Open AccessAcute Acalculous Choecystitis in Critically Injured Patients
Author(s) -
Edward E. Cornwell,
Aurelio Rodríguez,
Stuart E. Mirvis,
Robert M. Shorr
Publication year - 1989
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198907000-00008
Subject(s) - medicine , narcotic , cholecystectomy , radiology , ascites , computed tomographic , gangrene , edema , mortality rate , surgery , computed tomography
The potential lethality and predisposing factors of acute acalculous cholecystitis (AAC) are well established; however, preoperative diagnosis remains a challenge. This update of a previous report of 30 cases of AAC at a Level I trauma center describes 14 multiply injured patients who developed AAC and underwent cholecystectomy. All 14 patients had acutely inflamed gallbladders; 6 (42.8%) had areas of necrosis or gangrene. The mortality rate was 7% (1 patient). While the percentage of patients receiving prolonged intensive care (100%), narcotic analgesics (100%), and TPN (93%) correlates with the experience cited previously, the percentage undergoing preoperative diagnostic imaging is unusually high, reflecting a heightened suspicion for AAC. Computed tomographic or sonographic evidence of gallbladder wall thickness greater than or equal to 4 mm, pericholecystic fluid or subserosal edema without ascites, intramural gas, or a sloughed mucosal membrane was considered diagnostic criteria for AAC. We conclude that preoperative computed tomogram or ultrasound imaging leads to earlier recognition of this life-threatening problem.