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Gluhovschi C, Gadalean F, Velciov S, Petrica L, Duta C, Botoca M, Cipu D. Acute Acalculous Cholecystitis Associated with Abscesses-An Unknown Dual Pathology. Biomedicines 2023; 11:biomedicines11020632. [PMID: 36831168 PMCID: PMC9953605 DOI: 10.3390/biomedicines11020632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/-16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis.
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Affiliation(s)
- Cristina Gluhovschi
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Correspondence: or
| | - Florica Gadalean
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Silvia Velciov
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ligia Petrica
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ciprian Duta
- Department X Surgery II, Division of Surgery II, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Mircea Botoca
- Department XV Orthopedics-Traumatology, Urology, Radiology and Medical Imaging, Division of Urology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Daniela Cipu
- Department XV Orthopedics-Traumatology, Urology, Radiology and Medical Imaging, Division of Radiology and Medical Imaging, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
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Bhuvaneswari S, Aakash VB, Ramalakshmi N, Arunkumar S. Quantitative Structure–Activity Relationship Analysis and Validation of New DNA Gyrase Inhibitors. Pharm Chem J 2022. [DOI: 10.1007/s11094-021-02513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yasukawa K, Shimizu A, Kubota K, Notake T, Sugenoya S, Hosoda K, Hayashi H, Kobayashi R, Soejima Y. Clinical characteristics and management of acute cholecystitis after cardiovascular surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:211-220. [PMID: 33259684 DOI: 10.1002/jhbp.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to propose an optimal treatment strategy. METHODS We retrospectively reviewed the records of 88 patients who underwent cholecystectomy for grade II or III AC between 2008 and 2019 (AC after CS: Group CS, n = 37; AC without CS: Group non-CS, n = 51). RESULTS The proportion of grade III AC in Group CS was significantly higher than that in Group non-CS (73% vs 41%, P = .005). Furthermore, the incidences of acalculous (81% vs 39%) and gangrenous (86% vs 59%) AC were significantly higher in Group CS (P < .05 for both). In Group CS, 11 patients had had percutaneous drainage preceding surgery, for whom cholecystectomy within 3 days was eventually necessary because their general condition was exacerbated. The incidence of a positive culture from the gallbladder bile and blood samples of Group CS were significantly higher (P < .05 for both); multidrug-resistant bacteria were detected at an especially high rate. However, the morbidity rate was comparable, and zero mortality was achieved in both groups. CONCLUSIONS Timely surgical intervention without hesitation is recommended for AC after CS.
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Affiliation(s)
- Koya Yasukawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Shimizu
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koji Kubota
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsuyoshi Notake
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shinsuke Sugenoya
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kiyotaka Hosoda
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hikaru Hayashi
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryoichiro Kobayashi
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Clemente-Gutiérrez U, Sánchez Morales GE, Moctezuma Velazquez P, Rueda de León Aguirre A, Morales Maza J, Dominguez-Rosado I, Medina-Franco H. Acute cholecystitis in neutropenic patients. Ann Hepatobiliary Pancreat Surg 2019; 23:234-239. [PMID: 31501811 PMCID: PMC6728248 DOI: 10.14701/ahbps.2019.23.3.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 01/03/2023] Open
Abstract
Backgrounds/Aims The frequency of acute cholecystitis reported in neutropenic patients is between 0.4-1.65%. Clinical manifestations differ from general population as well as clinical approach, diagnosis and treatment. The aim of this work is to describe clinical characteristics, diagnostic approach, and outcomes of patients with hematological diseases that presented with neutropenia and fever associated with acute cholecystitis in a tertiary referral hospital. Methods We performed a retrospective analysis of patients with diagnosis of neutropenia and fever associated with acute cholecystitis in the period between January 2000 and January 2017. Quantitative variables were analyzed with mean and standard deviation, and qualitative variables with frequency and percentage. Results During the study period, 2007 patients presented with neutropenia and fever. Twelve of them (0.59%) had associated acute cholecystitis. The most common hematologic disease among these patients was lymphoblastic leukemia. Acute acalculous cholecystitis was diagnosed in 6 cases (50%). Eleven patients (91.6%) had a severe presentation and cholecystostomy was performed in 9 (75%) cases. The main cause of mortality was septic shock (33.3%). Conclusions Treatment of acute cholecystitis in patients with neutropenia must be individualized. Cholecystostomy should be considered as a bridge therapy for an interval cholecystectomy.
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Affiliation(s)
- Uriel Clemente-Gutiérrez
- Department of Surgery, National Institute of Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Paulina Moctezuma Velazquez
- Department of Surgery, National Institute of Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Jesus Morales Maza
- Department of Surgery, National Institute of Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Department of Surgery, National Institute of Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Heriberto Medina-Franco
- Department of Surgery, National Institute of Health Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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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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Iqbal S, Khajinoori M, Mooney B. A case report of acalculous cholecystitis due to Salmonella paratyphi B. Radiol Case Rep 2018; 13:1116-1118. [PMID: 30233740 PMCID: PMC6138858 DOI: 10.1016/j.radcr.2018.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/24/2018] [Accepted: 07/08/2018] [Indexed: 12/11/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare condition occurring in only 5%-10 % of patients with acute cholecystitis. Systemic illness caused, for example, by E coli, Klebsiella pneumoniae, Vibrio cholera, and Salmonella species can result acute inflammation of gallbladder wall. It is a surgical emergency and if left untreated can lead to high mortality due to gangrene or perforation of gallbladder. We managed a 60-year-old female with clinical presentation of acute cholecystitis caused by Salmonella-induced gastroenteritis. Prompt use of radiological modalities such as computer tomography (CT scan) and ultrasound played an important role in pathologic diagnosis, overall follow up, and management of the patient.
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Affiliation(s)
- Syma Iqbal
- Barwon Health, 2 Villiers Drive Point cook, Victoria 3030, Australia
| | - Mesooma Khajinoori
- Barwon Health, Ryrie Street & Bellerine Street, Geelong, Victoria 3220, Australia
| | - Brendon Mooney
- South West Healthcare, 25 Ryot St, Warrnambool, Victoria 3280, Australia
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Hashimoto M, Koide K, Arita M, Kawaguchi K, Tokunaga M, Mikuriya Y, Iwamoto T. Acute acalculous cholecystitis due to breast cancer metastasis to the cystic duct. Surg Case Rep 2016; 2:111. [PMID: 27730536 PMCID: PMC5059227 DOI: 10.1186/s40792-016-0239-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/05/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is a relatively rare disorder of the gallbladder. Breast cancer recurrence more than 10 years after curative surgery is also infrequent. CASE PRESENTATION Here, we report a case of a 59-year-old woman who presented with right flank pain. Her medical history included a lumpectomy for cancer of the left breast 12 years prior. Laboratory tests showed a severe inflammatory reaction and mild liver function abnormalities. Ultrasonography and computed tomography revealed an enlarged gallbladder and inflammation of the surrounding tissues; however, no gallstone was present. She was diagnosed with AAC. We performed an emergency laparoscopic cholecystectomy, and histopathological examination revealed a poorly differentiated adenocarcinoma in the cystic duct. Both metastatic and primary tumor cells were positive for estrogen and progesterone receptors on immunohistochemistry. The final pathological diagnosis was acute cholecystitis due to breast cancer metastasis to the cystic duct. CONCLUSION Although AAC secondary to metastatic breast cancer is rare, it should be included in the differential diagnosis for abdominal pain in patients with a previous history of breast cancer.
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Affiliation(s)
- Masakazu Hashimoto
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
| | - Kei Koide
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Michinori Arita
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Koji Kawaguchi
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Masakazu Tokunaga
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Yoshihiro Mikuriya
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Toshiyuki Iwamoto
- Department of Pathology, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
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Abstract
Acute acalculous cholecystitis has been recognized with increasing frequency in recent years. The condition has been associated with trauma, burns, total parenteral nutrition, and unrelated surgical procedures. This report describes 3 patients who developed a particularly fulminant form of the disease following cardiovascular surgical procedures. Rapid deterioration and signs of impending cardiovascular collapse were characteristic of these patients; emergency sur gery was needed in each case. Tube cholecystostomy was performed in each case with no mortality. No patient required subsequent cholecystectomy during a mean follow-up of 4.3 years. It is concluded that the patient with cardiovascular disease may develop a more fulminant form of acute acalculous cholecystitis owing to the underlying vascular disease. Awareness of this condition and early surgical intervention with performance of tube cholecystostomy will decrease the mortality of this lethal process.
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Affiliation(s)
- George J. Todd
- Department of Surgery, Columbia University, College of Physicians and Surgeons, The Presbyterian Hospital, New York, New York
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Heyman SJ, Rinaldo JE. Multiple System Organ Failure in the Adult Respiratory Distress Syndrome. J Intensive Care Med 2016. [DOI: 10.1177/088506668900400503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Recently completed studies suggest that patients with the adult respiratory distress syndrome (ARDS) manifest early evidence of multiple-site endothelial injury. Ex trapulmonary disease is usually the cause of death in these patients. Furthermore, prognosis in individual cases of ARDS is strongly influenced by specific organ failures (e.g., hepatic and renal failure). The mechanisms by which ARDS and extrapulmonary organ system fail ure interact, however, are poorly delineated. We ad dress three aspects of the multisystemic nature of ARDS. First, we analyze evidence that suggests ARDS is a mul tisystem disorder fron the outset, involving panendothe lial injury mediated by cellular interactions and humoral substances that act similarly at many vascular target sites. Second, we discuss the role of three extrapulmo nary organs in the modulation of ARDS: the liver, the gastrointestinal mucosa, and the kidneys. Third, we ad dress the unifying hypothesis that uncontrolled ongoing inflammation, which is often but not always caused by infection, is the essential link between ARDS and its progression to multiple system organ failure.
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Affiliation(s)
- Stephen J. Heyman
- Center for Lung Research, Vanderbilt University, and the Nashville Veterans Administration Medical Center, Nashville, TN
| | - Jean E. Rinaldo
- Center for Lung Research, Vanderbilt University, and the Nashville Veterans Administration Medical Center, Nashville, TN
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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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Acute acalculous cholecystitis caused by Hepatitis C: A rare case report. Int J Surg Case Rep 2015; 19:78-81. [PMID: 26722714 PMCID: PMC4756201 DOI: 10.1016/j.ijscr.2015.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022] Open
Abstract
We present a very rare case of acute Acute acalculous cholecystitis (AAC). Hepatitis C virus infection has not been documented as a cause of Cholecystitis. Management of AAC mostly conservative, rarely need surgical intervention. Understanding pathophysiology of AAC in crucial for the management. Introduction Acute acalculous cholecystitis (AAC) is rarely encountered in clinical practice and has a high morbidity and mortality. AAC caused by viral hepatitis, with hepatitis A, B and EBV infections are rare, but well documented in the literature. Hepatitis C virus has not been reported as cause of AAC. This case report documents the first case of AAC associated with Acute Hepatitis C. Presenting concerns We present a 40 years old female with abdominal pain. She has a history of previous HCV infection. Her liver function tests were markedly deranged with elevated inflammatory markers. USS scan showed rather a very unusual appearance of an inflamed gallbladder with no gallstones and associated acute hepatitis, confirmed by an abdominal CT scan. HCV RNA PCR confirms flair up of the virus. The patient was managed conservatively in the hospital with follow up USS scan and Liver function tests showed complete recovery. Follow up HCV RNA PCR also returned to an undetectable level. The patient recovered completely with no adverse outcomes. Conclusion This case report is to the first to document the association between acute HCV and AAC. Despite being uncommon in western countries, viral hepatitis should be suspected as a causative agent of AAC, particularly when there is abnormal liver function test and no biliary obstruction.
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Tana M, Tana C, Cocco G, Iannetti G, Romano M, Schiavone C. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion. J Ultrasound 2015; 18:317-20. [PMID: 26550069 DOI: 10.1007/s40477-015-0176-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/22/2015] [Indexed: 12/20/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.
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Affiliation(s)
- Marco Tana
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy ; Internal Medicine Unit, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Claudio Tana
- Internal Medicine Unit, Guastalla Hospital, Ausl Reggio Emilia, Italy
| | - Giulio Cocco
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Iannetti
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | | | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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Gu MG, Kim TN, Song J, Nam YJ, Lee JY, Park JS. Risk factors and therapeutic outcomes of acute acalculous cholecystitis. Digestion 2015; 90:75-80. [PMID: 25196261 DOI: 10.1159/000362444] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/25/2014] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Min Geun Gu
- Yeungnam University College of Medicine, Daegu, Korea
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14
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Desautels CN, Tierney DM, Rossi F, Rosborough TK. Case report: an unrecognized etiology of transient gallbladder pain in heart failure diagnosed with internist-performed point-of-care ultrasound. Crit Ultrasound J 2015; 7:2. [PMID: 25852843 PMCID: PMC4384720 DOI: 10.1186/s13089-014-0019-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
The excellent sensitivity and specificity of right upper quadrant (RUQ) ultrasound for gallbladder pathology in patients with abdominal pain is heavily relied upon in routine diagnostic evaluation. The hour-to-hour timing of this test in a patient with fluctuating symptoms is not widely recognized as having a significant impact on its sensitivity. However, we present a case report describing the essential role of symptom-timed point-of-care ultrasound in making an elusive diagnosis of transient cholecystalgia in a patient with RUQ pain and congestive heart failure (CHF). This case also demonstrates an important etiology of RUQ pain in patients with CHF beyond that of congestive hepatopathy. A review of the related entities of acalculous cholecystitis, congestive hepatopathy, and diffuse gallbladder wall thickening is provided.
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Affiliation(s)
- Christine N Desautels
- Department of Medical Education, Abbott Northwestern Hospital, Graduate Medical Education, Mail Route #11135, 800 E. 28th Street, Minneapolis, MN 55407 USA
| | - David M Tierney
- Department of Medical Education, Abbott Northwestern Hospital, Graduate Medical Education, Mail Route #11135, 800 E. 28th Street, Minneapolis, MN 55407 USA
| | - Federico Rossi
- Minnesota Gastroenterology, 15700 37th Avenue North #300, Plymouth, MN 55446 USA
| | - Terry K Rosborough
- Department of Medical Education, Abbott Northwestern Hospital, Graduate Medical Education, Mail Route #11135, 800 E. 28th Street, Minneapolis, MN 55407 USA
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15
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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 2014; 400:421-7. [PMID: 25539703 DOI: 10.1007/s00423-014-1267-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. MATERIALS AND METHODS This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. RESULTS LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. CONCLUSIONS We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
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16
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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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Percutaneous cholecystostomy for treatment of acute cholecystitis in the era of early laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2014; 23:474-80. [PMID: 24105289 DOI: 10.1097/sle.0b013e318290142d] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute cholecystitis is a common surgical problem that is optimally managed by early laparoscopic cholecystectomy when possible. Percutaneous cholecystostomy (PC) has been used in certain high-risk cases as a bridge to surgery or for definitive therapy. The aim of this study was to determine the short-term and long-term outcomes of patients with acute cholecystitis treated by PC. STUDY DESIGN Patients with acute cholecystitis treated by PC between 2005 and 2011 in a tertiary hospital were identified from a prospectively maintained database. Outcome differences between patients with acalculous acute cholecystitis (AAC) and those with acute cholecystitis relating to gallstones were determined. RESULTS There were 32 cases from a total of 443 patients with acute cholecystitis treated by PC during the study period. The overall 30-day mortality rate after PC was 9%. There were 8 patients with AAC in this series. Ischemic heart disease and chronic renal failure were noted in 47% and 41% of patients, respectively. In all cases, patients were considered unfit for surgery. AAC was more common in male patients. In all other aspects patients with AAC had similar characteristics to those with gallstones. Patients underwent percutaneous drainage a median of 3 days after admission with a direct transperitoneal route used in 16 (75%) cases. Positive bile cultures from the gallbladder were noted in 60% of cases tested. Complications were noted in 53% of patients and were related to the cholecystostomy tube in 19% of cases. Subsequent cholecystectomy was performed in 9 (28%) patients, at a median of 73 days after initial tube insertion. No differences in morbidity and mortality were noted between patients with AAC and those with gallstones. The overall mean and 12 months survival was 43 months and 72%, respectively. Hypotension at presentation (odds ratio 9.2; 95% confidence interval, 1.4-59.8; P=0.019) and absence of bile duct filling on cholecystography (odds ratio 4.6; 95% confidence interval, 1.2-16.3; P=0.017) were independently associated with decreased survival. CONCLUSIONS PC can be performed safely in patients considered unfit for surgery at presentation. Outcomes are similar in patients with or without gallstones. Hypotension and absence of common bile duct filling on initial cholangiography are markers of decreased long-term survival. A significant number of patients require subsequent definitive cholecystectomy.
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18
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Reurings JC, Diaz RPD, Penninga L, Nellensteijn DR. Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa). BMJ Case Rep 2014; 2014:bcr-2014-203781. [PMID: 24739656 DOI: 10.1136/bcr-2014-203781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare condition normally occurring in critically ill patients. Compared to acute calculous cholecystitis, AAC is associated with complications and has a worse outcome. Hence, knowledge of this condition is very important. We describe a case of a 31-year-old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients, AAC can also occur postoperatively in outpatients. Early recognition and treatment of AAC may improve outcome.
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Abstract
Acute acalculous cholecystitis is uncommon in pediatrics and more likely to be encountered in adult patients. Signs and symptoms of acute cholecystitis are similar to other causes of acute abdominal pain such as pancreatitis, gastritis, and acute appendicitis, further making diagnosis difficult. We present a case of acute acalculous cholecystitis in a child with cystic fibrosis and discuss the role of emergency physician bedside sonography in the evaluation of right-upper-quadrant pain.
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20
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Acute acalculous cholecystitis induced by acute hepatitis B virus infection. Case Reports Hepatol 2012; 2012:132345. [PMID: 25374703 PMCID: PMC4208425 DOI: 10.1155/2012/132345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/28/2012] [Indexed: 01/05/2023] Open
Abstract
During the course of acute viral hepatitis, some functional and anatomical changes to the gallbladder can occur. Acute acalculous cholecystitis (ACC) is a rare complication of acute hepatitis B virus infection; only few cases are reported as ACC associated with acute hepatitis B virus infection. ACC cases are self-limiting, while other limited cases can progress to a gangrenous state, perforation, and even death. We present a 27-year-old female case diagnosed to have acute acalculous cholecystitis and associated with acute hepatitis B virus infection, and she recovered within one week of her presentation without complication or surgical intervention.
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Goenka U, Majumder S, Banerjee P, Kapoor N, Nandi S, Sethy PK, Goenka MK. Spontaneous perforation of acalculous gall bladder presenting as acute abdomen. J Emerg Med 2012; 43:637-640. [PMID: 20580518 DOI: 10.1016/j.jemermed.2010.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 01/06/2010] [Accepted: 04/07/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute abdominal pain is commonly encountered in the emergency department (ED), but a diagnosis of gall bladder perforation (GBP) is rarely considered in the absence of predisposing factors. OBJECTIVES This article will highlight the risk factors, diagnosis, and management of GBP, a rare but potentially life-threatening biliary pathology. CASE REPORT A 73-year-old diabetic man presented to the ED with a 12-h history of severe upper abdominal pain. He was hemodynamically stable, but abdominal examination showed distention, guarding, and diffuse tenderness. Abdominal X-ray study showed mildly distended small bowel loops without any air-fluid levels. Abdominal sonography revealed mild ascites and pericholecystic fluid collection but no gall bladder calculi. Laboratory reports documented a white blood cell count of 13,700/mm(3) and elevated serum amylase of 484 IU/L. A contrast-enhanced computed tomography (CT) scan of the abdomen suggested discontinuity of the gall bladder wall along with fluid accumulation in the pericholecystic, perihepatic, right subphrenic, and right paracolic spaces. In view of the possibility of spontaneous GBP developing as a complication of acute acalculous cholecystitis, laparotomy was planned. At surgery, several liters of bile-stained peritoneal fluid were aspirated and inspection of the gall bladder revealed a perforation at the fundus. After cholecystectomy, the patient had an uneventful recovery. CONCLUSION The diagnosis of spontaneous gall bladder perforation should be considered in elderly patients presenting to the ED with symptoms and signs of peritonitis even in the absence of pre-existing gall bladder disease. Abdominal CT scan is an invaluable tool for the diagnosis, and early surgical intervention is usually life-saving.
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Affiliation(s)
- Usha Goenka
- Department of Radiology, Apollo Gleneagles Hospital, Kolkata, India
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22
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Nikfarjam M, Manya K, Fink MA, Hadj AK, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of patients with histologically proven acute acalculous cholecystitis. ANZ J Surg 2012; 82:918-22. [PMID: 22943584 DOI: 10.1111/j.1445-2197.2012.06202.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is traditionally described in the setting of critical illness, where the diagnosis is based on clinical assessment and imaging criteria. Very few studies have assessed the features and outcomes of AAC in patients treated by cholecystectomy. METHODS Patients with histologically confirmed acute cholecystitis treated in a specialized unit in a tertiary hospital between 2005 and 2011 were identified from prospectively maintained database. Retrospective review of data was undertaken and patients with AAC were compared with those patients with acute cholecystitis and confirmed gallstones. RESULTS AAC was identified in 35 of 412 (8.5%) patients with acute cholecystitis. These patients were older (69 years versus 61 years; P = 0.004) and were more likely to be febrile (46% versus 21%; P = 0.001) and hypotensive (23% versus 5%; P < 0.001) at initial presentation. There was a higher incidence of chronic obstructive airways disease (COAD) in the AAC group (26% versus 6%; P < 0.001). Other co-morbidities were similar among the groups. Operative outcomes were similar between the groups. There were no overall differences in postoperative complications between AAC and calculous acute cholecystitis patients (17% versus 16%; P = 0.063). However, the postoperative length of stay was higher in the AAC group (5 days versus 3 days; P = 0.026). CONCLUSION AAC more commonly occurs in older patients and those with COAD. The operative outcomes and complications of AAC treated by cholecystectomy are similar to cases of acute calculous cholecystitis.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
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23
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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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24
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Abstract
Infections of the gastrointestinal tract can often involve the gallbladder. Infection probably plays a role in the formation of gallstones but is more commonly thought to contribute to acute illness in patients. Acute calculous cholecystitis caused by an impacted gallstone is often complicated by secondary bacterial infection and is a major cause of morbidity and even mortality in patients. A wide variety of organisms can be associated with acute acalculous cholecystitis, a less common but potentially more severe form of acute cholecystitis. This review focuses on infections and their role in the above-mentioned processes involving the gallbladder.
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Affiliation(s)
- Kabir Julka
- Division of Gastroenterology, University of Washington, Seattle, WA 98195, USA
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25
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Acalculous cholecystitis in a healthy 4-year-old boy. Am J Emerg Med 2010; 29:962.e1-2. [PMID: 20970290 DOI: 10.1016/j.ajem.2010.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 08/11/2010] [Indexed: 01/28/2023] Open
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26
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Acalculous cholecystitis in severely burned patients: Incidence and predisposing factors. Burns 2009; 35:405-11. [DOI: 10.1016/j.burns.2008.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 08/11/2008] [Indexed: 11/21/2022]
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27
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Unal H, Korkmaz M, Kirbas I, Selcuk H, Yilmaz U. Acute acalculous cholecystitis associated with acute hepatitis B virus infection. Int J Infect Dis 2009; 13:e310-2. [PMID: 19372059 DOI: 10.1016/j.ijid.2009.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 01/06/2009] [Accepted: 01/28/2009] [Indexed: 01/05/2023] Open
Abstract
During the course of acute viral hepatitis, some functional and structural changes to the gallbladder can occur. Acute acalculous cholecystitis is an extremely rare complication of acute viral hepatitis. Acalculous cholecystitis associated with acute viral hepatitis can present as different conditions. Some of these are self-limiting and heal spontaneously, while a limited number of cases progress to a gangrenous state, gallbladder perforation, and even to death. We present here a case of acute acalculous cholecystitis associated with an acute hepatitis B virus infection.
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Affiliation(s)
- Hakan Unal
- Department of Gastroenterology, Baskent University, Fevzi Cakmak Caddesi 10. sokak No: 45, Ankara 06490, Turkey.
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28
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29
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Starost MF, Burkholder TH. Acalculous and clostridial cholecystitis in a pig. J Vet Diagn Invest 2008; 20:527-30. [PMID: 18599865 DOI: 10.1177/104063870802000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 21-month-old domestic Hanford pig (Sus scrofa domestica) in a 1-year study for experimental myocardial infarction was euthanized at the end of the study. One week earlier, the animal had symptoms and elevated clinical chemistry results suggestive of hepatobiliary disease, which resolved after medical therapy. At necropsy, the gallbladder was markedly enlarged, discolored, and had a thickened wall. Within the gallbladder, there was abundant friable green-brown material. A culture of the gallbladder luminal material yielded Clostridium perfringens type A. Histopathology of the gallbladder demonstrated multifocal areas of necrosis of varying depths, admixed with an inflammatory infiltrate that was also observed on the serosa and within the associated adipose tissue. Luminal material was composed of cellular debris and bile sludge admixed with numerous bacterial rods. Smooth-muscle hypertrophy of numerous small arterioles with narrowed lumina was observed in the gallbladder. A diagnosis of acalculous cholecystitis presumably because of ischemia of the gallbladder with secondary clostridial infection was made. To the authors' knowledge, this is the first reported case of acalculous cholecystitis with evidence of vascular compromise in a pig, as well as cholecystitis secondarily attributed to Clostridium perfringens type A.
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Affiliation(s)
- Matthew F Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, MD 20892, USA.
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30
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Leveau P, Andersson E, Carlgren I, Willner J, Andersson R. Percutaneous cholecystostomy: a bridge to surgery or definite management of acute cholecystitis in high-risk patients? Scand J Gastroenterol 2008; 43:593-596. [PMID: 18415753 DOI: 10.1080/00365520701851673] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Cholecystectomy is the standard treatment for acute cholecystitis, but in high-risk patients with serious comorbidity and in patients of advanced age there is substantial morbidity and mortality associated with the intervention. In these selected patients, percutaneous cholecystostomy (PCS) is an alternative mode of management. The aim of the present study was to evaluate the outcome of PCS in selected patients with acute cholecystitis. MATERIAL AND METHODS Thirty-five patients, representing 0.6% of all acute cholecystitis patients managed during the period 1994-2003, were subjected to PCS. Patients' charts were reviewed retrospectively for age, gender, comorbidity, hospital stay, procedure, complications and final outcome, including requirement of additional interventions. RESULTS PCS was considered successful in 34/35 patients, 26 of whom responded within 3 days. Two patients required additional cholecystectomy 3 days and 20 months, respectively, after the PCS procedure. Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and one patient underwent rotation lithotripsy. Four patients suffered recurrent biliary complaints after the acute episode of cholecystitis, while the only serious procedure-related complication was bile leakage from the gallbladder in one patient, which necessitated cholecystectomy. CONCLUSIONS PCS is a comparatively safe and efficient procedure in the treatment of acute cholecystitis in high-risk patients with serious comorbidity and in elderly patients, contraindicating the general anaesthesia required for laparoscopic or open cholecystectomy.
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Affiliation(s)
- Per Leveau
- Department of Surgery, Lund University Hospital, Lund, Sweden
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31
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Shin YH, Shin JI, Park JM, Kim JH, Lee JS, Kim MJ. A five-year-old boy with nephrotic syndrome complicated with acute acalculous cholecystitis. Pediatr Int 2007; 49:674-6. [PMID: 17875099 DOI: 10.1111/j.1442-200x.2007.02436.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, Pochon Cha University College of Medicine, Seoul, Korea
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Acute Cholecystitis as Cause of Death after Surgery for Lumbar Canal Stenosis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gorschlüter M, Mey U, Strehl J, Schepke M, Lamberti C, Sauerbruch T, Glasmacher A. Cholecystitis in neutropenic patients: Retrospective study and systematic review. Leuk Res 2006; 30:521-8. [PMID: 16483649 DOI: 10.1016/j.leukres.2005.08.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 07/21/2005] [Accepted: 08/29/2005] [Indexed: 11/17/2022]
Abstract
Abdominal infections are life-threatening complications in neutropenic patients. Among these, neutropenic cholecystitis is relatively rare. Nevertheless, its actual relevance is only investigated by anecdotal reports. We present a consecutive retrospective series of nine patients over a 12-year period. We calculated a frequency of 0.4% among all neutropenic episodes in patients with acute leukemia or aggressive lymphoma undergoing myelosuppressive chemotherapy. Only three of these patients had gallstones. Four patients died during the course of cholecystitis but in none of them cholecystitis was the primary cause of death. Systematic review of the literature revealed 45 patients with neutropenic cholecystitis of whom 26.7% died.
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Affiliation(s)
- Marcus Gorschlüter
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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Beardsley SL, Shlansky-Goldberg RD, Patel A, Freiman DB, Soulen MC, Stavropoulos SW, Clark TWI. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy. Cardiovasc Intervent Radiol 2005; 28:319-25. [PMID: 15886948 DOI: 10.1007/s00270-003-0260-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. METHODS A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. RESULTS Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. CONCLUSION No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis among patients referred for percutaneous cholecystostomy.
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Affiliation(s)
- Shannon L Beardsley
- Section of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Bauer C, Kuntz W, Ohnsmann F, Gasser H, Weber C, Redl H, Marzi I. The attenuation of hepatic microcirculatory alterations by exogenous substitution of nitric oxide by s-nitroso-human albumin after hemorrhagic shock in the rat. Shock 2004; 21:165-9. [PMID: 14752291 DOI: 10.1097/01.shk.0000107442.26299.fb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hepatic microcirculatory disorders such as narrowing of sinusoids after hemorrhagic shock play a major role in the pathogenesis of organ failure. It is known that the balance of vasoactive mediators such as endothelin and nitric oxide (NO) regulate microvascular perfusion, including the diameter of hepatic sinusoids. The present study was designed to evaluate the role of exogenous substitution of NO by S-nitroso-albumin (S-NO-HSA) in the prevention of pathophysiological alterations of hepatic microcirculation. Anesthetized Sprague-Dawley rats were instrumented for invasive hemodynamic monitoring. Hemorrhagic shock was induced by bleeding to a mean arterial pressure (MAP) of 40 mmHg and was maintained for 60 min. Thereafter, the animals were resuscitated with shed blood and Ringer's solution. During the first hour of resuscitation, S-NO-HSA or pure HSA was infused continuously (10 micromol/kg/h) and hepatic microcirculation was detected by intravital epifluorescence microscopy either 5 or 24 h after the insult. Results were compared with a sham-treated group (n = 6-8 per group). Shock-induced microcirculatory narrowing of sinusoids was significantly reduced in the S-NO-HSA group compared with the HSA group both at 5 and 24 h (HSA: 9.3 +/- 0.2 microm; S-NO-HSA: 12.1 +/- 0.2 microm, P < 0.05). Sinusoidal perfusion was significantly higher in the S-NO-HSA group than in the HSA group (HSA: 50,934 +/- 1,382 microm3/s; S-NO-HSA: 78,120 +/- 2,348 microm3/s, P < 0.05). Reversible leukocyte adhesion to sinusoidal endothelium, an indicator of the inflammatory response, was significantly reduced in the S-NO-HAS-treated group. The findings of this study in a rat model of hemorrhagic shock suggest that NO substitution by S-NO-HSA during resuscitation attenuates both early and late hepatic microcirculatory disturbances as well as the increase in leukocyte adherence.
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Affiliation(s)
- Clemens Bauer
- Departments of Trauma Surgery and Anesthesiology, University of Saarland, Homburg/Saar, Germany
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Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003; 9:2821-3. [PMID: 14669342 PMCID: PMC4612061 DOI: 10.3748/wjg.v9.i12.2821] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).
METHODS: The medical records of patients hospitalized from January1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness > 3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or abscess.
RESULTS: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males predominated. Most patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52%, group A) and absent in 25 (group B). Six patients died with a mortality of 12%. Four of the 6 who died were in group A. Patients in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P = 0.04) and had a significantly higher white blood cell count (mean 15885.19 vs. 9948.40, P = 0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band forms. The most commonly cultured bacteria in both blood and bile were E. coli and Klebsiella pneumoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points.
CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC.
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Affiliation(s)
- Ay-Jiun Wang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China.
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Pelinka LE, Schmidhammer R, Hamid L, Mauritz W, Redl H. Acute acalculous cholecystitis after trauma: a prospective study. THE JOURNAL OF TRAUMA 2003; 55:323-9. [PMID: 12913644 DOI: 10.1097/01.ta.0000054648.26933.21] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors for the development of acute acalculous cholecystitis (AAC) and useful criteria to facilitate the decision to perform cholecystectomy. METHODS This was a prospective study of patients with an Injury Severity Score (ISS) > or = 12 requiring intensive care for > 4 days (n = 255), divided into three groups by ultrasound: AAC (n = 27), hydropic gallbladder (n = 37), and normal gallbladder (n = 191). Multivariate analysis was conducted for trauma scores and laboratory and intensive care unit (ICU) data and complemented by logistic regression analysis. RESULTS Three factors sufficiently define the risk for AAC: ISS, heart rate, and units of packed red blood cells required at ICU admission. All patients who underwent cholecystectomy (n = 21) had both highly pathologic ultrasound and major clinical symptoms, and all had histologically verified AAC. There was no significant difference in daily laboratory data between patients with and without AAC. CONCLUSION Patients with a high ISS who are tachycardic and have required several units of packed red blood cells at ICU admission should be monitored early by ultrasound. When ultrasound is highly pathologic together with major clinical symptoms, cholecystectomy should be performed. Daily laboratory data are of no additional value regarding the decision to perform cholecystectomy.
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Affiliation(s)
- Linda E Pelinka
- Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Research Unit of the Austrian Worker's Compensation Board, Vienna, Austria.
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Ko CW, Lee SP. Gastrointestinal disorders of the critically ill. Biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol 2003; 17:383-96. [PMID: 12763503 DOI: 10.1016/s1521-6918(03)00026-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biliary sludge develops commonly in critically ill patients and may be associated with biliary colic, acute pancreatitis or acute cholecystitis. Sludge often resolves upon resolution of the underlying pathogenetic factor. It is generally diagnosed on sonography. Treatment of sludge itself is unnecessary unless further complications develop. Acute acalculous cholecystitis also develops frequently in critically ill patients. It may be difficult to diagnose in these patients, manifesting only as unexplained fever, leukocytosis or sepsis. Sonography and hepatobiliary scintigraphy are the most useful diagnostic tests. Management decisions should take into account the underlying co-morbid conditions. For many patients, percutaneous cholecystostomy may be the best management option. Cholecystostomy may also provide definitive drainage as patients recover and underlying critical illness resolves.
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Affiliation(s)
- Cynthia W Ko
- Division of Gastroenterology, Department of Medicine, University of Washington, Box 356424, Seattle, WA 98195, USA.
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Rolain JM, Lepidi H, Harlé JR, Allegre T, Dorval ED, Khayat Z, Raoult D. Acute acalculous cholecystitis associated with Q fever: report of seven cases and review of the literature. Eur J Clin Microbiol Infect Dis 2003; 22:222-7. [PMID: 12687414 DOI: 10.1007/s10096-003-0899-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Q fever is a worldwide-occurring zoonosis caused by Coxiella burnetii. There are various clinical manifestations of acute Q fever, of which acute cholecystitis is a very rare clinical presentation. This study reports seven cases of acute cholecystitis associated with Coxiella burnetii and reviews two other cases from the literature. All patients were admitted to hospital for fever and abdominal pain in the right upper quadrant. Abdominal echography showed a distended gallbladder with biliary sludge without concrements in eight cases and with a single stone in one case. Diagnosis was made by specific serological investigation (microimmunofluorescence assay) for Coxiella burnetii. All nine patients were cured, six after laparoscopic cholecystectomy and three with antibiotics only. Histological examination of the gallbladders showed inflammation in five cases, although Coxiella burnetii was not detected by immunohistochemistry. The results show that laboratory investigations in patients admitted to hospital for symptoms consistent with acute acalculous cholecystitis should include a systematic search for Coxiella burnetii.
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Affiliation(s)
- J M Rolain
- Unité des Rickettsies CNRS UMR-A 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
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40
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Kettaneh A, Weill FX, Poilane I, Fain O, Thomas M, Herrmann JL, Hocqueloux L. Septic shock caused by Ochrobactrum anthropi in an otherwise healthy host. J Clin Microbiol 2003; 41:1339-41. [PMID: 12624082 PMCID: PMC150285 DOI: 10.1128/jcm.41.3.1339-1341.2003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reported is a case of life-threatening septic shock that occurred in an otherwise healthy host after administration of a peripheral venous infusion of a solution contaminated with Ochrobactrum anthropi, an unusual human pathogen. The rapid onset of shock may have been due to a large inoculum caused by nonsterile practices at the time of reconstitution.
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Affiliation(s)
- Adrien Kettaneh
- Service de Médecine Interne. Laboratoire de Bactériologie, Hôpital Jean Verdier, Bondy, Paris, France
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41
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Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) tends to have a fulminant course and be associated with critically ill diseases, there have been reports of AAC without any risk factors but good prognosis. GOALS To assess the risk factors, clinical features and prognosis of AAC. STUDY All patients who had a cholecystectomy due to acute cholecystitis at Pundang Jesaeng General Hospital during a 43-month period were prospectively enrolled. AAC was defined by ultrasonographic, intraoperative and pathologic findings of acute cholecystitis without evidence of gallstones. Clinical features and pathologic findings were analyzed and outcome was assessed. RESULTS 156 patients with acute cholecystitis were enrolled and 14% (22 of 156) met the criteria of AAC. Fifteen (68%) of the patients with AAC were male and the average age was 63 year old. Twenty patients were presented with AAC as outpatients of whom seven of them (35%) had atherosclerotic vascular disease. Laparoscopic cholecystectomy was performed in 126 patients (80.8%) with acute cholecystitis but was possible in only 12 patients (54.5%) with AAC. AAC was associated with a high incidence of gangrene (59%) but no patients died of acute cholecystitis. CONCLUSIONS We conclude that AAC frequently occurs in elderly male outpatients without critical illness and gangrene is common but the prognosis is better than reported previously.
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Affiliation(s)
- Ji Kon Ryu
- Digestive Disease Center, Pundang Jesaeng General Hospital, Sungnam, Korea.
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Vibert E, Azoulay D. [Alithiasic cholecystitis in the adult: etiologies, diagnosis and treatment]. ANNALES DE CHIRURGIE 2002; 127:330-6. [PMID: 12094414 DOI: 10.1016/s0003-3944(02)00768-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acalculous cholecystitis represents 2% to 14% of cholecystectomies performed for acute cholecystitis. Its main etiology is ischemia of the gallbladder wall, which mainly occurs in critically ill patients, particularly in case of cardiovascular previous disease or diabetes. Acalculous cholecystitis associated with VIH are rare and have a better prognosis. Other etiologies are exceptional. Diagnosis of acalculous cholecystitis is difficult, with a lack of specificity of abdominal ultrasound for the diagnosis of ischemic cholecystitis. In all cases, cholecystectomy is a definitive treatment allowing certain diagnosis. Percutaneous drainage must be reserved to patients whose general condition does not allow general anesthesia. Medical treatment alone is not indicated in acalculous cholecystitis.
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Affiliation(s)
- E Vibert
- Centre hépato-biliaire, hôpital Paul-Brousse, université Paris-Sud UPRES 1596, 94804 Villejuif, France
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Puc MM, Tran HS, Wry PW, Ross SE. Ultrasound is Not a Useful Screening Tool for Acute Acalculous Cholecystitis in Critically Ill Trauma Patients. Am Surg 2002. [DOI: 10.1177/000313480206800115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Acute acalculous cholecystitis remains a diagnostic challenge in critically ill trauma patients. Laboratory studies are nonspecific and associated injuries or mental status changes may mask clinical signs and symptoms. We conducted a retrospective study to assess the utility of ultrasound in the diagnosis of acute acalculous cholecystitis. We hypothesized that ultrasound is inadequate as a screening tool for acute acalculous cholecystitis. The abdominal ultrasounds of all patients undergoing evaluation for acute acalculous cholecystitis in a 40-month period at our Level I trauma center were reviewed. Thickened gallbladder wall, pericholecystic fluid and emphysematous gallbladder were considered positive sonographic criteria. Sludge, cholelithiasis, and hydrops were considered suggestive. Patients who did not undergo cholecystectomy had their gallbladders evaluated either during subsequent laparotomy or at autopsy or they were discharged from the hospital without need for intervention. Sixty-two patients were included. Twenty-one patients underwent cholecystectomy for presumed acute acalculous cholecystitis. The data revealed a sensitivity of 30 per cent (6/20) and a specificity of 93 per cent (39/42) for ultrasound evaluation. Twenty patients had subsequent hepatobiliary scans [hepato-iminodiacetic acid (HIDA)] with a sensitivity of 100 per cent (12/12) and specificity of 88 per cent (7/8). Our data do not support ultrasound as a reliable routine screening tool for acute acalculous cholecystitis. Despite its convenience as a bedside procedure ultrasound has insufficient sensitivity to justify its use and a more sensitive diagnostic tool should be used.
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Affiliation(s)
- Matthew M. Puc
- From the Department of Surgery, Division of Trauma, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey
| | - Hoang S. Tran
- From the Department of Surgery, Division of Trauma, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey
| | - Philip W. Wry
- From the Department of Surgery, Division of Trauma, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey
| | - Steven E. Ross
- From the Department of Surgery, Division of Trauma, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey
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Saito A, Shirai Y, Ohzeki H, Hayashi J, Eguchi S. Acute acalculous cholecystitis after cardiovascular surgery. Surg Today 2000; 27:907-9. [PMID: 10870575 DOI: 10.1007/bf02388137] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The development of acute acalculous cholecystitis (AAC) after cardiovascular surgery is an infrequent but devastating complication, the etiology and management of which remains controversial. To evaluate the etiology, treatment, and outcome of patients with AAC, the cases of six patients encountered within an 8-year period who developed AAC after cardiovascular surgery requiring cardiopulmonary bypass (CPB) were reviewed. Atherosclerotic risk factors including diabetes, hyperlipidemia, and smoking were evident in five patients, three of whom had a history of stroke or arteriosclerosis obliterans, while low cardiac output was recognized in three. Percutaneous transhepatic cholecystostomy was performed in five patients, and another required cholecystectomy for peritonitis due to gangrene of the gallbladder. Two patients died of respiratory failure and sepsis after 15 and 82 days of percutaneous drainage, respectively; however, the four survivors had an excellent outcome without any biliary tract disease during a mean follow-up period of 5.3 years. In conclusion, AAC after cardiovascular surgery may result from hypoperfusion of the gallbladder due to various factors including CPB, visceral atherosclerosis, and low cardiac output. We advocate early percutaneous cholecystostomy for patients without peritonitis, while early cholecystectomy is indicated for those with peritonitis.
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Affiliation(s)
- A Saito
- Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan
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Cullen JJ, Conklin JL, Ephgrave KS, Oberley LW. The role of antioxidant enzymes in the control of opossum gallbladder motility. J Surg Res 1999; 86:155-61. [PMID: 10452883 DOI: 10.1006/jsre.1999.5691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Superoxide rapidly oxidizes nitric oxide (NO) to form peroxynitrite, thus terminating the biological activity of NO. The aims of our study were to determine if superoxide alters the motor function of the gallbladder and to localize the antioxidant enzymes in the gallbladder. MATERIALS AND METHODS Immunostaining and immunoblots were performed and enzyme activities were measured in the gallbladder. In physiologic experiments, force-displacement transducers recorded tension in gallbladder muscle strips. Superoxide was generated by the addition of xanthine with xanthine oxidase, while superoxide radicals were scavenged by the addition of superoxide dismutase (SOD) and catalase. SOD was inhibited by deithyldithiocarbamate. RESULTS Immunostaining demonstrated superoxide dismutase and catalase immunoreactivity in ganglia situated throughout the smooth muscle. Total superoxide dismutase activity was 115 +/- 12 U/mg. Western blots detected expression of proteins of 19.4 kDa for copper/zinc SOD and 25.0 kDa for manganese SOD. Generation of superoxide increased isometric tension, while pretreatment with SOD prevented the increase in isometric tension induced by superoxide. Inhibition of SOD diminished the EFS-induced off response. CONCLUSIONS We conclude that superoxide alters gallbladder motor function, and the presence of superoxide scavenging enzymes in enteric plexuses suggests that they may regulate gallbladder neuromuscular function by clearing endogenous superoxide.
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Affiliation(s)
- J J Cullen
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
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Affiliation(s)
- R A Montgomery
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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47
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Abstract
BACKGROUND Acute acalculous cholecystitis is a well recognized complication of many acute illnesses. Ischaemia of the gallbladder seems to have an important role in its pathogenesis. METHODS Microangiography was performed in 15 gallbladders immediately after cholecystectomy by infusing 10 per cent barium sulphate into the specimen. Five patients had symptomatic gallstone disease, five had acute gallstone-associated cholecystitis and five had acalculous cholecystitis. Sections for histological examination were taken from adjacent sides of the microangiography section. Filling of the vessels by contrast medium was compared with histological findings. RESULTS Microangiography of the gallbladder in acute gallstone-associated cholecystitis showed strongly dilated arterioles and regular filling of the capillary network, whereas in acalculous cholecystitis the capillary filling was poor and irregular. CONCLUSION Disturbed microcirculation may play an important role in the pathogenesis of acute acalculous cholecystitis.
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Affiliation(s)
- T Hakala
- Department of Surgery, University Hospital of Kuopia, Finland
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Abstract
BACKGROUND Acute acalculous cholecystitis is a well recognized complication of many acute illnesses. Ischaemia of the gallbladder seems to have an important role in its pathogenesis. METHODS Microangiography was performed in 15 gallbladders immediately after cholecystectomy by infusing 10 per cent barium sulphate into the specimen. Five patients had symptomatic gallstone disease, five had acute gallstone-associated cholecystitis and five had acalculous cholecystitis. Sections for histological examination were taken from adjacent sides of the microangiography section. Filling of the vessels by contrast medium was compared with histological findings. RESULTS Microangiography of the gallbladder in acute gallstone-associated cholecystitis showed strongly dilated arterioles and regular filling of the capillary network, whereas in acalculous cholecystitis the capillary filling was poor and irregular. CONCLUSION Disturbed microcirculation may play an important role in the pathogenesis of acute acalculous cholecystitis.
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Affiliation(s)
- T Hakala
- Department of Surgery, University Hospital of Kuopia, Finland
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Abstract
The case of a 57-year-old woman admitted with symptoms and signs suggesting an intestinal infection caused by Vibrio cholerae, and who also developed a clinical picture compatible with acute cholecystitis, is presented. Cholera was diagnosed by examining a fresh sample of stools and cultures. An abdominal sonogram disclosed signs of acute acalculous cholecystitis. She underwent cholecystectomy, and cultures of a clear fluid and a "milky" sediment found within the gallbladder were also positive for V. cholerae. This microorganism was seen at the gallbladder mucosa microscopically. The strain was serotyped V. cholerae 01 (El Tor) Ogawa and was the etiology of the acute acalculous cholecystitis in this patient.
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Affiliation(s)
- N A Gomez
- Gastrointestinal Unit, Esperanza Foundation, Guayaquil, Ecuador
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