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

In 460 cholecystectomies performed for acute cholecystitis 215 (47%) positive gallbladder bile cultures were obtained. In 73% of emergency operations bacteria were recovered, in 48% of early operations (p less than 0.001) and in 29% of late operations (p less than 0.001). In vitro concentrations of 8-16 mcg/ml of ampicillin or cephalothin inhibited in most cases the growth of E. coli, Klebsiella and Enterococci, which comprised 75% of all strains isolated. One hour after intravenous infusion of 1 g ampicillin the mean serum level was 21 mcg/ml, the mean common duct level 16 mcg/ml and the mean gallbladder bile level 4.4 mcg/ml. In acute cholecystitis 2 g cephalothin gave mean concentrations of 14, 8, and 1.2 mcg/ml. Most of these patients had cystic duct obstruction both on intravenous cholegraphy and during operation. Control patients with patent cystic ducts who received ampicillin had mean gallbladder and common duct bile levels of 47 and 56 mcg/ml, and those receiving cephalothin 23 and 28 mcg/ml. It appears that adequate gallbladder bile concentrations of antibiotics are not attainable in acute cholecystitis because of the obstruction to the bile flow. The favourable results of prophylactic antibiotic treatment in reducing septic complications seem to depend more on adequate serum and tissue concentrations than on the concentration of antibiotics in the bile.
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PMID:Antibiotics in acute cholecystitis. 73 4

Perforation of the gallbladder into the retroperitoneum is a very rare event. A case report is given of a 71 year old patient suffering from acute cholecystitis. A perforation occurred and a retroperitoneal abscess developed. Cholecystectomy, appendectomy and retroperitoneal drainage were performed, and the patient recovered. A review from the literature is given covering 6 other cases.
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PMID:[Retroperitoneal perforation of the gallbladder (author's transl)]. 73 16

The authors consider the urgent surgery for acute cholecystitis complicated with pancreatitis and with marked bile and pancreatic hypertension to be indicated. In their opinion, the best method of eliminating the cause of duct hypertension in the bile and pancreatic duct system is the transduodenal dissection of the papilla followed with papillocholedochoplasty combined in some patients with plasty of the Wirsung's duct. A separate drainage of the common bile duct and main pancreatic duct according to the Doubilet's method was used. Cholecystectomy was carried out upon all the patients. On patient died of progressive pancreonecrosis.
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PMID:[Transduodenal transpapillar operations in acute cholecystitis complicated by pancreatitis]. 74 66

In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.
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PMID:Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones. 74 32

A retrospective analysis has been made of 89 patients, who were treated for acute pancreatitis and later underwent cholecystectomy. The object was to elucidate whether cholecystectomy can be performed soon after recovery from the pancreatitis ('early operation') or must be postponed a few months ('elective operation'). While waiting for operation a quarter of the patients in the elective group had a recurrent attack of pancreatitis or acute cholecystitis. A further quarter of the patients had slight symptoms. The postoperative complications were few, their frequency being comparable in both groups. No damage resulted to the common bile duct, there was no postoperative bleeding and only one case of postoperative pancreatitis in the group of patients operated early. It is concluded that 'early operation' is to be preferred provided a firm diagnosis of gallstone disease has been made. However, the oral cholecystogram is unreliable during the first three weeks after the attack of pancreatitis. If an oral cholecystogram is performed during these weeks and shows nonvisualization of the gallbladder but no stones, a repeated examination must be performed.
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PMID:The timing of cholecystectomy in patients with gallstone pancreatitis. A retrospective analysis of 89 patients. 74 68

The Author describes 151 cases of acute cholecystitis in patients ranging from 70 to 95 years of age. He examines then the literature on the subject paying attention to the treatment of cases of acute cholecyst disease in aged patients. The Author shows the outstanding features of these cases in synoptic tables and discusses them making a comparison with the materials and results of the colleagues. Leaving necessarily aside the urgent operations a discussion is made on the choice between a cholecyst extirpation and a cholecyst anastomosis. On course, advantages and disadvantages of such operations in aged and weakened patients are taken into account. Death percentage results to be equal to 26,4%, a figure which is not far from that furnished by other statistics, bearing in mind the age of the patients.
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PMID:[The acute calculus cholecystitis in the elderly patients. (Prognosis and therapy (author's transl)]. 75 42

A case of acute cholecystitis in a patient of 66 is reported. The aetiopathogenetic aspects are examined with particular regard to the microbiology of such forms, the particular radiological and anatomo-pathological findings and the medical and surgical implications, in the light of a review of the question.
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PMID:[Acute emphysematous cholecystitis]. 75 24

Twelve patients developed acute cholecystitis complicating trauma. Acute acalculus cholecystitis was present in 11 patients. Nine patients died. A review of 20 reports comprising 98 patients shows 86.7% had acute acalculus cholelithiasis, and 61.1% had necrosis, gangrene, and/or perforation of the gallbladder. The overall mortality was 33.3% and only 16.1% of patients treated by cholecystectomy died. The etiology of acute cholecystitis complicating trauma is multifactorial. Gallstones are present infrequently whereas shock, increased bile pigment load, drugs, surgery, and (other) trauma are common precursors. Diagnosis is difficult and depends upon clinical suspicion and the physical examination. Immediate surgical intervention is required. Cholecystectomy is the procedure of choice. We recommend cholecystectomy at initial laparotomy whenever there is evidence of trauma to the gallbladder, or if the right or common hepatic artery is ligated for hepatic bleeding.
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PMID:Acute cholecystitis complicating trauma. 75 68

99mTc-IDA (99mTc-dimethyl-acetanilide-iminodiacetic acid) hepato-biliary imaging was evaluated for its efficacy in distinguishing acute cholecystitis from acute pancreatitis. In a retrospective review, gallbladders were demonstrated by 99mTc-IDA in 13 of 15 patients (87%) with acute pancreatitis. This is significantly higher than reports on the frequency of gallbladder filling with oral and intravenous cholangiography in the presence of acute cholecystitis.
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PMID:99mTc-IDA imaging in the differential diagnosis of acute cholecystitis and acute pancreatitis. 76 Jan 73

The high incidence of calculous biliary tract disease accounts for surgical operation upon the biliary tract disease accounts for surgical operation upon the biliary tract being the most frequently performed within the abdomen. Untreated surgically critical sequelae tend to occur with advancing age and duration of the disease. The more common of these are: acute cholecystitis, choledocholithiasis, acute obstructive suppurative cholangitis, biliary enteric fistulas, liver abscess, related pancreatitis, and biliary cirrhosis. The greater the pathological changes in the biliary tract and the more debilitated the individual, the greater is the risk of surgery. However, the risk is even greater without operation.
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PMID:Critical sequelae in biliary tract disease. 78 79


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