Acute acalculous cholecystitis after breast reconstruction

Postoperative acute acalculous cholecystitis (AAC) is a potentially lethal complication that presents with a high morbidity and mortality. Some elective plastic surgery patients are at risk to developing this complication, although it has not been previously reported in the plastic surgery population. Patients at risk are those affected of ischaemic diseases, artheroschlerotic factors, smoking, diabetes, and patients requiring postoperative intensive care monitoring. The clinical presentation is non-specific and it is usually masked by postoperative pain and by the signs and symptoms of the primary disease. Significant delays in diagnosis result in a high incidence of gangrene, perforation, abscess, and death. Although difficult to prevent, a good preoperative planning, with correction of all physiologic abnormalities prior to surgery may help in minimising the incidence of AAC. Cessation of smoking is essential, and careful monitoring of patients during anaesthesia is crucial to avoid low cardiac output and ischaemic insults to the enteric circulation.