Acute acalculous cholecystitis in critically injured patients. Preoperative diagnostic imaging.
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.
Cornwell
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Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
Rodriguez
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Mirvis
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Shorr
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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