tissue sample to exclude any underlying histological aetiological factors.
authors.affiliation: Department of Upper GI Surgery, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom. Electronic address: darrenyap.jx@gmail.com.
authors.forename: Darren
authors.initials: D
authors.lastname: Yap
authors.affiliation: Department of Upper GI Surgery, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom. Electronic address: ashraf.rasheed@wales.nhs.uk.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Rasheed
authors.affiliation: Department of Histopathology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom. Electronic address: majid.rashid@wales.nhs.uk.
authors.forename: Majid
authors.initials: M
authors.lastname: Rashid
keywords: Diagnostic laparoscopy; Gallbladder; Meckel’s diverticulum; Necrosis