title: Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging.
abstract: The potential lethality and predisposing factors of acute acalculous cholecystitis (AAC) are well established; however, preoperative diagnosis remains a challenge. This update of a previous report of 30 cases of AAC at a Level I trauma center describes 14 multiply injured patients who developed AAC and underwent cholecystectomy. All 14 patients had acutely inflamed gallbladders; 6 (42.8%) had areas of necrosis or gangrene. The mortality rate was 7% (1 patient). While the percentage of patients receiving prolonged intensive care (100%), narcotic analgesics (100%), and TPN (93%) correlates with the experience cited previously, the percentage undergoing preoperative diagnostic imaging is unusually high, reflecting a heightened suspicion for AAC. Computed tomographic or sonographic evidence of gallbladder wall thickness greater than or equal to 4 mm, pericholecystic fluid or subserosal edema without ascites, intramural gas, or a sloughed mucosal membrane was considered diagnostic criteria for AAC. We conclude that preoperative computed tomogram or ultrasound imaging leads to earlier recognition of this life-threatening problem.
authors.affiliation: Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
authors.forename: E E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
authors.forename: S E
authors.initials: SE
authors.lastname: Mirvis
authors.forename: R M
authors.initials: RM
authors.lastname: Shorr
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D002764:Cholecystitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D012189:Retrospective Studies; D014463:Ultrasonography