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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 4/2015

01-05-2015 | Review Article

Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies

Authors: Charles Treinen, Daniel Lomelin, Crystal Krause, Matthew Goede, Dmitry Oleynikov

Published in: Langenbeck's Archives of Surgery | Issue 4/2015

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Abstract

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.
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Metadata
Title
Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies
Authors
Charles Treinen
Daniel Lomelin
Crystal Krause
Matthew Goede
Dmitry Oleynikov
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 4/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-014-1267-6

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