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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute acalculous cholecystitis is an uncommon but very serious illness, that, if undiagnosed, may lead to gallbladder perforation and death. The condition has numerous causes that result in bile stasis and ischemia leading to inflammation and infection in the gallbladder wall. The bedside diagnosis may be difficult, especially in critically ill patients. Current imaging techniques including ultrasonography, computer tomography, and radionuclide cholescintigraphy are very helpful. Depending on the clinical situation, the gallbladder should either be drained by a surgical or percutaneous cholecystostomy under local anesthesia or removed.
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PMID:Acute acalculous cholecystitis. A review. 147 70

Acute acalculous cholecystitis is a virulent disease of uncertain etiology observed most commonly in critically ill patients. Although the precise mechanism is unknown, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis, and ischemia. The role of ischemia in this process, whose etiology is multifactorial, has been difficult to elucidate. Consequently, we report two patients who developed acute acalculous cholecystitis without apparent risk for the disease other than severe visceral atherosclerosis. Both patients had symptomatic mesenteric vascular disease requiring revascularization and developed fulminant acalculous cholecystitis temporally related to exacerbation of their visceral ischemia. These cases suggest that patients with visceral atherosclerosis may be at increased risk for acute acalculous cholecystitis, perhaps due to impaired mucosal resistance when other factors, such as bile statis and sepsis, are also present.
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PMID:Does visceral ischemia play a role in the pathogenesis of acute acalculous cholecystitis? 230 85

Acute acalculous cholecystitis is common, accounting for 5% to 10% of cases of acute cholecystitis. Although originally attributed to stasis and inspissated bile with subsequent obstruction of the cystic duct, acalculous cholecystitis has more recently been attributed to gallbladder ischemia from such conditions as hypotension or vasculitis. However, a significant number of cases of acute acalculous cholecystitis occur with no obvious cause. This report notes acute acalculous cholecystitis, diagnosed in 12 patients from 1982 to 1987, that was apparently precipitated by initiation of antibiotic therapy. Histologic sections of these gallbladders each disclosed a massive eosinophilic infiltrate. Two of the patients had identical signs, symptoms, and abnormal laboratory values during a previous course of erythromycin. These findings subsided when the antibiotic therapy was discontinued. We hypothesize that a significant cause of acute acalculous cholecystitis may be a hypersensitivity reaction to concurrent antibiotic therapy. Such patients should have antibiotic therapy halted or altered, which, it is hoped, will result in resolution of symptoms and avoidance of unnecessary laparotomy.
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PMID:Acalculous hypersensitivity cholecystitis: hypothesis of a new clinicopathologic entity. 318 4

Nine cases of acute acalculous cholecystitis were diagnosed in the surgical intensive care unit at Hartford Hospital during a 2 year period after abdominal, cardiovascular, and traumatic surgery. A tender mass in the right upper quadrant was suggestive but not diagnostic of the condition. Hyperamylasemia was seen in all patients. Ultrasonography is the most useful diagnostic tool; serial studies reveal progressive gallbladder dilatation and edema. Tube cholecystostomy was used in five patients and cholecystectomy in four. Cholecystostomy led to resolution of the inflammatory process in all five patients. Cholecystectomy should be reserved for those patients with extensive gallbladder necrosis. Six of the nine patients in the series died, all from multiple systems failure with concomitant sepsis. Hypotension is probably central to the development of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Acute acalculous cholecystitis represents another organ failure in critically ill patients who are experiencing progressive failure of multiple organ systems. An aggressive approach to the manifestations of organ failure, including acalculous cholecystitis, must be employed.
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PMID:Acute acalculous cholecystitis in the critically ill patient. 618 83

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.
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PMID:Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis. 653 18

Acute acalculous cholecystitis is uncommon, but not rare. Classically, this disease is observed in the intensive care unit associated with major trauma, burns, or surgery. Moreover, comorbidity such as infection, hypertension, and diabetes mellitus is often found. Although the exact pathogenesis is still not fully understood, it may be multifactorial and ischemia seems to play a central role. We herein report an unusual case of acute alithiasic cholecystitis predisposing to a de Bakey type III aortic dissection. A 57-year-old man was referred to our hospital for investigation of persistent right upper abdominal pain with tenderness and fever, associated with a newly diagnosed aortic dissection treated conservatively. The diagnosis of acalculous cholecystitis, which is often difficult to establish, was particularly delayed. An open cholecystectomy was performed, revealing a preperforating gangrenous gallbladder without any stones. The patient was discharged from hospital 9 days postoperatively without any early or late complications. No operative treatment for the aortic dissection was needed.
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PMID:Acute acalculous cholecystitis associated with aortic dissection: report of a case. 1288 5

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.
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PMID:Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. 1725 93

Acute acalculous cholecystitis (AAC), inflammation of the gallbladder without evidence of calculi, comprises approximately 10% of all cases of acute cholecystitis. Although the mechanism of AAC has not yet been sufficiently clarified, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis and ischemia. We present a case of AAC associated with ischemia of the gallbladder caused by aortic dissection Bakey type III.
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PMID:Acute acalculous cholecystitis induced by aortic dissection: report of a case. 2051 60

Acute acalculous cholecystitis is defined by ultrasonographic, intraoperative and pathologic findings of acute cholecystitis, without evidence of gallstones. It is associated to recent operations, trauma, burns, multisystem organ failure and parenteral nutrition. It can also occur as the first episode, in patients with pathological conditions which generate local ischemia: diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure. The authors present a series of 20 patients, operated in the Surgical Department of the Clinical Hospital "Dr. I. Cantacuzino", between 2004 and 2010. There are analysed the significant risk factors, the diagnostic methods and the surgical procedures--laparoscopic or classical cholecystectomies. Among the 20 patients, 14 had a favorable postoperative evolution, 4 had wound infections and in 1 patient a cerebral vascular stroke occurred in the 2nd day after the operation. Another patient died 3 days after the operation, due to an extended myocardial infarction. The medical literature referring to this subject is also reviewed.
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PMID:[Acute acalculous cholecystitis--difficulties of diagnosis and treatment]. 2094 66

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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PMID:Acute acalculous cholecystitis immediately after gastric operation: case report and literatures review. 2513 87


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