Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis

Patients who require prolonged intensive care following traumatic injuries are at risk for developing acute acalculous cholecystitis (AAC). The diagnosis of AAC is often difficult to establish, resulting in increased morbidity and mortality in this critically ill population. We reasoned that diagnostic laparoscopy might provide a more accurate and timely method of diagnosis. Laparoscopy was performed in nine trauma ICU patients with suspected AAC. Four procedures were considered positive and five were negative. There were no false-positive or false-negative laparoscopic exams, and no procedure-related morbidity occurred. Comparison of multiple clinical, laboratory, and radiologic findings showed that only laparoscopy accurately distinguished between those patients with AAC and those without AAC. We conclude that diagnostic laparoscopy is safe and definitive in trauma ICU patients with suspected AAC and should be performed prior to proceeding with laparotomy.