Acute acalculous cholecystitis complicating trauma: A prospective sonographic study

Abstract

Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (> 3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow-up of this complication.

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

“…Tachycardia is unusual in the acute stage of patients with spinal cord lesions above T5 and this ®nding should alert about a possible complication. 11,12,22 Laboratory reports were in accord with what has been previously described, 11,14 and were compatible with a pattern of cholestasis. The transaminases were either minimally elevated or were not elevated.…”

“…22,24 In some patients asymptomatic with minimal laboratory abnormalities and ultrasonography or CT scan criteria of AAC, conservative treatment with antibiotics, total parenteral nutrition, gastric decompression by continuous nasogastric tube aspiration and hemodynamic stabilization, was eective in the remission of the clinical process. 10,22 Isolation of bacteria in the bile is infrequent but reports of bile cultures were sometimes positive for Enterococcus, Klebsiella, Pseudomonas, E coli, Candida, Staphylococcus and Bacteroides fragilis. Based on these reports antibiotic treatment should be started with third generation Cephalosporins plus Metronidazole.…”

“…30 When routine sonographic studies are performed in critically injured patients this condition can be found in 14 ± 18% of them. 10,22 There should be prospective epidemiological studies to determine the real prevalence in the acute phase of SCI in patients with polytrauma. AAC should be diagnosed as early as possible 15 because of its complications and mortality.…”

Acute Acalculous Cholecystitis Complicating the Course of Infectious Mononucleosis

“…Usually patients present with fever, jaundice, RUQ or epigastric pain which is less localized in younger children, nausea and vomiting. Ultrasonography is the main diagnostic modality of AAC (19,13). Ultrasonographic findings in AAC include gallbladder wall thickening of at least 3.5mm, globular distention of the gallbladder, sludge, pericholecystic fluid and striated gallbladder wall.…”

Influence of Ceruletid on Gallbladder Contraction: A Possible Prophylaxis of Acute Acalculous Cholecystitis in Intensive Care Patients?

“…Various risk groups have been described for ACC: patients with large-scale burns [20], patients after major surgery [4,21], multitraumatized patients [22,23] and those suffering from severe cardiovascular disease [24], However, it most commonly affects patients who are treated in intensive care units. For this reason, we used this group of patients for our studies.…”