Die postoperative und posttraumatische akute Cholecystitis Stellenwert der sonographischen Diagnostik

Abstract

An often unrecognized but potentially fatal complication, mostly seen in posttraumatic patients under intensive care, is reactive acute cholecystitis. On account of the high specificity of ultrasound diagnosis in the biliary system we decided to examine the ultrasound criteria for early detection of posttraumatic cholecystitis. Ultrasound of the abdomen was performed prospectively, seven times on different days, in each of 40 artificially respirated patients under intensive care conditions over a period of 12 months. The results show that artificial respiration, parenteral feeding and previous trauma can lead to tardive (28/40) wall-thickening or to a three-layered wall of the gallbladder (9/40). In 22.5% of patients (9/40) we found the sonographic signs of acute cholecystitis. In correlation with the clinical signs, cholecystectomy was indicated in only two patients. The preoperative ultrasonographic findings and clinical signs of 23 patients with the diagnosis of acute reactive cholecystitis were analysed retrospectively. We found good correlation between sonographic and clinical signs of acute cholecystitis in 21 of these 23 patients. Our study shows that the morphological correlate of a thickened three-layered gallbladder wall can occur in the context of systemic alterations, even if there is no underlying cholecystitis. The diagnosis of acute reactive cholecystitis and the indication for cholecystectomy should be based on the synopsis of pathologic and clinical findings.

Association Between Method of Delivery and Maternal Rehospitalization

“…[10][11][12][13] Our finding of increased risk of rehospitalization for gallbladder disease among women with cesarean delivery has not been reported previously, but postoperative acute cholecystitis has been associated with other types of intra-abdominal surgery. [14][15][16] Factors related to abdominal surgery and the development of subsequent gallbladder disease include stasis of bile with high viscosity induced by dehydration, hypovolemia, fever, anesthesia, and narcotics, all of which may be associated with cesarean delivery. We also found an 80% increased risk of rehospitalization for appendicitis among women with cesarean delivery, an association not noted in previous research.…”