Ischemic Cholecystitis – Gangrenous, Perforated and Acalculous Cholecystitis

Abstract

The charts of 200 patients with acute inflammatory gallbladder disease were reviewed. Forty-eight patients were found with grangrenous, perforated or acalculous cholecystitis. These three conditions resulting from an ischemic gallbladder, differ from simple acute cholecystitis in its pathogenesis, laboratory findings and clinical course. Gangrenous and perforated cholecystitis accompany chronic systemic vascular compromise, whereas acalculous cholecystitis is found in a severe acute low-flow state. Awareness, together with careful clinical history, physical examination, selective blood tests and high-quality ultrasound, all contribute in the accurate diagnosis of this neglected condition. Intensive perioperative management is recommended.

Acute Acalculous Cholecystitis in China

“…It always accompanies dysfunction of other organs or some systemic disease which can cause a hypoperfused state, such as chronic vascular disease, perivascular disease, sepsis, hypovolemic shock and diabetes 2–6 . Compared with acute calculi cholecystitis, AAC is more likely to include gangrene and perforation and has significantly higher morbidity and mortality rates 2–6 . For these reasons, AAC in western countries is often a serious condition that develops quickly and always needs emergency treatment in an intensive care unit; the 58 cases in our series did not have a serious condition such as shock or heart failure.…”

“…Furthermore, AAC in western countries is often secondary to critical burns, trauma or surgery, 2,4 and develops quickly. It always accompanies dysfunction of other organs or some systemic disease which can cause a hypoperfused state, such as chronic vascular disease, perivascular disease, sepsis, hypovolemic shock and diabetes 2–6 . Compared with acute calculi cholecystitis, AAC is more likely to include gangrene and perforation and has significantly higher morbidity and mortality rates 2–6 .…”