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Acute acalculous cholecystitis complicating trauma: A prospective sonographic study

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Abstract

Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (>3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow-up of this complication.

Résumé

La cholécystite aiguë alithiasique (CAL) est une complication bien connue chez le polytraumatisé grave. La plupart des données de la littérature émanent d'analyses rétrospectives ou de cas isolés. Entre le 1er Janvier 1989 et le 30 Juin 1990, 45 patients admis dans notre unité de soins intensifs ont eu, à des intervalles bien définis, un examen clinique et échographique de façon prospective. Deux indices, le “ISS” ou “injury severity score” et le “PTS” ou “polytrauma score”, ont été calculées. La CAL a été définie comme la combinasion d'hydrocholécyste avec épaississement de la paroi vésiculaire (>3.5 mm) et de la présence de sludge. Cette triade a été retrouvée chez 8 des 45 patients (18%). Une cholécystectomie précoce a été décidée chez un de ces patients, alors que les 7 autres ont été traités médicalement. L'incidence de CAL chez le polytraumatisé grave est sûrement plus élévée qu'il n'est classique de le dire. L'échographie est une méthode fiable pour la détection précoce et pour suivre cette complication post-traumatique.

Resumen

La colelitiasis acalculosa (CAA) es una reconocida complicación en pacientes con trauma severo. El conocimiento sobre la CAA emana de análisis retrospectivos y de reportes esporádicos de casos individuales. En un estudio prospectivo se investigó esta entidad por medio de examenes clínicos y sonográficos seriados en 45 pacientes politraumatizados que ingresaron a nuestra unidad de cuidado intensivo entre el 1° de enero de 1989 y el 30 de junio de 1990. La severidad del trauma fue determinada mediante el ISS (Injury-Severity-Score) y el PTS (Polytrauma-Score). La CAA fue definida como la combinación de hidrops de la vesícula biliar, aumento del aspesor de la pared (>3.5 mm) y la demonstración de barro biliar. Esta traida diagnóstica pudo ser documentada en 8 de 45 pacientes (=18%). Consecuentemente, se preacticó colecistectomía precoz electiva en 1 de 8 pacientes con la traida diagnóstica de CAA; el resto de los casos fue tratado en forma conservadora. La incidencia de CAA es más alta de lo que sugieren las estadísticas publicadas. La ultrasonografía constituye un método confiable de detección precoz y de seguimiento de esta complicación.

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Authors and Affiliations

  1. Department of General and Trauma Surgery, Heinrich-Heine-University, Moorenstr. 5, 4000, Düsseldorf, Federal Republic of Germany

    M. Imhof, J. Raunest, Ch. Ohmann &  H. -D. Röher

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  1. M. Imhof
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  4. H. -D. Röher
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Imhof, M., Raunest, J., Ohmann, C. et al. Acute acalculous cholecystitis complicating trauma: A prospective sonographic study. World J. Surg. 16, 1160–1165 (1992). https://doi.org/10.1007/BF02067089

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