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Acute alithiasic cholecystitis: a not so rare disease
Revista Espanola De Enfermedades Digestivas
|December 10, 2014
Summary
Acute acalculous cholecystitis (AAC) in critically ill children often presents with subtle symptoms. Prompt diagnosis and supportive care can lead to favorable outcomes without surgery.
Area of Science:
- Pediatric Intensive Care Medicine
- Gastroenterology
- Critical Care
Background:
- Acute acalculous cholecystitis (AAC) is a severe condition with high morbidity and mortality, often seen in critically ill patients.
- Pathogenesis involves ischemia, infection, and gallbladder stasis.
- AAC is prevalent postoperatively, after trauma, or in extensive burns.
Purpose of the Study:
- To investigate the clinical presentation, diagnosis, and outcomes of AAC in a pediatric intensive care unit.
- To highlight the importance of early suspicion and management in critically ill children.
Main Methods:
- Retrospective analysis of AAC cases diagnosed in a pediatric intensive care unit from January 1997 to December 2012.
- Inclusion criteria: diagnosed AAC.
- Data collected included clinical presentation, laboratory findings, imaging, and treatment outcomes.
Main Results:
- Seven pediatric patients with AAC were identified, all linked to viral or bacterial infections.
- Common symptoms included right upper quadrant abdominal pain, jaundice, and dark urine.
- Abdominal ultrasound revealed gallbladder wall thickening and hypervascularity in all cases.
- All patients achieved satisfactory outcomes without surgical intervention.
Conclusions:
- AAC in children often presents with oligosymptomatic signs amidst severe systemic illness.
- Suspicion of AAC is warranted with abdominal pain, jaundice, dark urine, and elevated transaminases in critically ill or infected children.
- Conservative management may be effective, leading to positive outcomes.
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