Top

World Journal of Emergency Surgery

Published in:

Open Access 01-12-2018 | Research article

Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis

Authors: Stefan Jansen, Maciej Stodolski, Hubert Zirngibl, Daniel Gödde, Peter C. Ambe

Published in: World Journal of Emergency Surgery | Issue 1/2018

Abstract

Background

Acute perforated cholecystitis (APC) is probably the most severe benign gallbladder pathology with high rates of morbidity and mortality. The cause of APC has not been fully understood. We postulated that APC is a complication of advanced gallbladder inflammation. The aim of this study was to investigate the extent of gallbladder inflammation in patients with APC.

Methods

Patients with intraoperative and histopathologic diagnosis of APC were compared with cases with acute cholecystitis without perforation with respect to the extent of inflammation on histopathology as well as surgical outcomes.

Results

Fifty patients with APC were compared to 150 cases without perforation. Advanced age > 65 years and elevated CRP were confirmed on multivariate analysis as independent risk factors for APC. Advanced gallbladder inflammation was seen significantly more often in patients with APC (84.0 vs. 18.7%). Surgery lasted significantly longer 131.3 ± 55.2 min vs. 100.4 ± 47.9 min; the rates of conversion (22 vs. 4%), morbidity (24 vs. 7%), and mortality (8 vs. 1%) were significantly higher in patients with APC. ICU management following surgery was needed significantly more often in the APC group (56 vs. 15%), and the overall length of stay (11.2 ± 12.0 days vs. 5.8 ± 6.5 days) was significantly longer compared to the group without perforation.

Conclusion

Acute gallbladder perforation in patients with acute cholecystitis represents the most severe complication of cholecystitis. Acute perforated cholecystitis is a sequela of advanced gallbladder inflammation like empyematous and gangrenous cholecystitis and is associated with poor outcome compared to non-perforated cases.

Jansen S, Doerner J, Macher-Heidrich S, Zirngibl H, Ambe PC. Outcome of acute perforated cholecystitis: a register study of over 5000 cases from a quality control database in Germany. Surg Endosc. 2017;31(4):1896–900.CrossRefPubMed

Ambe PC, Jansen S, Macher-Heidrich S, Zirngibl H. Surgical management of empyematous cholecystitis: a register study of over 12,000 cases from a regional quality control database in Germany. Surg Endosc. 2016;30(12):5319–24.CrossRefPubMed

Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I. Prognostic parameters for the prediction of acute gangrenous cholecystitis. J Hepato-Biliary-Pancreat Surg. 2006;13(2):155–9.CrossRef

Ambe PC, Kohler L. Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis? Int Surg. 2015;100(5):854–9.CrossRefPubMedPubMedCentral

Botaitis S, Polychronidis A, Pitiakoudis M, Perente S, Simopoulos C. Does gender affect laparoscopic cholecystectomy? Surg Laparosc Endosc Percutan Tech. 2008;18(2):157–61.CrossRefPubMed

Kanakala V, Borowski DW, Pellen MG, Dronamraju SS, Woodcock SA, Seymour K, Attwood SE, Horgan LF. Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg. 2011;9(4):318–23.CrossRefPubMed

Kortram K, van Ramshorst B, Bollen TL, Besselink MGH, Gouma DJ, Karsten T, Kruyt PM, Nieuwenhuijzen GAP, Kelder JC, Tromp E, et al. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials. 2012;13

Laurila J, Syrjala H, Laurila PA, Saarnio J, Ala-Kokko TI. Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand. 2004;48(8):986–91.CrossRefPubMed

Cho JY, Han HS, Yoon YS, Ahn KS. Risk factors for acute cholecystitis and a complicated clinical course in patients with symptomatic cholelithiasis. Archives of surgery (Chicago, Ill : 1960). 2010;145(4):329–33. discussion 333CrossRef

10.

Fagan SP, Awad SS, Rahwan K, Hira K, Aoki N, Itani KM, Berger DH. Prognostic factors for the development of gangrenous cholecystitis. Am J Surg. 2003;186(5):481–5.CrossRefPubMed

11.

Niemeier OW. Acute free perforation of the gall-bladder. Ann Surg. 1934;99(6):922–4.CrossRefPubMedPubMedCentral

12.

Papadakis M, Ambe PC, Zirngibl H. Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation. World J Emerg Surg. 2015;10:59.CrossRefPubMedPubMedCentral

13.

Ambe PC, Papadakis M, Zirngibl H. A proposal for a preoperative clinical scoring system for acute cholecystitis. J Surg Res. 2016;200(2):473–9.CrossRefPubMed

14.

Ambe PC, Christ H, Wassenberg D. Does the Tokyo guidelines predict the extent of gallbladder inflammation in patients with acute cholecystitis? A single center retrospective analysis. BMC Gastroenterol. 2015;15(1):142.CrossRefPubMedPubMedCentral

15.

Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepato-Biliary-Pancreat Surg. 2007;14(1):15–26.CrossRef

16.

Kimura Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Buchler MW, Windsor JA, Mayumi T, Yoshida M, et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):8–23.CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral

18.

Nazeer MA, Ali M, Ahmed K, Saleem R, Ali M, Suleman B. Outcomes of laparoscopic cholecystectomy in the elderly versus young patients. Pak J Med Health Sci. 2012;6(3):544–6.

19.

Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002;325(7365):639–43.CrossRefPubMedPubMedCentral

20.

Ausania F, Guzman Suarez S, Alvarez Garcia H, Senra del Rio P, Casal Nunez E. Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surg Endosc. 2015;29(4):955–60.CrossRefPubMed

21.

Ambe PC, Kaptanis S, Papadakis M, Weber SA, Jansen S, Zirngibl H. The treatment of critically ill patients with acute cholecystitis. Dtsch Arzteblatt Int. 2016;113(33–34):545–51.

22.

Ambe PC, Zirngibl H. The fate of patients managed with percutaneous cholecystostomy for acute cholecystitis. Surgery. 2016;159(5):1479–80.CrossRefPubMed

23.

Anderson JE, Inui T, Talamini MA, Chang DC. Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res. 2014;190(2):517–21.CrossRefPubMed

24.

Gurusamy KS, Rossi M, Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev. 2013;8:CD007088.

25.

Winbladh A, Gullstrand P, Svanvik J, Sandstrom P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11(3):183–93.CrossRef

Title: Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis
Authors: Stefan Jansen
Maciej Stodolski
Hubert Zirngibl
Daniel Gödde
Peter C. Ambe
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2018
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-018-0169-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional survey

Vacuum-assisted closure (VAC®) systems and microbiological isolation of infected wounds

ICEAGE (Incidence of Complications following Emergency Abdominal surgery: Get Exercising): study protocol of a pragmatic, multicentre, randomised controlled trial testing physiotherapy for the prevention of complications and improved physical recovery after emergency abdominal surgery

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

The abdominal wall hernia in cirrhotic patients: a historical challenge

Should ambulatory appendectomy become the standard treatment for acute appendicitis?