[Acute cholecystitis. Do you send the patient to the operating room or to bed?].
Acute cholecystitis is increasingly becoming a disease of the elderly. The condition begins with colic-like pain in the upper abdomen radiating to the right shoulder, and is accompanied by fever, nausea and vomiting. The diagnosis is confirmed by tenderness and palpable resistance in the right upper abdomen. Ultrasound detects the stone in 95% of cases, and confirms the diagnosis. Differential diagnostic considerations include appendicitis, duodenal or gastric ulcer, and myocardial infarction. Early cholecystectomy is associated with a low complication rate which, however, increases, the longer the intervention is delayed. Laparoscopic cholecystectomy has a lower complication rate and a reduced hospital stay; the reported mortality rate is between 0% and 3.5%. Conventional cholecystectomy is recommended when there is concomitant choledocholithiasis and no possibility of carrying out ERCP, and in patients with previous upper abdominal surgery. Conservative treatment is applied when the patient refuses surgery or is at high risk from anaesthesia.
Waninger
J
J
Chirurgischen Abteilung, Kreiskrankenhaus Lörrach. waninger.joerg@klinloe.de
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001510:Bed Rest; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D011379:Prognosis