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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A transversal retrolective analysis of all patients undergoing surgical treatment for cholelithiasis and choledocholithiasis between 1980 and 1987 was performed. The aim of the study was to investigate risk factors for the development of postoperative complications and mortality in elderly patients. A group of 187 patients above 70 years old were comparatively analyzed with 962 younger patients (total group: 1,149). Medical records were evaluated with emphasis to the diagnosis, associated diseases, characteristics of the surgical treatment, postoperative complications and mortality. Fifty percent of the elderly patients presented one or more concomitant diseases which significantly contributed to their operative risk. Acute cholecystitis, choledocholithiasis and cholangitis were more frequently found in aged patients (p < 0.05). In this group more patients also required bile duct exploration (p < 0.005). Major complications occurred in 16% and nine developed wound infection (5%). Operative mortality was 5.3%. In contrast, operative mortality of patients under 70 years of age was 1.5% and postoperative complications occurred infrequently. Acute cholecystitis, congestive heart failure, a history of myocardial infarction, and liver insufficiency were found as specific risk factors in the elderly.
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PMID:[Surgical treatment of biliary lithiasic disease in elderly patients]. 130 95

Sonographic identification of thickening of the gallbladder wall that consists of multiple striations (alternate hypoechoic and hyperechoic layers) has been considered strong evidence of the presence of acute cholecystitis. We studied 27 patients in whom sonograms showed striated thickening of the gallbladder wall to determine the diagnostic significance of this finding. Striations were classified as focal or diffuse. Sonograms were correlated with pathologic findings in 16 patients and with clinical diagnoses and laboratory findings in 11. Patients were categorized as having cholecystitis with or without gangrene or edema of the gallbladder wall unrelated to gallbladder disease. Striated thickening of the gallbladder wall was due to cholecystitis in 10 patients, and all 10 had gangrenous changes at surgery or at pathologic examination. Striations were focal in eight of these patients and diffuse in two. Striated thickening of the gallbladder wall was due to edema of the wall unrelated to gallbladder disease in 17 patients. Causes included congestive heart failure (n = 4), renal failure (n = 5), liver disease (hepatic failure [n = 1], hepatitis [n = 6]), ascites (n = 2), hypoalbuminemia (n = 3), pancreatitis (n = 1), blockage of the lymphatic/venous drainage of the gallbladder (n = 2), and prominent Rokitansky-Aschoff sinuses (n = 1). More than one abnormality was present in five patients. Striations were focal in 11 of these patients and diffuse in six. The sonographic finding of striated gallbladder wall thickening is no more specific for cholecystitis than the observation of gallbladder wall thickening by itself, and it may occur in a variety of diseases. However, in the clinical setting of acute cholecystitis, the presence of striations suggests gangrenous changes in the gallbladder. The extent of the striations (focal or diffuse) is not useful in predicting the cause of the striated gallbladder wall thickening.
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PMID:Sonography of the gallbladder: significance of striated (layered) thickening of the gallbladder wall. 201 56

Forty-nine patients with clinical signs of acute cholecystitis underwent conventional and computed tomographic cholangiography. Among 39 patients with signs of contrast medium in the biliary system at both examinations there was a diagnostic discrepancy in only one patient. Conventional radiography demonstrated cholecystopathy in this patient while contrast medium in the gallbladder and an acute pancreatitis were found at computed tomography. Ten patients with an indeterminate conventional cholangiography had a conclusive computed tomographic examination. Twenty of 30 patients with an abnormal computed tomographic cholangiography underwent cholecystectomy and all had diseased gallbladders. All 17 patients with histopathologically confirmed acute cholecystitis had signs of subserosal edema and/or changes in the omental fatty tissue adjacent to the gallbladder at computed tomography. A layer of tissue of water-density adjacent to the gallbladder and/or changes in omental fatty tissue were also seen in one patient with congestive heart failure and in one with a penetrating duodenal ulcer. None of the 19 patients with a normal computed tomographic cholangiography had a proven acute cholecystitis.
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PMID:Intravenous computed tomographic cholangiography in acute cholecystitis. A comparison with conventional cholangiography. 648 61

Sixty-three patients, 49 men and 14 women, developed acute cholecystitis without gallbladder stones. Only eight patients had a history suggestive of gallbladder disease. In 17 patients cholecystitis developed in the postoperative period, and cholecystitis occurred in 7 patients who had extensive trauma. The signs and symptoms did not differ markedly from those found when acute cholecystitis is associated with cholelithiasis. Pain and tenderness in the right upper abdominal quadrant, vomiting, abdominal distention, decreased bowel sounds, jaundice and fever were common. Thirty (47.6 percent) gallbladder specimens had gangrene, and perforation occurred in five instances. Bacteria were cultured from 28 of 43 bile specimens. E. coli was the most common organism. A high incidence of acalculous gallbladders is found when acute cholecystitis occurs in the postoperative period or after trauma and in children. Decreased blood flow to the gallbladder, cystic duct obstruction and concentrated bile are necessary to produce experimental cholecystitis. These factors are probably necessary in humans also. Decreased gallbladder perfusion caused by shock, congestive heart failure and arteriosclerosis probably contributed to the development of acute acalculous cholecystitis in these patients.
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PMID:Acute acalculous cholecystitis. 745 36

From August 1989 to January 1993, the authors performed laparoscopic biliary operations in 900 patients, 13 of whom had severe cardiac dysfunction. Nine patients were Goldman Class IV, and four patients were Goldman Class III. Three patients had recent myocardial infarction, five patients were known to have low left ventricular ejection fractions (10%, 21%, 25%, 26%, and 30%), one had severe myocardial ischemia, one had severe congestive heart failure, and one was in profound shock. Nine patients underwent successful laparoscopic cholecystectomy. Laparoscopic cholecystostomies were performed in three patients. One operation was converted to an open cholecystectomy. There was one death within 30 days of surgery. With appropriate hemodynamic monitoring and adequate perioperative support of cardiac function, laparoscopic cholecystectomy can be performed safely for acute cholecystitis in patients with severe cardiac disease. When compared with historical controls, laparoscopic cholecystectomy appears to be safer than open cholecystectomy.
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PMID:Laparoscopic cholecystectomy in critically ill cardiac patients. 825 28

Using a statewide hospital discharge database and a novel epidemiology method, sequence symmetry analysis (Epidemiology. 1996;7:478-84), I examined the relative risk for hospital admission for acute cholecystitis after admission for myocardial infarction. In sequence symmetry analysis, the ratio of the number of subjects in a fixed population who experienced two events in a "causal" vs "noncausal" temporal sequence estimates the incidence rate ratio (IRR). Of 514 patients admitted for both myocardial infarction and acute cholecystitis during a 3-year window period, 295 were admitted for myocardial infarction first and 219 for acute cholecystitis first, yielding a null sequence-adjusted IRR of 1.45 [95% confidence interval (CI) = 1.28-1.64]. A similar analysis for a known relation (myocardial infarction-->congestive heart failure, N = 27,850) showed the expected association [adjusted IRR = 1.92 (95% CI = 1.88-1.95)], whereas an analysis for a relation hypothesized not to be strong (congestive heart failure-->acute cholecystitis, N = 775) showed only a small association [adjusted IRR = 1.16 (95% CI = 1.05-1.28)]. Subgroup analysis revealed time courses that supported each relation as causal. Hospitalization for myocardial infarction may increase the risk for subsequent hospitalization for acute cholecystitis.
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PMID:Myocardial infarction and acute cholecystitis: an application of sequence symmetry analysis. 1087 53

Acute cholecystitis requires a prompt diagnosis and early surgical treatment, either open or laparoscopic surgery. Currently, most of the patients can be treated by laparoscopic surgery.Delayed surgery of acute cholecystitis must be considered only if the patient has other clinical conditions such as congestive heart failure, other uncontrolled disease, and whenever cholecystitis is not complicated (epyema, perforation, gangrene, cholangitis, etc.) Percutaneous cholecystostomy by interventionist radiologist or surgical cholecystostomy must be considered in the therapeutic armamentarium in patients with poor clinical conditions. Acute cholangitis management requires a multidisciplinary team approach of internists, gastroenterologists, interventionist radiologists and surgeons. Each patient requires an integral evaluation with an initial energic medical treatment, followed by drainage of the biliary tract, ideally by endoscopic sphincterectomy or by transhepatic percutaneous drainage. Only if these procedures do not solve the patient's problem, or if its application is not possible, we proceed with an emergency surgery in order to decompress the biliary tree.
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PMID:[SURGICAL MANAGEMENT OF BILIARY TRACT INFECTIONS] 1229 86

Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered.
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PMID:Acute acalculous cholecystitis. 1286 60

Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high-risk patients. Although the success rate of endoscopic gallbladder stenting is 79%-100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035-inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7-Fr 12-cm double-pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.
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PMID:Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt. 1613 94

Evaluation and management of abdominal pathology in patients with ventricular assist devices is likely to become increasingly important as the utilization of these devices expands. Ventricular assist devices represent a class of intracorporeal or paracorporeal mechanical devices that augment cardiac output in patients with congestive heart failure. Patients with ventricular assist devices supporting both right and left ventricles (biventricular assist devices) are uniquely challenging to the general surgeon because these devices restrict direct access to the abdominal cavity and because of the perioperative implications of biventricular heart failure. We describe herein the first reported successful laparoscopic cholecystectomy in a patient with a paracorporeal biventricular assist device. Cholecystectomy was performed in this patient for acute cholecystitis that occurred while the patient was awaiting heart transplantation. Our results add weight to the small body of evidence that laparoscopy is well tolerated in ventricular assist devices patients. The unique aspects of the biventricular assist device patient make laparoscopic abdominal intervention particularly suitable in this patient population.
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PMID:Laparoscopic cholecystectomy in a patient with a biventricular cardiac assist device. 1638 73


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