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[Acute acalculous cholecystitis: not only in the intensive care department]
J H M van Steijn1, W W H Roeloffzen, B M G Appeltans
1Afd. Interne Geneeskunde, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen. j.h.m.van.steijn@int.azg.nl
Insights
Acute acalculous cholecystitis (AAC) is difficult to diagnose, often requiring surgery. Early suspicion and hepatobiliary scintigraphy are crucial for improving patient outcomes in this condition.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Acute acalculous cholecystitis (AAC) presents non-specifically, complicating diagnosis.
- AAC is more prevalent in older males with atherosclerotic vascular disease.
Observation:
- Two male patients (65 and 40 years) with abdominal pain required exploratory laparotomy for AAC diagnosis.
- One patient died from sepsis post-operatively, while the other recovered after intensive care.
Findings:
- Diagnostic delay in AAC can lead to severe complications like gangrene and perforation.
- Radiologic imaging for AAC is often incomplete, necessitating a high index of suspicion.
Implications:
- Early clinical suspicion and prompt diagnosis are vital for reducing AAC mortality.
- Hepatobiliary scintigraphy should be integrated into the diagnostic workup for suspected AAC.
Abstract:
In two men aged 65 and 40 years with abdominal pain, the diagnosis 'acute acalculous cholecystitis' (AAC) could be reached only after exploratory laparotomy. The first patient was initially admitted to the coronary-care department because of known atherosclerotic vascular disease; he died a few days after the operation due to sepsis. The second patient recovered satisfactorily after admission to intensive care because of haemodynamic instability. AAC is an illness with a non-specific clinical presentation and incomplete radiologic imaging. AAC is more frequently seen in outpatients than in acutely ill inpatients, especially in older male patients who have atherosclerotic vascular disease. Diagnostic and therapeutic delay leads to gangrene, empyema and perforation, resulting in a high mortality. To improve the outcome, a high and early index of suspicion is needed. Hepatobiliary scintigraphy should be included in the diagnostic pathway.