Laparoscopic cholecystostomy for acute acalculous cholecystitis

Area of Science:

• Trauma Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Acute acalculous cholecystitis (AAC) affects up to 18% of severely injured patients.
• AAC diagnosis involves ultrasound findings like gallbladder sludge, wall thickening, and Murphy's sign, often presenting with unexplained sepsis.
• High mortality rates, up to 50%, underscore the urgency of effective AAC management.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic cholecystectomy (LC) as an early intervention for acute acalculous cholecystitis in ICU trauma patients.
• To assess the safety and outcomes of a specific laparoscopic decompression technique for AAC.

Main Methods:

• Six ICU trauma patients with AAC underwent laparoscopic confirmation and decompression.
• The technique involved initial gallbladder decompression via the fundus, followed by Foley catheter insertion through an Endoloop for sustained decompression.
• Laparoscopic cholecystectomy was performed when indicated.

Main Results:

• Laparoscopic decompression successfully resolved sepsis in all six patients.
• Only one patient required a subsequent laparoscopic cholecystectomy.
• The procedure demonstrated low morbidity and was effective in the early stages of AAC.

Conclusions:

• Laparoscopic decompression is a potentially life-saving procedure for early-stage AAC in trauma patients.
• This minimally invasive approach offers low morbidity and high success rates in resolving sepsis.
• LC is not recommended for cases involving gallbladder gangrene or perforation.