The management of acute cholecystitis in the elderly

This paper assesses the value of hepatobiliary scanning and surgical treatment of acute cholecystitis in patients above the age of 60 years over a 3 year period (1980-1982). During this period 382 cholecystectomies for biliary disease were performed in 257 women and 125 men with mean ages of 55 X 6 and 61 X 1 years respectively. Of the 382, 208 were older than 60, with a female to male ratio of 1 . 3:1. Acute cholecystitis occurred in 74 of the 208 patients; they were subjected to early cholecystectomy. Biliary tract imaging using 99 m technetium-labelled diisopropyl-IDA (DISIDA) proved valuable in confirming the diagnosis of acute cholecystitis. Of 85 patients over 60 years who underwent hepatobiliary scanning with a presumptive diagnosis of acute cholecystitis, 74 had positive scans and acute cholecystitis was confirmed at subsequent operation in these cases. There were two false positive and nine negative scans showing that biliary scintigraphy proved to be a rapid non-invasive and sensitive method of diagnosing acute cholecystitis. The advent of hepatobiliary scanning has strengthened our surgical strategy in the management of acute cholecystitis in the elderly and allows early elective surgery with an acceptable morbidity and in this series no mortality.