Related Experiment Videos
[Acute acalculous cholecystitis as a complication of cerebrovascular disease]
M Ushiyama1, J Koike, H Zenisaka
1Department of Neurology, Kenwakai Hospital.
Insights
Acute acalculous cholecystitis (AAC) can complicate cerebrovascular disease (CVD). This study found a 1.0% incidence of AAC in CVD patients, often presenting with fever and elevated CRP, suggesting it
Area of Science:
- Neurology
- Gastroenterology
- Critical Care Medicine
Background:
- Acute acalculous cholecystitis (AAC) is a severe complication typically seen in critically ill patients.
- The occurrence of AAC following cerebrovascular disease (CVD) has not been well-established.
- This study investigates the incidence and clinical features of AAC in patients with acute CVD.
Observation:
- A total of 1013 patients with acute CVD were analyzed.
- Twelve patients developed acute cholecystitis, with ten diagnosed with AAC (1.0% incidence).
- AAC patients often presented with severe hemiparesis, fever, elevated C-reactive protein (CRP), and abnormal gallbladder ultrasound findings.
Findings:
- The mean time from CVD onset to AAC development was 25.1 days.
- In five patients, AAC onset occurred within 16 days of initiating oral or tube feeding.
- Fever was the most common initial symptom (70%), while abdominal pain was infrequent (20%).
Implications:
- AAC is an unrecognized but significant complication in acute CVD patients.
- Multifactorial causes, including fasting and increased bile concentration, likely contribute to AAC in CVD.
- Early recognition and management of AAC are crucial for improving outcomes in CVD patients.
Abstract:
Acute acalculous cholecystitis (AAC) is a potentially life-threatening complication, which is sometimes found in patients with multiple injuries, burns, or after an operation. It is unclear, however, whether AAC occurs after cerebrovascular disease (CVD). We studied the incidence of AAC complicating CVD and the clinical characteristics of AAC that occurs after CVD. One thousand three patients with CVD were studied who had been admitted at the acute stage to Kenwakai Hospital from January 1989 through September 1995 and to Seguchi Hospital of Neurosurgery from January 1993 through September 1995. There were 557 patients with cerebral infarction, 273 with cerebral hemorrhage, 94 with subarachnoid hemorrhage, and 79 with TIA/RIND. Twelve patients developed acute cholecystitis, ten of whom had AAC. Of the ten patients with AAC, six had cerebral infarction, two cerebral hemorrhage, and two TIA/RIND. Eight of ten were male. The incidence of AAC was 1.0% in the CVD patients studied. The majority of the AAC patients showed severe hemiparesis. The time interval from CVD to the onset of AAC ranged from 1 to 89 days, with a mean of 25.1 days. AAC occurred 0 to 16 days (mean 5.8 days) after the start of oral or tube food intake in five patients. The most common initial symptom was fever (70%), whereas abdominal pain was infrequent (20%). All the patients showed elevated CRPs and abnormal ultrasonographic findings for the gallbladder and some also had leukocytosis (60%) and elevated aminotransferase of more than 100 IU/l (30%). Cholecystectomy was performed on four AAC patients, but five were successfully treated with antibiotics. The cause of AAC complicating CVD seems to be multifactorial and probably is related to fasting, increased bile concentration, and arteriosclerosis. Our results strongly suggest that AAC is an unrecognized but important complication during acute stage CVD patients.