title: Preoperative complications of gallstones and their relevance to treatment and prognosis: experience with 451 cases.
abstract: Of 451 patients with cholelithiasis, 273 suffered from 396 preoperative complications; the common ones were acute cholecystitis (n = 120), jaundice (n = 135), and acute pancreatitis (n = 52). Of the 195 patients under the age of 50 years 48% had complications, compared with 70% of the 256 above the age of 50 years. For acute cholecystitis and acute pancreatitis, an interval cholecystectomy was carried out 3-6 wk after initial conservative treatment. Except in the 33 cases with obstructive jaundice of indeterminate etiology (n = 15) or jaundice associated with uncontrollable cholangitis (n = 18), surgery in icteric patients was deferred until serum bilirubin became normal or reached a plateau. Routine intraoperative radiology detected unsuspected stones in common bile ducts in 11 cases. In all, 139 choledochotomies were carried out; the frequency of ductal exploration rose after the age 50 years. Operative elimination of sphincter of Oddi (by sphincteroplasty or by choledochoduodenostomy) was required in 82 cases. Bile culture was positive in only 17 of 178 cases without preoperative complications but in 97 of 273 with preoperative complications. Of the 21 cases who died, 19 had preoperative complications and 66% had positive bile culture. Nine of 139 requiring choledochotomy died. Mortality after 60 years was 15 of 119.
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001646:Bile / Q000382:microbiology; D002648:Child; D002764:Cholecystitis / Q000209:etiology; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D009803:Sphincter of Oddi / Q000601:surgery; D013997:Time Factors