Acute acalculous cholecystitis complicating trauma: a prospective sonographic study

Area of Science:

• Trauma Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Acute acalculous cholecystitis (AAC) is a recognized complication in severely traumatized patients.
• Current data on AAC prevalence in trauma is limited, primarily from retrospective studies and case reports.
• Early detection and management of AAC are crucial for improving patient outcomes.

Purpose of the Study:

• To prospectively investigate the incidence of AAC in polytraumatized patients.
• To evaluate the reliability of ultrasound in diagnosing AAC in this patient population.
• To establish defined screening intervals for AAC in intensive care unit settings.

Main Methods:

• A prospective study involving 45 polytraumatized patients admitted to the ICU.
• Clinical and sonographic screening for AAC at defined intervals.
• AAC diagnosis based on gallbladder hydrops, wall thickness (>3.5 mm), and sludge detection.
• Trauma severity assessment using Injury Severity Score and Polytrauma Score.

Main Results:

• The diagnostic triad for AAC was identified in 8 out of 45 patients (18% incidence).
• One patient underwent early elective cholecystectomy; the remaining 7 were managed conservatively.
• Ultrasound proved to be a reliable method for early AAC detection and monitoring.

Conclusions:

• The incidence of AAC in severely traumatized patients is higher than previously suggested.
• Ultrasound is a valuable tool for the early detection and follow-up of AAC in trauma patients.
• Prompt diagnosis and appropriate management strategies are essential for this critical complication.