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Acute acalculous cholecystitis in the critically ill
M J Shapiro1, W B Luchtefeld, S Kurzweil
1Department of Surgery, St. Louis University Medical Center, Missouri 63110-0250.
The American Surgeon
|May 1, 1994
Summary
Acute acalculous cholecystitis, gallbladder inflammation without stones, affects up to 15% of adults and 32% of pediatric patients undergoing cholecystectomy. Early diagnosis and intervention, such as cholecystectomy, are crucial for improving outcomes in this critical condition.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Acute acalculous cholecystitis (AAC) is gallbladder inflammation without gallstones.
- It accounts for 2-15% of acute cholecystitis cases, with higher incidence in pediatric populations (up to 32%).
- AAC often affects critically ill patients, necessitating prompt diagnosis and management.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, and outcomes of patients with AAC.
- To evaluate the effectiveness of cholecystectomy in managing AAC.
- To emphasize the importance of early diagnosis and intervention for improving patient survival rates.
Main Methods:
- Retrospective review of 22 intensive care unit (ICU) patients who underwent cholecystectomy for AAC over 10 years.
- Analysis of patient demographics, clinical findings, diagnostic imaging (HIDA, ultrasound, CT), and treatment outcomes.
- Correlation of clinical presentation and diagnostic findings with pathological results (gangrene/necrosis).
Main Results:
- The study included 22 patients (82% male, average age 61) with an average ICU stay of 19 days prior to surgery.
- Common symptoms included right upper quadrant tenderness and pain; 68% had prior surgery.
- Diagnostic imaging showed high positive rates: HIDA (100%), Ultrasound (76%), CT (78%). Gangrene/necrosis was found in 59% of cases.
- Mortality rate was 41% (9 patients).
Conclusions:
- AAC is a severe condition often presenting in critically ill patients, frequently with gangrene or necrosis.
- Diagnostic imaging plays a vital role, with HIDA scans showing high sensitivity.
- Early diagnosis and prompt surgical intervention, likely cholecystectomy, are critical for improving outcomes and reducing mortality in AAC.