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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies

Abstract

Purpose

Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database.

Materials and methods

This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database.

Results

LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients.

Conclusions

We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.

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Acknowledgments

The authors acknowledge support from the following source: The Center for Advanced Surgical Technology at the University of Nebraska Medical Center.

Authors’ contributions

Dmitry Oleynikov, MD did the study conception and design. Charles Treinen, BS and Daniel Lomelin, MPH performed the acquisition of data and did the analysis and interpretation of data. Charles Treinen, BS; Daniel Lomelin, MPH; and Crystal Krause, PhD drafted the manuscript. Charles Treinen, BS; Daniel Lomelin, MPH; Crystal Krause, PhD; and Dmitry Oleynikov, MD critically revised the manuscript.

Ethics statement

This study utilized the University HealthSystem Consortium database, which uses de-identified patient information, and as such does not require informed consent or IRB approval. The manuscript does not contain clinical studies or individual patient data.

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None.

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Treinen, C., Lomelin, D., Krause, C. et al. Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 400, 421–427 (2015). https://doi.org/10.1007/s00423-014-1267-6

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Keywords

  • Acute acalculous cholecystitis
  • Open cholecystectomy
  • Laparoscopic cholecystectomy
  • Percutaneous cholecystostomy