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Acute acalculous cholecystitis after cardiovascular surgery.
1Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan.
Surgery Today
|January 1, 1997
Summary
Acute acalculous cholecystitis (AAC) after cardiovascular surgery is rare but serious. Management involves early percutaneous cholecystostomy for non-peritonitis cases and cholecystectomy for peritonitis.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Surgical Complications
Background:
- Acute acalculous cholecystitis (AAC) is a rare complication following cardiovascular surgery.
- The etiology and optimal management of AAC post-cardiovascular surgery remain controversial.
Purpose of the Study:
- To evaluate the etiology, treatment, and outcomes of patients who developed AAC after cardiovascular surgery.
- To identify risk factors and recommend management strategies for AAC in this patient population.
Main Methods:
- Retrospective review of six patients who developed AAC after cardiovascular surgery requiring cardiopulmonary bypass (CPB) over an 8-year period.
- Analysis of patient risk factors, interventions, and outcomes.
Main Results:
- Common risk factors included atherosclerosis (diabetes, hyperlipidemia, smoking) and low cardiac output.
- Five patients underwent percutaneous transhepatic cholecystostomy; one required cholecystectomy for gangrenous cholecystitis.
- Two patients died from sepsis and respiratory failure; four survivors had excellent long-term outcomes.
Conclusions:
- AAC post-cardiovascular surgery may stem from gallbladder hypoperfusion due to CPB, atherosclerosis, or low cardiac output.
- Early percutaneous cholecystostomy is recommended for patients without peritonitis.
- Early cholecystectomy is indicated for patients presenting with peritonitis.