Acute acalculous cholecystitis and cardiovascular disease: a land of confusion

Abstract

Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.Keywords Acute acalculous cholecystitis Á Gallbladder Á Cardiovascular disease Á Ultrasonography Á Emergency Department Á Surgery Riassunto La colecistite acuta alitiasica (AAC) può essere definita come una infiammazione acuta della colecisti in assenza di calcoli. Uno dei primi casi clinici riportati in letteratura risale al 1844 (Duncan et al.) ma verosimilmente alcuni di questi sono passati inosservati a causa della complessitá del percorso diagnostico. Numerosi fattori di rischio sono stati identificati e, tra questi, le malattie cardiovascolari, in considerazione di diversi meccanismi d'azione, sembrano assumere una posizione importante e giocare un ruolo chiave. Molti casi possono passare inosservati per varie ragioni che vanno dall'esordio clinico atipico, la povertá di sintomi, la sovrapposizione clinica e strumentale con altre comorbiditá, la carenza di trial controllati. Inoltre i test di laboratorio possono risultare negativi o non specifici anche negli stadi avanzati della malattia, quando la terapia chirurgica può non rivelarsi più utile in caso di complicanze. Una diagnosi rapida é dunque necessaria per instaurare un trattamento mirato e per evitare un ulteriore deterioramento clinico. In questa breve revisione vogliamo mettere in risalto le evidenze attuali che riguardano l'epidemiologia, la fisiopatologia e la presentazione clinica della complessa relazione esistente tra le malattie cardiovascolari e la colecistite acuta alitiasica. Il nostro intento é dunque quello di enfatizzare il ruolo dell'ultrasonografia nel raggiungimento, nei casi sospetti, di una diagnosi precoce e di un trattamento appropriato, al fine di ridurre il tasso di complicanze e la mortalitá.

Gallbladder polyps ultrasound: what the sonographer needs to know

“…Gallbladder optimal sonography should be performed with the patient in a fasting state (about 6-8 h) using convex (2-8-MHz) and linear (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) transducers. The exam should be optimised to acquire appropriate B-mode images and carried out through systematic scanning with subcostal and intercostal approaches, and by longitudinal and cross-sectional views of the organ.…”

“…The gallbladder parietal thickness may exceed this limit if the patient is not fasting because of the organ’s smooth muscle contraction or for certain pathological causes, including inflammatory, neoplastic, and systemic pathologies. These pathologies may be differentiated by means of a combined evaluation of clinical and imaging findings [ 6 , 7 ].

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Acute cholecystitis as a rare and overlooked complication in stroke patients

“…Acute acalculous cholecystitis occurs especially in critically ill patients of trauma, sepsis or burns with a mortality rate between 10% and 90%, with an average of 30% as opposed to 1% in calculous cholecystitis. [4] Patients of acalculous cholecystitis have a higher morbidity and mortality than those of acute calculous cholecystitis. [18] The atypical nature of clinical symptoms in elderly patients and the presence of acalculous cholecystitis can make the diagnosis of AC difficult.…”

“…[2,3] However, in critically ill patients, such as those with trauma, sepsis, or burns, AC without gallstones (acalculous cholecystitis) occur more commonly and result in higher mortality. [4] Similarly, acute acalculous cholecystitis is a more common presentation in patients with stroke. [5] Early diagnosis and treatment of AC are critical to avoid rapid progression to perforation and mortality.…”

Gastrointestinal complications in critical care patients and effects of mechanical ventilation on the gastrointestinal tract

“…Acute acalculous cholecystitis (ACC) is defined as a condition involving severe gall-bladder (GB) inflammation in the absence of gallstones 125 . It accounts for roughly 10% of all cholecystitis cases with an incidence of 0.2 to 3% in critically ill patients.…”