TY - JOUR
T1 - Acute acalculous cholecystitis in the critically ill
T2 - risk factors and surgical strategies
AU - Treinen, Charles
AU - Lomelin, Daniel
AU - Krause, Crystal
AU - Goede, Matthew
AU - Oleynikov, Dmitry
N1 - Funding Information:
The authors acknowledge support from the following source: The Center for Advanced Surgical Technology at the University of Nebraska Medical Center.
Publisher Copyright:
© 2014, Springer-Verlag Berlin Heidelberg.
PY - 2015/5/26
Y1 - 2015/5/26
N2 - Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
AB - Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
KW - Acute acalculous cholecystitis
KW - Laparoscopic cholecystectomy
KW - Open cholecystectomy
KW - Percutaneous cholecystostomy
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U2 - 10.1007/s00423-014-1267-6
DO - 10.1007/s00423-014-1267-6
M3 - Review article
C2 - 25539703
AN - SCOPUS:84929844237
VL - 400
SP - 421
EP - 427
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
SN - 1435-2443
IS - 4
ER -