Acute cholecystitis as a rare and overlooked complication in stroke patients

Abstract

Acute cholecystitis (AC) is a rare but possible medical complication found in stroke patients. As many stroke patients present with neurologic symptoms, such as altered mental status, motor weakness, global aphasia, or dysarthria, clinical symptoms and signs of AC are often unexpressed or overlooked. As a result, the diagnosis of AC is often delayed with subsequent secondary complications in these stroke patients. This study aims to evaluate the clinical incidence, manifestations, and predictive factors of AC in stroke patients.A retrospective cohort study was conducted between January 2013 and December of 2017 of all stroke patients (n = 2699) who have been admitted to our stroke center of the university hospital. We evaluated patient demographics, presenting symptoms, vital signs, laboratory results, mean initial consecutive fasting time, mean total fasting time, modified Rankin Scale (mRS), as well as radiological findings of abdominal computed tomography (CT) or ultrasonography.AC was diagnosed in 28 of the 2699 patients (1.04%). Of these patients with AC, gallbladder stones (calculous cholecystitis) were found in 4 patients (14.3%), and 24 patients (85.7%) were diagnosed with a calculous cholecystitis. Subgroup analysis revealed that of the 28 stroke patients with AC, those who underwent neurosurgical intervention (n = 15) had increased incidence of AC compared with those who did not (2.3% vs 0.6%, respectively, P < .001). Furthermore, the initial consecutive fasting time, total fasting time, and mRS were all predictive factors (P < .05) for developing AC in stroke patients.The incidence of AC was higher in acute stroke patients who required neurosurgical intervention, with longer initial consecutive fasting time, total fasting time, and higher mRS. We recommend early enteral nutrition and to maintain a high degree of clinical suspicion to make an early diagnosis of AC in stroke patients for improved outcome.

Acute acalculous cholecystitis and cardiovascular disease, which came first? After two hundred years still the classic chicken and eggs debate: A review of literature

“…It has been suggested that cerebrovascular disease is a risk factor in the pathogenesis of AAC [ 63 , 64 ], but there is not enough evidence in medical literature regarding this subject.…”

Cholecystitis may decrease the risk of sudden death: A 2-sample Mendelian randomization study

“…[9][10][11] Notably, case studies have surfaced, demonstrating instances wherein individuals afflicted with hypertrophic obstructive cardiomyopathy, accompanied by cholecystitis, encountered complete atrioventricular block, a phenomenon attributable to the cardio-biliary reflex, thereby positioning cholecystitis as an infrequent but notable cause of complete atrioventricular block. [12] The research conducted by Yoo et al [13] revealed that acute cholecystitis complications frequently emerge in patients suffering from cerebral infarction. Nevertheless, the pervasiveness of neurological manifestations in patients with stroke, such as altered mental status, motor weakness, global aphasia, or dysarthria, often results in underrepresentation or overshadowing of clinical symptoms indicative of cholecystitis.…”

Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service

“…This condition is a common cause of hospital admission and contributes to 3%−10% of all cases of abdominal pain 18 . In nearly 95% of cases, cholecystitis is associated with cholelithiasis 19 …”

“…18 In nearly 95% of cases, cholecystitis is associated with cholelithiasis. 19 Cholecystitis is a multi-etiology pathology with a wide range of sonographic presentations, which can be primarily divided into calculous and acalculous forms. 20 The primary diagnostic criterion for sonography is the presence of the sonographic Murphy sign in association with gallstones.…”