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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In acute obstructive cholecystitis the increased intraluminal pressure in the gallbladder is reduced by nonsteroid anti-inflammatory drugs which effectively relieve biliary pain. To investigate if such drugs influence the clinical course, a double-blind study was performed in which indomethacin (suppositories 75 mg b.d.) was tested against placebo in 34 patients with acute obstructive cholecystitis. During the 3-day treatment period both the indomethacin and the placebo group improved significantly as regards pyrexia, pain, abdominal tenderness and leukocytosis. The indomethacin group showed significantly greater improvement than the placebo group in temperature, pain and white blood cell count on day 1, and significantly greater reduction of abdominal tenderness on day 2. The serum bilirubin fell significantly during the 3-day period in the indomethacin, but not the placebo group. The hospital stay in cases without early surgery was significantly shorter in the indomethacin group (5.4 vs. 8.5 days). Because of its favourable effect on the clinical course of acute cholecystitis, rectally administered indomethacin is useful for patients awaiting operation or scheduled for later elective surgery.
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PMID:Effect of short-term indomethacin treatment on the clinical course of acute obstructive cholecystitis. 167 6

In analysis of a group of 48 patients, the authors describe an entity they call acute cholangio-cholecystitis (or acute cholecystitis of choledochal origin) and define it by 4 obligatory criteria: 1. vesicular lesion of acute cholecystitis type; 2. the obstruction of the main bile duct in the direction of its junction with the cystic duct; 3. free duct communication between the gallbladder and the main bile ducts; 4. fluid content (purulent gallbladder) found identical over the whole biliary territory (the gallbladder the main bile ducts the intrahepatic bile ducts). This entity represents 7.6% of the total of acute cholecystitis and was met in 2.8% of the total of the interventions for the main bile ducts obstruction. The deficient biological background of the patients (60% over 60 years old), and other seriousness factors--vesicular destructive lesions associated with biliary peritonitis (7/48), the existence of the duct obstruction, usually calculous (42/48), but also hydatic (3/48) or tumoural (3/48), the multitude and seriousness of the associated lesions are emphasized. The surgery, performed in over 80% emergent cases, was directed to the decomprimation of the main biliary axis to which the increase of the gangrenous cholecyst, treatment of the duct obstructive factor, repair of the internal biliary fistulas, treatment of the consequent peritonitis were added. The results, very often good (71%), were shadowed by a series of complications (29%) which ended in deaths (14.5%). The paper pleads for the early surgery of the lithiasic biliary disease, before the appearance of the inevitable complications.
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PMID:[Acute cholangiocholecystitis]. 168 26

A 6-year-old boy was admitted to hospital with acute gangrenous cholecystitis requiring emergency cholecystectomy. Examination of the gall-bladder revealed severe inflammation with areas of necrosis and mucosal sloughing; serology confirmed hepatitis A infection. Acute cholecystitis due to hepatitis A infection has very rarely been reported.
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PMID:Gangrenous cholecystitis due to hepatitis A infection. 174 Aug 24

Analysis of the features of calculous cholecystitis in 522 females and 106 males showed that acute cholecystitis takes a course which is more severe and acute in males than in females. Its gangrenous forms were encountered more often in males, which was an indication for more frequent emergency operations. In males the process was complicated by obstructive jaundice more frequently. In females acute cholecystitis was attended more frequently by peritonitis and was often combined with pancreatitis. Chronic cholecystitis also had some distinguishing features. Chronic indurative pancreatitis and hydrops of the gallbladder were encountered more often in females. The mortality in the abnormality was higher among males.
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PMID:[Characteristics of manifestations of calculous cholecystitis in men]. 177 47

We studied 25 patients with gangrenous cholecystitis and observed a new sonographic finding--striated thickening of the gallbladder wall--and three patterns of pericholecystic fluid collections. Heterogeneous thickening of the gallbladder wall was characterized by either multiple striations (alternating hypoechoic and hyperechoic layers) or irregular mass-like protrusions projecting into the gallbladder lumen. We observed striated thickening far more frequently (in 10 of 25 patients) than other findings reported previously as being associated with gangrenous cholecystitis, such as intraluminal membranes (1 in 25 patients) and masslike protrusions into the gallbladder lumen (1 in 25 patients). Although the sensitivity and specificity of this finding cannot be determined by our study, we believe that mural striations in cases of acute cholecystitis should raise the question of gangrenous changes. Additionally, we found that two subtypes of pericholecystic fluid collections (types II and III) were associated with gallbladder wall perforation and abscess formation more frequently than type I collections.
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PMID:Gangrenous cholecystitis: new observations on sonography. 181 Oct 76

During a period of 13 weeks, 45 patients with symptom-producing gall bladder stones (attacks of gall stone colic n = 39 (87%); acute cholecystitis n = 6 (13%)), corresponding to approximately 85% of the total number of gall bladder stone patients during the period were selected for laparoscopic cholecystectomy. Two patients had previously undergone upper abdominal operations and had adhesions and one patient suffered from cirrhosis of the liver with portal hypertension. It proved necessary to convert five of the laparoscopic cholecystectomies to open cholecystectomies (11%) on account of technical difficulties (severe acute changes due to cholecystitis (n = 3), indeterminable anatomical conditions (n = 1) and one case of liver metastases (n = 1)). The median duration of operation was 90 minutes with a range from 30 to 360 minutes. Peroperative cholangiography was not undertaken routinely. No cases of forgotten stones in the common bile duct occurred. No deaths occurred and, in all, three slight complications occurred (7%): two patients had haematoma in the abdominal wall and one patient minimal leakage of bile from the stump of the gall bladder on account of insufficient ligation of the cystic duct. This patient was treated with an endoscopically placed drain in the common bile duct for two weeks, after which she was well. No lesions of the common bile duct occurred. None of the complications required laparotomy. The median duration of hospitalization was 24 hours with a range from one to 14 days. All of the patients were at work or could manage their usual activities after 14 days. The median duration of sick leave was seven days.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Laparoscopic cholecystectomy. The first 45 operations]. 183 52

Acute posttraumatic and postoperative cholecystitis is a serious and life-threatening complication with mortality rates ranging from 10 to 50%. The pathogenesis is multifactorial: possible reasons are blood transfusions, dehydration, narcotics, shock and positive end-expiratory pressure (PEEP). Between 1980 and 1990 12 patients underwent surgery for acute cholecystitis. Six of them suffered from a so-called acute acalculous cholecystitis. Two patients died postoperatively. The symptoms are that of a "common" cholecystitis with leukocytosis, fever, abdominal distension and upper right abdominal pain. Sonography is a good method to establish the diagnosis and helps in the decision for cholecystectomy. Clinicians must remember the possibility of an acute cholecystitis in any surgical patient developing abdominal pain or unexplained fever.
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PMID:[Acute stress-induced cholecystitis]. 187 Mar 63

Ultrasound examinations of 563 patients with right upper quadrant pain and a clinical suspicion of acute cholecystitis were reviewed. In 31 patients, a tender, dilated gall-bladder with a thick (more than 4 mm) partly hypoechoic wall without any detectable calculi was found on the emergency examination. This was interpreted as due to acute acalculous cholecystitis. None of the patients was critically ill. Twenty-one of the patients had follow-up studies with either oral cholecystography, cholangiography, or ultrasound. Fourteen of the 21 had gall-bladder calculi while seven did not. These seven patients presumably represent the true frequency (1.2%) of acute acalculous cholecystitis in this clinical setting. In five other patients with an initial diagnosis of acute acalculous cholecystitis the gall-bladder wall thickening probably was secondary to concomitant pancreatitis, appendicitis, hepatitis or peptic ulcer disease. A meticulous and careful search for gall-bladder calculi should be performed in the presence of a dilated, tender thick-walled gall-bladder.
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PMID:The clinical importance of a thick-walled, tender gall-bladder without stones on ultrasonography. 187 51

An open-label prospective study was performed employing intramuscularly administered imipenem as an adjunct to surgery in 20 patients with acute cholecystitis and 24 patients with perforated or gangrenous appendicitis. Three (12.5%) septic failures occurred in appendicitis patients and 2 (10%) failures in cholecystitis patients. There were no deaths. Adverse effects were minor, and there was no toxicity. Although failures were not associated with in vitro resistance, Pseudomonas spp. were recovered from 2 of 3 appendicitis failures. Intramuscular imipenem appeared to be an effective single-drug antimicrobial when used as an adjunct to surgery in patients with acute cholecystitis or perforated appendicitis. It should be a more cost-effective alternative to the current multiple-drug therapy frequently employed in patients with intra-abdominal sepsis.
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PMID:Intramuscular imipenem as adjuvant therapy for acute cholecystitis and perforated or gangrenous appendicitis. 187 86

The timing of cholecystectomy in acute cholecystitis is still controversial. A marked change toward early surgery has been noted in the past decade. In a retrospective study of 197 patients we evaluated the results of cholecystectomy in 117 who underwent elective cholecystectomy, and in 80 operated on during the acute phase of cholecystitis. The diagnosis of acute cholecystitis was by isotope scan (HIDA) or ultrasound. There was no case of misdiagnosis. 3 patients died postoperatively: 2 in the early operation group (1 had emergency cholecystectomy) and 1 in the elective group. Postoperative complications were more frequent in the early surgery group (p = 0.06). The highest morbidity was in early cholecystectomy in those older than 60 years who had cardiovascular disease (p less than 0.0002). Hernia in the scar was a unique complication of the early operation. According to most studies reviewed, early operation eliminates the need for emergency operation when conservative treatment fails, without increasing morbidity or mortality. Therefore, early operation during the acute phase of cholecystectomy is advised. For patients older than 60 years who have cardiovascular disease, we recommend delaying surgery until the acute inflammation subsides. The waiting period before surgery should be as short as possible in order to reduce the risk of recurrent cholecystitis and its complications.
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PMID:[Early vs delayed cholecystectomy for acute cholecystitis]. 187 64


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