[The intensive care gallbladder--a transient phenomenon or a problem requiring therapy?]

Area of Science:

• Traumatology
• Gastroenterology
• Diagnostic Imaging

Background:

• Acute acalculous cholecystitis (AAC) is a known complication in critically ill and severely traumatized patients.
• Current understanding of AAC is based on limited retrospective data and case reports.
• The incidence and early detection of AAC in polytraumatized patients require further investigation.

Purpose of the Study:

• To prospectively evaluate the incidence of AAC in polytraumatized patients admitted to the intensive care unit.
• To establish reliable sonomorphological criteria for early detection and follow-up of AAC.
• To assess the role of ultrasound in managing AAC in this patient population.

Main Methods:

• A prospective study involving 45 polytraumatized patients screened clinically and sonographically at defined intervals.
• Defined AAC criteria: gallbladder hydrops, mural thickness > 3.5 mm, and sludge.
• Clinical and sonographical follow-up conducted annually from 1991 to 1993.
• Trauma severity assessed using Injury Severity Score (ISS) and Polytrauma Score (PTS).

Main Results:

• The diagnostic triad for AAC was identified in 8 out of 45 patients (18%).
• One patient underwent early elective cholecystectomy; others received conservative treatment.
• Ultrasound proved to be a reliable method for early detection and monitoring of AAC.
• A lithogenetic factor was observed, leading to gallstone disease in 27% of patients within 2-3 years.

Conclusions:

• The incidence of AAC in severely traumatized patients may be higher than previously suggested.
• Systematic ultrasound screening with defined criteria can identify patients requiring intervention.
• Ultrasound is crucial for the early detection and management of AAC in intensive care settings.