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Posttraumatic and postoperative acute cholecystitis
Insights
Diagnosing acute cholecystitis in hospitalized patients is challenging. Early diagnosis relies on recognizing clinical signs and symptoms, not just lab values, to reduce mortality.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Critical Care Medicine
Background:
- Acute cholecystitis in hospitalized patients, particularly those with comorbidities, presents diagnostic challenges.
- Delayed diagnosis can lead to severe complications and increased mortality.
- Distinguishing between acalculous and calculous cholecystitis is crucial for management.
Purpose of the Study:
- To determine the clinical presentation of acute cholecystitis in hospitalized patients.
- To identify predisposing factors and outcomes in posttraumatic and postoperative cases.
- To emphasize early diagnostic strategies for acute cholecystitis in this vulnerable population.
Main Methods:
- Retrospective analysis of 18 patients with posttraumatic or postoperative acute cholecystitis over a 10-year period.
- Review of clinical findings, laboratory values, and surgical outcomes.
- Comparison of characteristics between acalculous and calculous cholecystitis groups.
Main Results:
- Fever, right upper quadrant pain, and tenderness were common presenting symptoms.
- Leukocytosis, hyperbilirubinemia, and elevated alkaline phosphatase were frequently observed.
- Gangrenous cholecystitis was prevalent, indicating delayed diagnosis; mortality was 17%.
Conclusions:
- Awareness of predisposing factors, especially in acalculous disease, can reduce morbidity.
- Clinical signs and symptoms are more critical than laboratory values for early diagnosis.
- Prompt diagnosis and treatment are essential for improving outcomes in hospitalized patients with acute cholecystitis.
Abstract:
The development of peritonitis in hospitalized patients, especially those with significant associated illness, can be a difficult and delayed diagnosis. To ascertain the clinical presentation of acute cholecystitis in this group, a retrospective analysis was performed. Over a 10-year period 18 patients were identified who developed either posttraumatic or postoperative acute cholecystitis. The condition occurred in 12 patients admitted for some form of trauma and in six patients after elective surgery. Fever and right upper quadrant pain and tenderness were present in most. These physical findings were generally accompanied by leukocytosis (average = 16,200), hyperbilirubinemia (average = 4.2), and elevated alkaline phosphatase (average = 214). At laparotomy gangrenous cholecystitis was found in the majority, reflecting delayed diagnosis. Eleven patients had acalculous disease, and seven patients calculous cholecystitis. Three patients died, yielding a 17 per cent mortality. The majority with acalculous disease had significant underlying illness. Shock, multiple transfusions, or infection preceded acute cholecystitis in this group. Those with calculous cholecystitis were usually not as ill prior to its development. The morbidity of acute cholecystitis in previously hospitalized patients can be reduced by an awareness of the predisposing factors in those with acalculous disease. Emphasis should be placed on signs and symptoms rather than laboratory values to ensure early diagnosis and treatment of acute cholecystitis in hospitalized patients regardless of the presence or absence of gallstones.