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Acute cholecystitis complicating trauma

R W DuPriest, S C Khaneja, R A Cowley

    Annals of Surgery
    |January 1, 1979
    PubMed
    Summary
    This summary is machine-generated.

    Trauma-associated acute cholecystitis, often without gallstones, has a high mortality rate. Early surgical intervention, specifically cholecystectomy, significantly improves patient survival outcomes.

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    Area of Science:

    • Trauma Surgery
    • Gastrointestinal Surgery
    • Surgical Critical Care

    Background:

    • Acute cholecystitis can complicate trauma, presenting a significant clinical challenge.
    • This condition, particularly acute acalculus cholecystitis, is associated with high morbidity and mortality.
    • Gallstones are infrequent in trauma-related cases, suggesting alternative etiologies.

    Purpose of the Study:

    • To analyze the incidence, characteristics, and outcomes of acute cholecystitis in trauma patients.
    • To review the literature on trauma-induced cholecystitis and identify optimal management strategies.
    • To establish recommendations for surgical intervention in gallbladder trauma.

    Main Methods:

    • Retrospective case series of 12 patients with trauma-associated acute cholecystitis.

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  • Systematic literature review of 20 reports involving 98 patients.
  • Analysis of clinical presentation, etiology, treatment, and outcomes.

    • Main Results:

    • Eleven of 12 patients presented with acute acalculus cholecystitis.
    • Literature review showed 86.7% had acute acalculus cholelithiasis and 61.1% experienced gallbladder necrosis, gangrene, or perforation.
    • Overall mortality was 33.3%, but decreased to 16.1% with cholecystectomy.

    Conclusions:

    • Acute cholecystitis complicating trauma is multifactorial, with shock and other trauma being common precursors.
    • Diagnosis relies on clinical suspicion and physical examination due to diagnostic difficulties.
    • Immediate cholecystectomy during initial laparotomy is recommended for gallbladder trauma or hepatic artery ligation.