Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies

Treinen, Charles; Lomelin, Daniel; Krause, Crystal; Goede, Matthew R.; Oleynikov, Dmitry

doi:10.1007/s00423-014-1267-6

Cited by 70 publications

(43 citation statements)

References 69 publications

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“…48 Treinen et al have also suggested that PC may be the safest and most successful intervention in patients unfit for surgery. 49 Thus, we hypothesize that adequate bile drainage plays an important role in reducing recurrent AC.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Park

Yang

et al. 2019

J of Gastro and Hepatol

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Background and Aim Percutaneous cholecystostomy (PC) has been frequently used as an alternative treatment for acute cholecystitis in seriously ill patients unfit for surgery. The aim of this study was to investigate the recurrence rate and risk factors of recurrence. Methods Medical records of 102 patients who were followed up for more than 1 year after PC tube removal among 716 patients who underwent PC for acute cholecystitis treatment were retrospectively analyzed. Results The recurrence rate of acute cholecystitis after PC tube removal was 20.6% (21/102), and the mean time to recur was 660 days. Underlying cancer (odds ratio [OR]: 3.369; 95% confidence interval [CI]: 1.006–11.282; P = 0.0489), PC duration shorter than 44 days (OR: 5.596; 95% CI: 1.35–23.201; P = 0.0176), and the presence of common bile duct stone in initial imaging studies (OR: 24.393; 95% CI: 2.696–220.746; P = 0.0045) were positively correlated with recurrence. Tubogram before PC tube removal did not significantly lower the recurrence. However, PC tube clamping for several days significantly lowered the recurrence (OR: 0.108; 95% CI: 0.015–0.794; P = 0.0288). Fifty‐nine (57.8%) had acalculous cholecystitis. Calculous cholecystitis was negatively correlated with recurrence (OR: 0.267; 95% CI: 0.074–0.967; P = 0.0444). Receiver operating characteristic curve of the prediction model for recurrence verified its accuracy (area under the curve: 0.8475). Conclusion We should try to keep PC more than 6 weeks and clamp for 1–2 weeks before removal. For those with the presence of common bile duct stones, calculous cholecystitis, and underlying malignancy, we should keep PC for longer duration and carefully observe symptoms and signs of recurrence.

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Section: Discussionmentioning

confidence: 99%

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Park

Yang

et al. 2019

J of Gastro and Hepatol

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“…Only one of these patients experienced mortality during the index admission. Emergency LC was performed in 3 patients with AAC early during the index admission because they were fit enough for the procedure, in keeping with published guidance [14].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that PC prevents further complications in up to 85% of patients [2,14]. Indeed, in the critically ill, PC has been shown to have lower morbidity, mortality and shorter length-of-hospital stay compared to cholecystectomy [15].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, cholecystectomy may be reserved for patients with evidence of gallbladder gangrene or perforation as an aggressive immediate procedure to improve multi-organ failure [5]. Additionally, American Society of Anesthesiologists (ASA) 1-2 patients with AAC who are good anaesthetic candidates with a low risk of conversion to open cholecystectomy, could be treated with laparoscopic cholecystectomy (LC) early in the disease presentation [14]. The overall standard care appears to be initial treatment with antibiotics with progression to PC or rarely, cholecystectomy for non-responders with evidence of perforation or gangrene [2,5].…”

Section: Introductionmentioning

confidence: 99%

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Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

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“…Im Unterschied zur kalkulösen Cholezystitis haben 25 % der Patienten mit einer akalkulösen Cholezystitis als erstes klinisches Zeichen ein unerklärliches Fieber. Im Verlauf kommen klassische Symptome wie rechtsseitige Oberbauchschmerzen mit einem positiven Murphy-Zeichen sowie Übelkeit und Erbrechen hinzu [58]. Die Evaluation der genannten klinischen Zeichen ist bei einem intensivmedizinisch betreuten Patienten z.…”

Section: Diagnostikunclassified

Die akute Cholezystitis

2018

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Acute cholecystitis is inflammation of the gallbladder and is triggered by cholelithiasis in about 90% of cases. Gallstone-associated diseases are among the most expensive in the field of gastroenterology and are therefore of great economic importance. Development of gallstones is multifactorial. The risk of gallstone disease increases with age. In particular, the carbohydrate- and fat-rich diet and the lack of physical activity in the Western world are involved in the formation of gallstones. Another important risk factor is genetic variants in cholesterol transporters. Diagnosis is based on the combination of the medical history, the physical examination, abdominal ultrasound and infection parameters in clinical chemistry. Typical symptoms include colic-like upper abdominal pain lasting more than six hours, fever or leukocytosis, and ultrasound gallbladder wall oedema in combination with a positive Murphy sign. The treatment of choice is early laparoscopic cholecystectomy.

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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies

Cited by 70 publications

References 69 publications

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Long‐term outcome and recurrence factors after percutaneous cholecystostomy as a definitive treatment for acute cholecystitis

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Die akute Cholezystitis

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