Clinical and therapeutic features of acute cholecystitis in diabetic patients

Abstract

The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities.Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.

Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department

“…Consequently, the data that might have impacted this study, such as an underlying disease, were not collected. For example, patients with diabetes tended to have more severe clinical features than non-diabetic patients [ 24 ]. Besides, the previous article focusing on clinical features of acute cholecystitis found that >2 mg/mL of serum creatinine was observed in diabetic patients, which is more than in non-diabetes [ 24 ].…”

“…For example, patients with diabetes tended to have more severe clinical features than non-diabetic patients [ 24 ]. Besides, the previous article focusing on clinical features of acute cholecystitis found that >2 mg/mL of serum creatinine was observed in diabetic patients, which is more than in non-diabetes [ 24 ]. Furthermore, because several different levels of doctors are working in the ED, some physical examination requires both skill and experience in interpreting.…”

Diabetes and Cholecystectomy: Is There a Relation?

“…It is the treatment of choice for cholelithiasis with symptoms mostly biliary colic, acute cholecystitis, obstructive jaundice, or gallstone pancreatitis [9]. Other indications of cholecystectomy are complications of gallstone, that is acute calculus cholecystitis, gallstone in common bile duct, pancreatitis caused by gallstones, biliary dyskinesia, gall bladder polyps larger than 10 mm, cancer probability (calcified gallbladder) [10,11].…”

Pyogenic Liver Abscess Complicating Acute Cholecystitis: Different Management Options

“…Some studies mention a higher degree of gallbladder distension and an increased wall tension secondary to kinetic disorders caused by microangiopathy and diabetic neuropathy. Metabolic disorders and DM-related gallstone formation may play a role that is not fully elucidated [21]. Chronically elevated blood sugar levels alter the immune response and render the diabetic more susceptible to infections by various mechanisms, such as glycosylation of the complement proteins, inhibition of immunoglobulin-mediated opsonization of bacteria, inhibition of neutrophil migration phagocytosis, and apoptosis [22][23][24].…”

“…Moreover, septic site infection and wound dehiscence were encountered to be more frequent in diabetic patients [25][26][27][28][29]. In this regard, the advantages of the laparoscopic approach are extremely important in preventing perioperative morbidity [21].…”