Acute Cholecystitis: A Complication in Severely Injured Intensive Care Patients

Raunest, J.; Imhof, Michael; Rauen, Ursula; Ohmann, Ch.; Thon, K.; Bürrig, KF

doi:10.1097/00005373-199204000-00005

Cited by 46 publications

(20 citation statements)

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“…8,14 Contrary to the occurrence of cholecystitis secondary to lithiasis it is predominant in males. 8,10,15 These two facts were observed in this series, although one episode occurred later in the 12th week. Right upper quadrant abdominal pain was observed in only one patient, the one with a T12 lesion.…”

Section: 11supporting

confidence: 64%

“…The conjunction of three of these signs weigh more in favour of the diagnosis than if present singly. 10,15,23 CT scanning has a similar diagnostic value as does sonography, and demonstrate a diuse or nodular thickening of the gallbladder wall, a poor limit of demarcation between the liver and the vesicle, a distended vesicle with subserous edema, and¯uid collection in the perivesicular space. 11 In our series echographic diagnostic signs were positive in six patients.…”

Section: 11mentioning

confidence: 98%

“…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.…”

Section: 11mentioning

confidence: 99%

“…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.…”

Section: 11mentioning

confidence: 99%

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Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

et al. 1997

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Acute acalculous cholecystitis (AAC) is a very serious complication which can be found in patients with multiple serious traumatic lesions (`polytrauma'). Very few patients have been reported in the literature with an acute spinal injury and associated AAC. We report seven patients with polytrauma and acute spinal cord injury who developed AAC. All had no complaint of the principal warning symptom: right upper quadrant abdominal pain. All presented with a palpable mass in this site and the laboratory results were compatible with cholestasis. The diagnosis of AAC was con®rmed both by ultrasound and CT scanning. We discuss the possible precipitating factors and the treatment. One hundred and ninety one patients were admitted to the Intensive Care Unit in our Hospital with SCI over a period of 2 years, all of these in the acute stage. AAC was diagnosed in seven patients among them. Our purpose is to call attention to this clinical condition which can complicate the outcome of patients with multiple trauma and acute spinal cord injury. To date AAC in this group of patients has been infrequently described in the available literature.

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Section: 11supporting

confidence: 64%

Section: 11mentioning

confidence: 98%

Section: 11mentioning

confidence: 99%

Section: 11mentioning

confidence: 99%

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Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

et al. 1997

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“…Subsequently, AC was reported to follow thoracic surgical procedures, abdominal surgery (4-7), trauma (8,9), intensive care (9, 10) and burns (11)(12)(13). The frequency of the development of AC in patients with these underlying diseases is 1-4.6%, occurring within one week to one month after the preceding incident.…”

Section: Discussionmentioning

confidence: 99%

Clinical Review of 24 Patients with Acute Cholecystitis after Acute Cerebral Infarction

et al. 2014

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Objective Acute cholecystitis (AC) after acute cerebral infarction is rare and has not been fully investigated. Because patients with acute cerebral infarction often cannot complain of abdominal pain due to loss of consciousness, hemiparesis and aphasia, delays in diagnosis may increase the severity of the condition. It is clearly important to identify symptoms, reach a diagnosis and provide treatment as soon as possible. The purpose of this study was to investigate the clinical features of AC after acute cerebral infarction. Methods Among the 1,682 patients with acute cerebral infarction admitted to our hospital between April 2007 and July 2012, AC after acute cerebral infarction was diagnosed in 24 (1.4%). Data regarding age, sex, past history, fasting period, period from admission to the onset of cholecystitis, clinical type, severity of cholecystitis, diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, National Institutes of Health Stroke Scale (NIHSS) score at onset and modified Rankin scale at 90 days were investigated. Results The mean age of the 24 patients (15 men, 9 women) was 74.2±11.9 years (range, 45-90 years). The clinical type was atherothrombosis in five patients, lacunar infarction in seven patients, cardiac embolism in 10 patients and dissection in two patients. The past history included atrial fibrillation in 10 (42%) patients, hypertension in 20 (83%) patients and diabetes in 11 (46%) patients. The mean duration of fasting was 10.7 days (range, 1-32 days). The mean interval between the onset of cholecystitis and admission was 8.3 days (range, 0-24 days). The median NIHSS score at onset of cerebral infarction was 10, and 23 (96%) patients were bedridden at the onset of cholecystitis. Conclusion AC after acute cerebral infarction was frequently observed in the patients with severe hemiparesis and those who were fasted. It is important to identify symptoms, accurately diagnose the condition and provide treatment as soon as possible in order to achieve early ambulation and resumption of food intake using a feeding tube.

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