The Increasing Prevalence of Acalculous Cholecystitis in Outpatients

Savoca, Paul; Longo, Walter E.; Zucker, Karl A.; Mcmillen, Marvin M.; Modlin, Irvin M.

doi:10.1097/00000658-199004000-00009

Cited by 113 publications

(66 citation statements)

References 13 publications

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“…AAC is traditionally known to occur in patients with chronic debilitating diseases, superimposed critical illness, trauma, or a major burn injury. Although previous reports have consisted almost exclusively of critically ill patients, subsequent reports have demonstrated an increase in the number of cases of AAC that developed in the absence of an underlying acute illness or traumatic injury [8,14]. Some reports have documented development of AAC at home without evidence of preceding acute illness or trauma in 77% of AAC patients [8,9].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Therapeutic Outcomes of Acute Acalculous Cholecystitis

Kim

Song

et al. 2014

Digestion

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Objective: Acute acalculous cholecystitis (AAC) is traditionally known to occur in critically ill patients and to have a poor prognosis. Although cholecystectomy is usually recommended for treating AAC, nonsurgical management may be a good alternative. The objective of this study was to review the incidence, risk factors, treatment modality, and therapeutic outcomes of AAC compared to acute calculous cholecystitis (ACC). Material and Methods: Data from 69 patients with AAC and 415 patients with ACC between January 2007 and August 2011 were collected. Analysis and comparison of clinicopathological features and therapeutic outcomes between patients with AAC and those with ACC was performed. Results: The number of patients over 50 years of age was significantly higher in the AAC group compared with the ACC group (92.8 vs. 81.7%, p = 0.023). Cerebrovascular accidents were significantly more frequent in patients with AAC than in those with ACC (15.9 vs. 6.7%, p = 0.016). A higher incidence of gangrenous cholecystitis was observed in the AAC group (31.2 vs. 5.6%, p = 0.001). The overall therapeutic outcomes for patients did not differ statistically between the AAC and ACC groups, irrespective of treatment modalities. The recurrence rate after nonsurgical treatment was significantly lower in the AAC group than in the ACC group (2.7 vs. 23.2%, p = 0.005). Conclusions: The risk of AAC increases in patients with advanced age and cerebrovascular accidents. Incidence of gangrenous cholecystitis was higher in AAC compared to ACC. Nonsurgical treatments such as antibiotics alone or percutaneous cholecystostomy might be effective in selected patients.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Therapeutic Outcomes of Acute Acalculous Cholecystitis

Kim

Song

et al. 2014

Digestion

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“…In one large single center report, 36 of 47 patients (77%) identified over a seven-year period developed symptoms at home without evidence of acute illness or trauma 7 . This is in keeping with our patients' presentations.…”

Section: Discussionmentioning

confidence: 99%

Acalculous cholecystitis: Three Case Reports

Mungazi¹,

Mungani²

2017

East. Cent. Afr. J. Surg.

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Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder. Whilst acalculous cholecystitis accounts for approximately 10 percent of acute cholecystitis cases it is associated with a high morbidity and mortality.The condition rapidly progresses to complications such as gangrene, perforation and empyema of the gallbladder. Gangrenous cholecystitis is the most severe form and complication of acute cholecystitis. Acute acalculous cholecystitis warrants urgent surgical intervention to prevent catastrophic outcomes. We report a series of three patients that we managed for acute acalculous cholecystitis. The first patient was a 65-year-old, male who was positive of Human Immunodeficiency Virus (HIV) with a CD4 count of 165 cells/mm 3 and was on antiretroviral treatment. The second patient was a 73-year-old male with no comorbidities. The last patient was a 72-year-old female with congestive cardiac failure due to hypertension. One patient had a successful laparoscopic cholecystectomy and the other two had open cholecystectomies. Two of the patients did well and were discharged whilst the third patient died in intensive care unit day 2 postoperatively. All the three patients had no evidence of gallbladder stones. Two of the histology reports confirmed acalculous gangrenous cholecystitis and the third histology showed acalculous haemorrhagic cholecystitis. Acalculous cholecystitis is a surgical emergency. Once suspected, principles of management include resuscitation, hospital admission, broad spectrum antibiotics, adequate analgesia and emergency surgery.

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“…[4][5][6][7][8][9][10] It is clinically indistinguishable from acute calculous cholecystitis and the findings of right upper quadrant pain, fever, leukocytosis and abnormal liver function tests are non-specific clinical findings of AAC. Critically ill patients are more susceptible to developing AAC, but trauma is a well-known risk factor.…”

Section: Discussionmentioning

confidence: 99%