Histopathology of acute acalculous cholecystitis in critically ill patients

Laurila, Jouko; Ala‐Kokko, Tero; Laurila, Päivi; Saarnio, Juha; Koivukangas, Vesa; Syrjälä, Hannu; Karttunen, Tuomo J.

doi:10.1111/j.1365-2559.2005.02238.x

Cited by 61 publications

(50 citation statements)

References 19 publications

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“…Mortality in the critically ill with AAC is as high as 30% but can range from 10% if diagnosed at an early stage to 90% when detected late in its pathological progression [2,[4][5][6][7][8][9]. Therefore, early recognition and treatment are essential to avoid a fulminant course and complications.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

“…Mortality rates for AAC range from 10 to 90% [2,[4][5][6][7][8][9]. Early recognition and treatment is advocated in order to avoid a fulminant course and complications carrying a high risk of mortality such as gangrene or perforation [2,6,7,[10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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“…[11][12][13][14][15] US and CT remain the main radiological investigations of choice as both are equally accurate in the diagnosis of AAC. [16][17][18] Radiologic criteria have also been developed for hepatobiliary iminodiacetic acid (HIDA) scintigraphy.…”

Section: Discussionmentioning

confidence: 99%

Acute acalculous cholecystitis after blunt abdominal trauma

et al. 2016

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“…Acute acalculous cholecystitis is associated with a high morbidity and mortality and is thought to be a manifestation of systemic disease rather than a process conined to the gallbladder alone [8]. Because it can be dificult to recognize clinical signs of acute acalculous cholecystitis and intensive care patients are often on antibiotics and pain medication as well as parenteral nutrition (increasing their risk), percutaneous cholecystostomy can be used as diagnostic and therapeutic procedure in patients with unexplained sepsis [9].…”

Section: Indicationsmentioning

confidence: 99%

Bedside Percutaneous Cholecystostomy

Maneevese¹,

Sheth²,

Rahman³

et al. 2018

Bedside Procedures

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Although percutaneous cholecystostomy historically is an alternative to cholecystectomy, it is typically performed as a bridge to gallbladder removal. As a low mortality procedure, it proves itself a valuable tool in morbid patients such as the elderly and the critically ill who present with acute cholecystitis and as an alternate route for biliary access. In high-risk patients, PC can be performed at the patient's bedside in patients who are too unstable to be transported outside the ICU. PC is performed using ultrasound, CT, or luoroscopic guidance; however, bedside PC can only be performed using ultrasound. Ultrasound is readily available and portable and allows for real-time imaging. A 2010 study performed by Donkol et al. demonstrated success rates for CT (93%), US (46%), and luoroscopy (62%). Though US had the lowest success rate, it remains the only option for those critically ill who cannot tolerate transportation or an immediate cholecystectomy. Contraindications of PC include hemorrhage, pericholecystic abscess, gallbladder tumor, etc. Complications include bile leak, hemorrhage, sepsis, bowel perforation, etc. The gallbladder is a small organ with much pathology. Having the knowledge and skill to adequately perform this procedure is essential, especially in patients with septic shock in need of source control.

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Histopathology of acute acalculous cholecystitis in critically ill patients

Cited by 61 publications

References 19 publications

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Acute acalculous cholecystitis after blunt abdominal trauma

Bedside Percutaneous Cholecystostomy

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