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Ishii S, Hosoda J, Iguchi K, Fukui K, Hibi K. A case of acute acalculous cholecystitis after pulmonary vein isolation-novel phenotype of perioesophageal vagal nerve injury: a case report. Eur Heart J Case Rep 2025; 9:ytaf204. [PMID: 40351453 PMCID: PMC12063096 DOI: 10.1093/ehjcr/ytaf204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 02/18/2025] [Accepted: 04/22/2025] [Indexed: 05/14/2025]
Abstract
Background Perioesophageal vagal nerve injury related to pulmonary vein isolation using radiofrequency catheter ablation sometimes causes somatic symptoms including gastric dilation and motility disorder. However, reports of acute acalculous cholecystitis after pulmonary vein isolation are rare. Case summary We report a case of a 64-year-old man diagnosed with paroxysmal atrial fibrillation. No acute complications occurred on the day of the procedure, but he complained of epigastric pain 27 h after the ablation procedure. He was diagnosed with mild acute acalculous cholecystitis and underwent laparoscopic cholecystectomy. Discussion Vagal nerve injury appears to be related to the development of acute acalculous cholecystitis because many patients with acute cholecystitis after abdominal surgery along with resection of vagal nerve have acute acalculous cholecystitis. We speculate that acute acalculous cholecystitis after pulmonary vein isolation is one phenotype of perioesophageal vagal nerve injury.
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Affiliation(s)
- Satoshi Ishii
- Department of Cardiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Junya Hosoda
- Department of Cardiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Kohei Iguchi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama 236-0051, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama 236-0051, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Gonzalez-Gil A, Gomez-Ruiz ÁJ, Gonzalez-Pérez C, Gil-Gomez E, Olivares-Ripoll V, Martinez J, Barceló F, Cascales-Campos PA. Systematic Cholecystectomy During Cytoreductive Surgery Plus HIPEC: A Critical Analysis of an Empirical Tradition. Ann Surg Oncol 2024; 31:7157-7164. [PMID: 39060691 PMCID: PMC11413086 DOI: 10.1245/s10434-024-15863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Some procedures performed during cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) are based on empirical data. One of these procedures is systematic cholecystectomy. This study aimed to perform a critical analysis of the need for systematic cholecystectomy during CRS+HIPEC of patients with peritoneal carcinomatosis using long-term follow-up data. METHODS Patients with peritoneal surface malignancies who were candidates for CRS+HIPEC and underwent surgery between January 2008 and December 2022 were analyzed. For patients with gallbladder involvement due to the disease or for patients whose preoperative study showed the presence of cholelithiasis, cholecystectomy was performed as part of the surgery, which was avoided for the remaining patients. All postoperative adverse events that occurred in the first 90 days were recorded, and clinical records focused on the development of biliary pathology during the follow-up period were studied. RESULTS The results from a consecutive series of 443 patients with peritoneal surface malignancies who underwent surgery between January 2008 and December 2022 were analyzed. The average age of the cohort was 50 years. The median follow-up period for the cohort was 41 months (range, 12-180 months), with a disease-free survival of 17 months. For 373 of the patients, CRS+HIPEC was completed without an associated cholecystectomy, and in 16 of them, the appearance of cholelithiasis was detected during the follow-up period. Only two patients in the series showed complications derived from gallstones and required a delayed cholecystectomy. CONCLUSIONS Although cholecystectomy is a safe procedure in the context of CRS+HIPEC, it is not risk free, and its routine performance may be unnecessary.
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Affiliation(s)
- Alida Gonzalez-Gil
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Álvaro Jesús Gomez-Ruiz
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Gonzalez-Pérez
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Elena Gil-Gomez
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Vicente Olivares-Ripoll
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jerónimo Martinez
- Departamento de Oncología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Barceló
- Departamento de Ginecología y Obstetricia, Unidad de Ginecología Oncológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pedro Antonio Cascales-Campos
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
- Servicio de Cirugía y Aparato Digestivo- Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
- Departamento de Cirugía, Universidad de Murcia, Murcia, Spain.
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Liu H, Liu J, Xu W, Chen X. Prophylactic cholecystectomy: A valuable treatment strategy for cholecystolithiasis after gastric cancer surgery. Front Oncol 2022; 12:897853. [PMID: 36176409 PMCID: PMC9513465 DOI: 10.3389/fonc.2022.897853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The main treatment for gastric cancer is surgical excision. Gallstones are one of the common postoperative complications of gastric cancer. To avoid the adverse effects of gallstone formation after gastric cancer surgery, we reviewed the causes and risk factors and mechanisms involved in gallstone formation after gastric cancer surgery. The evidence and value regarding prophylactic cholecystectomy (PC) during gastric cancer surgery was also reviewed. Based on previous evidence, we summarized the mechanism and believe that injury or resection of the vagus nerve or changes in intestinal hormone secretion can lead to physiological dysfunction of the gallbladder and Oddi sphincter, and the lithogenic components in the bile are also changed, ultimately leading to CL. Previous studies also have identified many independent risk factors for CL after gastric cancer, such as type of gastrectomy, reconstruction of the digestive tract, degree of lymph node dissection, weight, liver function, sex, age, diabetes and gallbladder volume are closely related to CL development. At present, there are no uniform guidelines for the selection of treatment strategies. As a new treatment strategy, PC has undeniable advantages and is expected to become the standard treatment for CL after gastric cancer in the future. The individualized PC strategy for CL after gastric cancer is the main direction of future research.
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Affiliation(s)
- Haipeng Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jie Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Xu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiao Chen
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
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Saragò M, Fiore D, De Rosa S, Amaddeo A, Pulitanò L, Bozzarello C, Iannello AM, Sammarco G, Indolfi C, Rizzuto A. Acute acalculous cholecystitis and cardiovascular disease, which came first? After two hundred years still the classic chicken and eggs debate: A review of literature. Ann Med Surg (Lond) 2022; 78:103668. [PMID: 35734727 PMCID: PMC9206910 DOI: 10.1016/j.amsu.2022.103668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
The existence of a close association between disease of the biliary tract and disease of the heart is known from the mists of time. Acute acalculous cholecystitis (AAC) can be defined as an acute necro inflammatory disease of the gallbladder in the absence of cholelithiasis. AAC is a challenging diagnosis. The atypical clinical onset associated to a paucity and similarity of symptoms and to laboratory data mimicking cardiovascular disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC has commonly a fulminant course compared to calculous cholecystitis and it is often associated with gangrene, perforation and empyema as well as considerable morbidity and mortality (up 50%). Early diagnosis is crucial to a prompt treatment in order to avoid complications and to increase survivability. Even today, although scientific evidence dating two hundred years has shown a close association between AAC and CVD, due to the lack of RCT, there is still a lot of confusion regarding the relationship and consequently the clinical management AAC and CVD. In addition, emergency physicians are not always familiar with transient ECG changes with AAC. The aim of this review was to provide evidence regarding epidemiology, pathophysiology, clinical presentation and treatment of the complex association between AAC and CVD. Our main findings indicate that AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA (Acute myocardial infarction) could be related to a misdiagnosed AAC. US – Ultrasonography-plays a key role in the early diagnosis and also in the follow up of AAC. Cholecystostomy and cholecystectomy as unique or sequential represent the two prevailing treatment options for AAC.
AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA could be related to a misdiagnosed AAC. Cholecystectomy is an only definitive treatment for AAC. The first report on this theme after 20 years.
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Kamei J, Kuriyama A, Shimamoto T, Komiya T. Incidence and risk factors of acute cholecystitis after cardiovascular surgery. Gen Thorac Cardiovasc Surg 2021; 70:611-618. [PMID: 34846684 DOI: 10.1007/s11748-021-01751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Acute cholecystitis is a complication in critically ill patients. However, a few studies have described its incidence, risk factors, and mortality in patients who underwent cardiovascular surgery. We investigated the incidence, perioperative predictors, and clinical features of acute cholecystitis after cardiovascular surgery. METHODS This retrospective cohort study examined 7013 patients who underwent cardiovascular surgery between October 2000 and March 2019 at a tertiary care hospital. We collected preoperative, intraoperative, and postoperative data from our database and electronic medical records. The primary outcome was the incidence of postoperative cholecystitis until hospital discharge. A multivariable logistic regression analysis to estimate perioperative predictors of acute cholecystitis was conducted. We described the clinical characteristics of patients complicated with acute cholecystitis. RESULTS Among the 7013 patients, 51 (0.7%) developed acute cholecystitis. Logistic regression analysis found that circulatory arrest (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.04-3.74; P = 0.037) and intraoperative massive transfusion (OR 2.03; 95% CI 1.03-4.01; P = 0.041) were associated with the incidences of cholecystitis. In-hospital mortality was significantly higher in the cholecystitis group than in the non-cholecystitis group (13.7% vs 3.9%, P = 0.004). Aortic disease was more frequent in the cholecystitis group (54.9% vs 38.6%, P = 0.021). The median time of acute cholecystitis onset from surgery was 12.5 days (interquartile range 7.0-27.75). Twenty-six patients (51.0%) developed asymptomatic cholecystitis. CONCLUSIONS Approximately 1% of patients who underwent cardiovascular surgery developed postoperative cholecystitis; half of them were asymptomatic. Since cholecystitis is associated with high mortality, it is a complication after cardiovascular surgery that needs to be considered.
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Affiliation(s)
- Jun Kamei
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
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Yao Z, Tian W, Xu X, Zhao R, Zhao Y. Compared With a Nasointestinal Route, Pre-operative Enteral Nutrition via a Nasogastric Tube Reduced the Incidence of Acalculous Acute Cholecystitis After Definitive Surgery for Small Intestinal Fistula. Front Med (Lausanne) 2021; 8:721402. [PMID: 34485348 PMCID: PMC8415823 DOI: 10.3389/fmed.2021.721402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose: This study aimed to investigate the difference in the efficacy of pre-operative enteral nutrition (EN) via a nasogastric tube (NGT) and pre-operative EN via a nasointestinal tube (NIT) in reducing the incidence of post-operative acalculous acute cholecystitis (AAC) after definitive surgery (DS) for small intestinal fistulas. Methods: Patients with a small intestinal fistula, who had a DS for the disease between January 2015 and March 2021, were enrolled in this study. They were divided into the NIT group and the NGT group based on the pre-operative routes of feeding they received. The clinical characteristics of the two groups were analyzed, and the incidences of post-operative AAC in the two groups were evaluated. Results: A total of 200 patients were enrolled in the study, 85 in the NGT group and 115 in the NIT group. Thirty-one patients developed post-operative AAC (8 in the NGT group and 23 in the NIT group). The incidence of post-operative AAC was 15.5%. EN via the NGT route was associated with a reduction in the incidence of post-operative AAC (adjusted HR = 0.359; 95% CI: 0.139-0.931; P = 0.035). Conclusion: Pre-operative EN via the NGT may reduce the incidence of post-operative AAC in patients who received a DS for small intestinal fistulas.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
- Department of General Surgery, Jinling Hospital, Nanjing, China
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Thampy R, Khan A, Zaki IH, Wei W, Korivi BR, Staerkel G, Bathala TK. Acute Acalculous Cholecystitis in Hospitalized Patients With Hematologic Malignancies and Prognostic Importance of Gallbladder Ultrasound Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:51-61. [PMID: 29708270 PMCID: PMC6207468 DOI: 10.1002/jum.14660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Patients with hematologic malignancies, especially those with acute disease or those receiving intense chemotherapy, are known to develop acute acalculous cholecystitis (AAC). The aim of this study was to evaluate the diagnostic and prognostic value of the established ultrasound (US) diagnostic criteria for AAC in patients with acute hematologic malignancies who were clinically suspected to have AAC. METHODS We retrospectively studied the US findings of the gallbladder in patients with hematologic malignancies and correlated these findings with the duration of clinical symptoms, complications, and gallbladder-specific mortality. The major criteria were a 3.5-mm or thicker wall, pericholecystic fluid, intramural gas, and a sloughed mucosal membrane. The minor criteria were echogenic bile and hydrops (gallbladder distension > 4 cm). Ultrasound findings were considered positive if they included 2 major criteria or 1 major and 2 minor criteria. RESULTS Ninety-four (25.5%) of 368 patients with hematologic malignancies had clinical signs of AAC during their acute phase of illness or during intense chemotherapy. Forty-three (45.7%) of these 94 patients had AAC-positive test results based on US criteria. The mean duration of symptoms was significantly longer (7.8 days) in this group than among the patients with negative test results (3.9 days; P < .001). Patients with positive test results had a higher rate of complications or mortality (20.9%) than those with negative test results (0%; P < .001). CONCLUSIONS Symptomatic patients who meet the US criteria for the diagnosis of AAC have a poor prognosis. Other patients require a close follow-up US examination within 1 week to detect early progression.
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Affiliation(s)
- Rajesh Thampy
- The University of Texas Health Science Center at Houston, Department of Diagnostic Imaging, 6431 Fannin Street, MSB 2.010A, Houston, Texas 77030, Telephone:713-500-7488
| | - Ahmad Khan
- Michael E. DeBakey VA Medical Center, Department of Radiology, 2002 Holcombe Blvd., Houston, Texas 77030, Telephone: 713-791-1414
| | - Islam H. Zaki
- Urology and Nephrology Center, Mansoura University, Egypt. Gomhoria Street, Urology and Nephrology Center, Mansoura, PO Box: 35516, Egypt, Telephone: +20 (50) 2202222
| | - Wei Wei
- The University of Texas MD Anderson Cancer Center, Department of Biostatistics, 1515 Holcombe Blvd., Unit 1411, Houston, TX, 77030, Telephone: 713-563-4281
| | - Brinda Rao Korivi
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Division of Diagnostic Imaging, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030, USA, Telephone: 713-563-8868
| | - Greg Staerkel
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Anatomical, 1515 Holcombe Blvd., Unit 0053, Houston, TX, 77030, USA, Telephone: 713-794-5625
| | - Tharakeswara K. Bathala
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Division of Diagnostic Imaging, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030, USA, Telephone: 713-792-2533
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Kimura J, Kunisaki C, Takagawa R, Makino H, Ueda M, Ota M, Oba M, Kosaka T, Akiyama H, Endo I. Is Routine Prophylactic Cholecystectomy Necessary During Gastrectomy for Gastric Cancer? World J Surg 2016; 41:1047-1053. [PMID: 27896408 DOI: 10.1007/s00268-016-3831-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Performing routine prophylactic cholecystectomy during gastrectomy in gastric cancer patients has been controversial. The frequency of cholelithiasis, cholecystitis, and cholangitis after gastrectomy has not been reported for large patient populations, so we carried out this retrospective study to aid the assessment of the necessity for prophylactic cholecystectomy. METHODS This retrospective study reviewed 969 patients with gastric cancer who underwent distal gastrectomies with Billroth I reconstructions (DG) or total gastrectomies with Roux-en-Y reconstructions (TG), preserving the gallbladder, between January 2000 and May 2012. Risk factors for cholelithiasis, cholecystitis, and cholangitis after gastrectomy were evaluated using logistic regression analysis. RESULTS The median follow-up period after gastrectomy was 48 months (range 12-159 months). After gastrectomy, cholelithiasis occurred in 6.1% (59/969) patients and cholecystitis and/or cholangitis occurred in 1.2% (12/969) patients. The method used for gastrectomy was an independent risk factor for both cholelithiasis (TG/DG: OR (95%CI): 1.900 (1.114-3.240), p = 0.018) and cholecystitis and/or cholangitis (TG/DG: OR (95%CI): 8.325 (1.814-38.197), p = 0.006). In patients who developed cholelithiasis, the incidence of cholecystitis and/or cholangitis was 31.3% (10/32) after TG, but only 7.4% after DG. CONCLUSIONS Prophylactic cholecystectomy may be unnecessary in distal gastrectomy with Billroth I reconstruction.
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Affiliation(s)
- Jun Kimura
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryo Takagawa
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hirochika Makino
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Michio Ueda
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mari Oba
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kosaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Yokoyama H, Hara H, Ogawa T, Ishizuka O. Acute cholecystitis after urological surgery: A report of 11 cases in our department and a review of the literature. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815603600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Postoperative acute cholecystitis (PAC) after gastrointestinal surgery is considered to be a relatively common complication. However, PAC after urological surgery is extremely rare. Patients and methods: We conducted a retrospective review of 2583 patients who underwent urological surgery in our department from 2006 to 2014 to identify those who developed acute cholecystitis in the postoperative period. Results: Of the 2583 patients, 11 (0.4%) were diagnosed with PAC. The study population consisted of 10 (91%) men and one (9%) woman. Among them, five (45%) patients had acalculous cholecystitis. The median interval between the preceding urological surgery and the onset of PAC was 16 days (range, 3–39 days). Emergent cholecystectomy and/or gallbladder drainage was performed in eight (73%) cases. Although four (36%) patients developed septic shock and were treated in the intensive care unit, cholecystitis improved in all cases. One patient died of her underlying disease (adrenal cancer) two months after PAC. Conclusion: Most routinely performed urological surgeries can cause PAC. The symptoms of PAC may be masked in the postoperative period. Urologists must be aware of PAC and should not hesitate to perform further inspection and consultation with a gastroenterologist in cases in which it is suspected.
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Affiliation(s)
- Hitoshi Yokoyama
- Department of Urology, School of Medicine Shinshu University, Japan
| | - Hiroaki Hara
- Department of Urology, School of Medicine Shinshu University, Japan
| | - Teruyuki Ogawa
- Department of Urology, School of Medicine Shinshu University, Japan
| | - Osamu Ishizuka
- Department of Urology, School of Medicine Shinshu University, Japan
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Cholecystectomy after breast reconstruction with a pedicled autologous tram flap. Types of surgical access. Wideochir Inne Tech Maloinwazyjne 2014; 9:473-8. [PMID: 25337177 PMCID: PMC4198638 DOI: 10.5114/wiitm.2014.43081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
The number of breast reconstruction procedures has been increasing in recent years. One of the suggested treatment methods is breast reconstruction with a pedicled skin and muscle TRAM flap (transverse rectus abdominis muscle – TRAM). Surgical incisions performed during a cholecystectomy procedure may be located in the areas significant for flap survival. The aim of this paper is to present anatomical changes in abdominal walls secondary to pedicled skin and muscle (TRAM) flap breast reconstruction, which influence the planned access in cholecystectomy procedures. The authors present 2 cases of cholecystectomy performed due to cholelithiasis in female patients with a history of TRAM flap breast reconstruction procedures. The first patient underwent a traditional method of surgery 14 days after the reconstruction due to acute cholecystitis. The second patient underwent a laparoscopy due to cholelithiasis 7 years after the TRAM procedure. In both cases an abdominal ultrasound scan was performed prior to the operation, and surgical access was determined following consultation with a plastic surgeon. The patient who had undergone traditional cholecystectomy developed an infection of the postoperative wound. The wound was treated with antibiotics, vacuum therapy and skin grafting. After 7 weeks complete postoperative wound healing and correct healing of the TRAM flap were achieved. The patient who had undergone laparoscopy was discharged home on the second postoperative day without any complications. In order to plan a safe surgical access, it is necessary to know the changes in the anatomy of abdominal walls following a pedicled TRAM flap breast reconstruction procedure.
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11
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Tsuboi I, Hayashi M, Miyauchi Y, Iwasaki YK, Yodogawa K, Hayashi H, Uetake S, Takahashi K, Shimizu W. Anatomical factors associated with periesophageal vagus nerve injury after catheter ablation of atrial fibrillation. J NIPPON MED SCH 2014; 81:248-57. [PMID: 25186578 DOI: 10.1272/jnms.81.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The periesophageal vagus nerve plexus controls the kinetics of the stomach, digestive tract, and gallbladder, and catheter ablation of atrial fibrillation (AF) can cause vagus nerve injury (VNI). We sought to clarify the incidence, clinical course, and anatomical factors related to periesophageal VNI. METHODS The present study included 257 consecutive patients with AF (mean age, 62±11 years) who underwent catheter-based pulmonary vein isolation. With 64-slice computed tomographic images, the left atrium (LA)-esophageal contact length, LA diameter, and distances between each mediastinal structure were compared between patients with VNI and those without VNI. RESULTS VNI occurred in 5 patients (1.9%), gastric hypomotility in 3 patients, and acalculous cholecystitis in 2 patients, within 3 days after ablation, and all patients recovered completely within 2 weeks. Compared with patients without VNI, those with VNI more frequently underwent ablation at the mitral isthmus (p=0.03) and inside the coronary sinus (p=0.03). On computed tomographic images, the esophagus was closer to the aorta than to the spine in 67% of patients and was defined as an aorta-sided esophagus. In patients with VNI, the distance from the LA to the spine or the descending aorta (in patients with an aorta-sided esophagus) was shorter (p=0.03), and the transverse LA-esophageal contact length was longer (p=0.01). CONCLUSION Acalculous cholecystitis, as well as gastric hypomotility, can develop as a result of periesophageal VNI in patients undergoing AF ablation. The anatomical relationships among the LA, esophagus, spine, and descending aorta may influence the occurrence of VNI.
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Affiliation(s)
- Ippei Tsuboi
- Department of Cardiovascular Medicine, Nippon Medical School
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12
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Liu FL, Li H, Wang XF, Shen KT, Shen ZB, Sun YH, Qin XY. Acute acalculous cholecystitis immediately after gastric operation: Case report and literatures review. World J Gastroenterol 2014; 20:10642-10650. [PMID: 25132787 PMCID: PMC4130878 DOI: 10.3748/wjg.v20.i30.10642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare complication of gastric surgery. The most commonly accepted concepts regarding its pathogenesis are bile stasis, sepsis and ischemia, but it has not been well described how to identify and manage this disease in the early stage. We report three cases of AAC in elderly patients immediately after gastric surgery, which were treated with three different strategies. One patient died 42 d after emergency cholecystectomy, and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage, respectively. These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery. We further reviewed reported cases of AAC immediately after gastric operation, which may expand our knowledge of this disease.
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13
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An SB, Yim J, Kim E, Shin JH, Park SY, Lee SC. Acute cholecystitis developed immediately after thoracic kyphoplasty -A case report-. Korean J Anesthesiol 2012; 63:266-9. [PMID: 23060986 PMCID: PMC3460158 DOI: 10.4097/kjae.2012.63.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/05/2022] Open
Abstract
Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment.
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Affiliation(s)
- Sang-Bum An
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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14
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Crichlow L, Walcott-Sapp S, Major J, Jaffe B, Bellows CF. Acute Acalculous Cholecystitis after Gastrointestinal Surgery. Am Surg 2012. [DOI: 10.1177/000313481207800242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute acalculous cholecystitis has been identified as a rare but potentially devastating entity after trauma, and burns, as well as in critically ill patients, and in the postoperative period. Gastrointestinal surgery is most frequently implicated in postoperative acute acalculous cholecystitis, especially after gastric and colorectal procedures. Review of the English literature identified 28 articles reporting 76 cases of acute acalculous cholecystitis after gastrointestinal operations, which included a case from Tulane University Medical Center of a 64-year-old man who developed postoperative acute acalculous cholecystitis after elective left hemicolectomy. A total of 52.4 per cent of the patients developed gangrenous acute acalculous cholecystitis, with a mortality rate of 21.1 per cent, much higher than that reported in postoperative calculous cholecystitis. This emphasizes the need for a high level of suspicion and early detection in the postoperative period to avoid devastating consequences.
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Affiliation(s)
- Lya Crichlow
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | | | - Joshua Major
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Bernard Jaffe
- Department of Surgery, Tulane University, New Orleans, Louisiana
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15
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Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 2010; 8:15-22. [PMID: 19747982 DOI: 10.1016/j.cgh.2009.08.034] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/14/2009] [Accepted: 08/19/2009] [Indexed: 02/07/2023]
Abstract
Although recognized for more than 150 years, acute acalculous cholecystitis (AAC) remains an elusive diagnosis. This is likely because of the complex clinical setting in which this entity develops, the lack of large prospective controlled trials that evaluate various diagnostic modalities, and thus dependence on a small data base for clinical decision making. AAC most often occurs in critically ill patients, especially related to trauma, surgery, shock, burns, sepsis, total parenteral nutrition, and/or prolonged fasting. Clinically, AAC is difficult to diagnose because the findings of right upper-quadrant pain, fever, leukocytosis, and abnormal liver tests are not specific. AAC is associated with a high mortality, but early diagnosis and intervention can change this. Early diagnosis is the crux of debate surrounding AAC, and it usually rests with imaging modalities. There are no specific criteria to diagnose AAC. Therefore, this review discusses the imaging methods most likely to arrive at an early and accurate diagnosis despite the complexities of the radiologic modalities. A pragmatic approach is vital. A timely diagnosis will depend on a high index of suspicion in the appropriate patient, and the combined results of clinical findings (admittedly nonspecific), plus properly interpreted imaging. Sonogram (often sequential) and hepatic iminodiacetic acid scans are the most reliable modalities for diagnosis. It is generally agreed that cholecystectomy is the definitive therapy for AAC. However, at times a diagnostic/therapeutic drainage via interventional radiology/surgery may be necessary and life-saving, and may be the only treatment needed.
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Affiliation(s)
- Jason L Huffman
- Department of Internal Medicine, Division of Gastroenterology and Nutrition, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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16
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Javidi D, Shafa M. Cholecystitis and its Risk Factors among Patients Undergoing Coronary Artery Bypass Grafting. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.233.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Yasuda H, Takada T, Kawarada Y, Nimura Y, Hirata K, Kimura Y, Wada K, Miura F, Hirota M, Mayumi T, Yoshida M, Nagino M, Yamashita Y, Hilvano SC, Kim SW. Unusual cases of acute cholecystitis and cholangitis: Tokyo Guidelines. JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2007; 14:98-113. [PMID: 17252303 PMCID: PMC2784504 DOI: 10.1007/s00534-006-1162-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/14/2022]
Abstract
Unusual cases of acute cholecystitis and cholangitis include (1) pediatric biliary tract infections, (2) geriatric biliary tract infections, (3) acalculous cholecystitis, (4) acute and intrahepatic cholangitis accompanying hepatolithiasis (5) acute biliary tract infection accompanying malignant pancreatic-biliary tumor, (6) postoperative biliary tract infection, (7) acute biliary tract infection accompanying congenital biliary dilatation and pancreaticobiliary maljunction, and (8) primary sclerosing cholangitis. Pediatric biliary tract infection is characterized by great differences in causes from those of adult acute biliary tract infection, and severe cases should be immediately referred to a specialist pediatric surgical unit. Because biliary tract infection in elderly patients, who often have serious systemic conditions and complications, is likely to progress to a serious form, early surgery or biliary drainage is necessary. Acalculous cholangitis, which often occurs in patients with serious concomitant conditions, such as those in intensive care units (ICUs) and those with disturbed cardiac, pulmonary, and nephric function, has a high mortality and poor prognosis. Cholangitis accompanying hepatolithiasis includes recurrent pyogenic cholangitis, an epidemic disease in Southeast Asia. Biliary tract infections, which often occur after a biliary tract operation and treatment of the biliary tract, may have a fatal outcome, and should be carefully observed. The causes of acute cholangitis associated with pancreaticobiliary maljunction differ before and after operation. Direct cholangiography is most useful in the diagnosis of primary sclerosing cholangitis. If cholangiography visualizes a typical bile duct, differentiation from acute pyogenic cholangitis is easy. This article discusses the individual characteristics, diagnostic criteria, treatment guidelines, and prognosis of these unusual types of biliary tract infection.
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Affiliation(s)
- Hideki Yasuda
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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18
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Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. ACTA ACUST UNITED AC 2007; 14:15-26. [PMID: 17252293 PMCID: PMC2784509 DOI: 10.1007/s00534-006-1152-y] [Citation(s) in RCA: 292] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/06/2006] [Indexed: 12/11/2022]
Abstract
This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.
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Affiliation(s)
- Yasutoshi Kimura
- First Department of Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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19
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Cadot H, Addis MD, Fames PL, Carroccio A, Burks JA, Gravereaux EC, Morrissey NJ, Teodorescu V, Sparacino S, Hollier LH, Marin ML. Abdominal Aortic Aneurysmorrhaphy and Cholelithiasis in the Era of Endovascular Surgery. Am Surg 2002. [DOI: 10.1177/000313480206801001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The incidence of acute cholecystitis complicating standard abdominal aortic aneurysm (AAA) repair has been reported between 0.3 and 18 per cent This has prompted considerable debate regarding the management of cholelithiasis discovered incidentally during open aortic reconstruction. This study seeks to determine the incidence of cholelithiasis and acute cholecystitis after endovascular AAA repair and evaluate options for management. Between February 1996 and October 2001 492 patients underwent endovascular AAA repair. All the procedures were performed in the operating room under fluoroscopic guidance. Epidural (98.9%), local (0.5%), or general (1.7%) anesthesia was used during these cases. The incidence of cholelithiasis and acute cholecystitis was evaluated by CT scan and abdominal ultrasound. Serum measurements of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total and direct bilirubin, and amylase were performed and clinical assessment was conducted at 1, 6, and 12 months postoperatively and annually thereafter. The mean age of these patients was 76.6 years; 84% were male. Comorbid medical conditions were present in all patients (average 3.5 conditions/patient). Follow-up ranged from 2 to 35 months (mean 12.8 months). Endovascular stent graft deployment was successful in 486 of the 492 patients (98.8%). Six patients were converted to standard open repair because of inability to achieve successful endovascular aneurysm repair. The perioperative major morbidity rate was 14.9 per cent. Minor morbidity rate was 8.5 per cent. The perioperative mortality rate was 1.9 per cent. No deaths were related to biliary disease. Cholelithiasis was identified in 64 (13%) patients preoperatively. One of 64 patients with a prior Billroth II reconstruction for peptic ulcer disease developed jaundice 8 days after AAA repair as a result of choledocholithiasis that required surgical repair. One patient without gallstones developed acute acalculous cholecystitis on postoperative day 16 as determined on pathologic analysis of the gallbladder. A third patient who had gallstones identified on preoperative CT scan developed calculous cholecystitis 16 months after endovascular AAA repair. These two patients underwent uncomplicated laparoscopic cholecystectomy and recovered uneventfully. The incidence of postoperative symptomatic cholelithiasis is 1.6 per cent (one of 64). The incidence of postoperative acute cholecystitis was 0.2 per cent (one of 486) and was unrelated to the presence of gallstones. The incidence of delayed symptomatic cholelithiasis was 1.6 per cent (one of 64). Endovascular repair of AAA does not appear to predispose the patient to the development of symptomatic cholelithiasis during the perioperative period. Therefore a preoperative or intraoperative diagnosis of cholelithiasis does not necessitate cholecystectomy in the setting of planned endovascular AAA repair. Patients who develop cholecystitis after endovascular AAA repair may be effectively treated by standard laparoscopic techniques.
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Affiliation(s)
- Hadley Cadot
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Michael D. Addis
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Peter L. Fames
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Alfio Carroccio
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - James A. Burks
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Edwin C. Gravereaux
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Nicholas J. Morrissey
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Victoria Teodorescu
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Salvatore Sparacino
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Larry H. Hollier
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
| | - Michael L. Marin
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, New York
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20
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Paull DE. Acute Cholecystitis in the Immediate Postoperative Period following Esophagogastrectomy. Am Surg 2001. [DOI: 10.1177/000313480106700121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Postoperative acute cholecystitis (PAC) occurs after 0.06 per cent of all operations. However, PAC may occur in up to 3.1 per cent of patients after gastrectomy. This increased incidence of PAC is due to bile stasis and gall bladder ischemia promoted by vagotomy and gastrohepatic ligament dissection during gastrectomy. Despite similar factors during esophagogastrectomy PAC is rarely reported in large American series of patients undergoing esophagogastrectomy. We report two cases of PAC occurring after esophagogastrectomy.
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Affiliation(s)
- Douglas E. Paull
- From the Department of Surgery, Wilkes-Barre General Hospital, Wilkes-Barre, Pennsylvania
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Abstract
Acute acalculous cholecystitis (AAC) is a dangerous complication of medical and surgical illnesses, and it is most commonly encountered in the intensive care setting. Although uncommon, recent reports have indicated an increasing incidence. AAC occurs most often following major trauma or nonbiliary surgical procedures, but it may be seen in conjunction with avariety ofmedical illnessesaswell. Transfusion, narcotics, mechanical ventilation, total parented nutrition, and sepsis have been associated with AAC, but it is likely that ischemic injury to the gallbladder is the most important pathogenetic factor. Primary infection of the biliary tract is not an important factor in the development of AAC, except in the acquired immunodeficiency syndrome. The incidence of gangrene and perforation is high in AAC in contrast to acute calculous choleqstitis. The clinical presentation may be highly variable; thus, a high index of suspicion is required for diagnosis. Fever, leukocytosis, and right upper quadrant tenderness are the most common findings. Early ultrasonography is appropriate when AAC is suspected, although computed tomography and cholescintigraphy may be useful in selected patients. Delay in diagnosis longer than 48 hours is associated with a perforation rate of 40%. Urgent cholecystectomy is the preferred treatment, but percutaneous cholecystostomy is an acceptable alternative in patients unable to withstand surgery.
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Affiliation(s)
- David T. Walden
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
| | - Fernando Urrutia
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
| | - Roger D. Soloway
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
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Imhof M, Raunest J, Ohmann C, Röher HD. Acute acalculous cholecystitis complicating trauma: a prospective sonographic study. World J Surg 1992; 16:1160-5; discussion 1166. [PMID: 1455890 DOI: 10.1007/bf02067089] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (> 3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow-up of this complication.
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Affiliation(s)
- M Imhof
- Department of General and Trauma Surgery, Heinrich-Heine-University, Düsseldorf, Federal Republic of Germany
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