[Our experience with treating acute noncalculous cholecystitis]

Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases. Diagnosis is made on the ground of active echographic and clinical observation. Conservative therapy is effective in 28 cases. The remainder (61) are operated at 1 to 4-day intervals after the onset of the disease because of persisting symptomatology and/or deterioration of the patient's condition. During laparotomy the gallbladder presents marked enlargement with thickened, exudate-imbibed wall. Cholecystectomy is done in all 61 cases. In twelve of them, owing to dilatation of the common bile duct and minimal serum bilirubin increase, stenosing papillitis is diagnosed by intraoperative cholangiography, treated by external biliary drainage and endoscopic sphincterotomy, undertaken after improvement of the general condition. Acute inflammation, free of fibrosis, with isolated foci of gangrene and necrosis of the bladder wall are histologically documented. In four senile patients presenting serious concomitant diseases, with exceptionally high operative risk, echographic percutaneous transhepatic cholecystectomy is resorted to, followed by antibiotic bladder instillations with a very good outcome. The summed up results of acute noncalculous cholecystitis treatment are estimated as very good.