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[Acute acalculous cholecystitis]
1Anaestesiologisk afdeling, Amtssygehuset Sankt Elisabeth, København.
Insights
Acute acalculous cholecystitis (AC) is a severe gallbladder inflammation often linked to critical illness. Early diagnosis and intervention, such as cholecystectomy or cholecystotomy, significantly reduce AC
Area of Science:
- Gastroenterology and Hepatology
- Surgical Pathology
- Critical Care Medicine
Context:
- Acute acalculous cholecystitis (AC) is a serious gallbladder inflammation.
- Often occurs secondary to severe underlying conditions like major surgery, trauma, or mechanical ventilation.
- Pathogenesis involves impaired gallbladder emptying, leading to inflammation.
Purpose:
- To highlight the significance of AC as a complication in critically ill patients.
- To outline diagnostic methods and treatment options for AC.
- To emphasize the impact of early intervention on patient outcomes.
Summary:
- AC presents with varied symptoms, often masked by severe illness; fever without a clear source can be the sole indicator.
- Diagnosis is confirmed via imaging (ultrasound, CT, cholangiography) and laboratory tests.
- Standard treatment is cholecystectomy; percutaneous cholecystotomy offers an alternative for early-stage cases.
Impact:
- Untreated AC has a high mortality rate (up to 85%).
- Prompt diagnosis and treatment, including surgical or percutaneous procedures, drastically reduce mortality.
- Recognizing AC is crucial for managing complex surgical and critically ill patients.
Abstract:
Acute acalculous cholecystitis (AC) is an inflammatory process of the gallbladder, often caused by other severe diseases. The etiology is multifactorial, but the pathogenesis is in all cases a reduction in the gallbladder's emptying capacity. The mortality of AC reaches 85% without treatment. This fact makes it important to consider AC as a possible complication to major surgery, multi-trauma, and artificial ventilation. Symptoms resemble "normal" cholecystitis, but may be masked by the underlying severe disease. Fever without known focus may be the only symptom. Ultrasound, CT-scanning or cholangiography are used to verify the diagnosis, supplemented by laboratory investigations. Treatment is cholecystectomy. Percutaneous ultrasonic guided cholecystotomy is a good alternative if the diagnosis made in an early stage. The mortality is considerably reduced by early intervention.