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Acute acalculous cholecystitis after cardiovascular surgery
1Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan.
Insights
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.
Abstract:
The development of acute acalculous cholecystitis (AAC) after cardiovascular surgery is an infrequent but devastating complication, the etiology and management of which remains controversial. To evaluate the etiology, treatment, and outcome of patients with AAC, the cases of six patients encountered within an 8-year period who developed AAC after cardiovascular surgery requiring cardiopulmonary bypass (CPB) were reviewed. Atherosclerotic risk factors including diabetes, hyperlipidemia, and smoking were evident in five patients, three of whom had a history of stroke or arteriosclerosis obliterans, while low cardiac output was recognized in three. Percutaneous transhepatic cholecystostomy was performed in five patients, and another required cholecystectomy for peritonitis due to gangrene of the gallbladder. Two patients died of respiratory failure and sepsis after 15 and 82 days of percutaneous drainage, respectively; however, the four survivors had an excellent outcome without any biliary tract disease during a mean follow-up period of 5.3 years. In conclusion, AAC after cardiovascular surgery may result from hypoperfusion of the gallbladder due to various factors including CPB, visceral atherosclerosis, and low cardiac output. We advocate early percutaneous cholecystostomy for patients without peritonitis, while early cholecystectomy is indicated for those with peritonitis.