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The management of acute cholecystitis

  • Published:
The American Journal of Digestive Diseases

Summary and Conclusions

  1. 1.

    Acute cholecystitis is usually dependent on an obstruction to the outlet of the gall bladder with interruption in the blood supply to the organ. In over 92 per cent of cases the obstructing agent is a calculus. Secondary infection of the ischemic areas may or may not occur.

  2. 2.

    Acute cholecystitis is a dangerous condition. Under conservative treatment perhaps 25 per cent of the patients will get worse. Serious complications such as empyema, gangrene, perforation of the gall bladder and generalized peritonitis frequently occur.

  3. 3.

    Unfortunately in these cases there is no good correlation between the severity of the clinical manifestations and the severity of the disease. Furthermore, it is impossible to predict in any one case whether the disease will quiet down or get worse.

  4. 4.

    Statistics show that the mortality is great in the “early” operations done after the symptoms have been present for forty-eight hours. Operations done within forty-eight hours after the onset of the acute attack have had the lowest mortality rate. Unfortunately few patients reach a hospital within this interval.

  5. 5.

    It is inadvisable, however, to operate on every patient seen within forty-eight hours after the onset of acute symptoms. If such an early operation is done as a routine many diagnoses will be wrong and patients will be operated on unnecessarily.

  6. 6.

    Patients and the disease vary widely, and hence the treatment must be individualized.

  7. 7.

    A plan of procedure which has been employed successfully in the management of patients with acute cholecystitis is outlined.

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Authors and Affiliations

  1. Gastro-Intestinal Service of Dr. Henry L. Bockus, Department of Medicine, Graduate Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

    J. Edward Berk

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  1. J. Edward Berk
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Full time Clinical Assistant in Gastro-enterology, Graduate Hospital of the University of Pennsylvania.

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Berk, J.E. The management of acute cholecystitis. Jour. D. D. 7, 325–332 (1940). https://doi.org/10.1007/BF02999359

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