title: Factors effecting the complications in the natural history of acute cholecystitis.
abstract: OBJECTIVE
  Gangrenous cholecystitis, empyema, gallbladder perforation, and biliary peritonitis are severe complications of acute cholecystitis associated with increased morbidity and mortality. This study aimed to evaluate perioperative factors associated with complications of acute cholecystitis.
  
  
  METHODS
  Between January 1993 and October 2000, we performed cholecystectomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultrasound, operative and microbiological findings, morbidity and mortality.
  
  
  RESULTS
  There were 305 cases (83%) of acute uncomplicated cholecystitis, 26 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladder, 12 (3.3%) of gallblader perforation, and 2 (0.5%) emphysematous cholecystitis. Risk factors for complicated cholecystitis included male gender, advanced age, associated diseases, temperature above 38 degrees C, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystectomy was attempted on 36 patients (11.8%) with uncomplicated and seven patients (11.1%) with complicated acute cholecystitis. The conversion rate to open cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicated cases. There were no differences in operative complications between complicated and uncomplicated cases, however, length of hospital stay, postoperative morbidity and mortality were significantly higher in complicated cases.
  
  
  CONCLUSIONS
  Sex (male), advanced age, presence of associated disease, high temperature (> 38 degrees C) and leukocytosis are all remarkable risk factors inducing complications in acute cholecystitis. Laparoscopic cholecystectomy can be performed with success in uncomplicated cases.
authors.affiliation: Department of General Surgery, University of Erciyes School of Medicine, 38039, Kayseri, Turkey. bedirlia@erciyes.edu.tr
authors.forename: A
authors.initials: A
authors.lastname: Bedirli
authors.forename: O
authors.initials: O
authors.lastname: Sakrak
authors.forename: E M
authors.initials: EM
authors.lastname: Sözüer
authors.forename: M
authors.initials: M
authors.lastname: Kerek
authors.forename: I
authors.initials: I
authors.lastname: Güler
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002768:Choledochostomy; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic