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Neitzel E, Laskus J, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med 2024:8850666241259421. [PMID: 38839258 DOI: 10.1177/08850666241259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Julia Laskus
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Radiology and Department of Student Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Morikawa T, Akada M, Shimizu K, Nishida Y, Izai J, Kajioka H, Miura T, Ishida M, Unno M. Current status and therapeutic strategy of acute acalculous cholecystitis: Japanese nationwide survey in the era of the Tokyo guidelines. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:162-172. [PMID: 38152049 DOI: 10.1002/jhbp.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to clarify the incidence, therapeutic modality, and prognosis of acute acalculous cholecystitis and to reveal its optimal treatment strategy. METHODS As a project study of the Japanese Society for Abdominal Emergency Medicine, we performed a questionnaire survey of demographic data and perioperative outcomes of acute acalculous cholecystitis treated between January 2018 and December 2020 from 42 institutions. RESULTS In this study, 432 patients of acute acalculous cholecystitis, which accounts for 7.04% of acute cholecystitis, were collected. According to the Tokyo guidelines severity grade, 167 (38.6%), 202 (46.8%), and 63 (14.6%) cases were classified as Grade I, II, and III, respectively. A total of 11 (2.5%) patients died and myocardial infarction/congestive heart failure was the only independent risk factor for in-hospital death. Cholecystectomy, especially the laparoscopic approach, had more preferable outcomes compared to their counterparts. The Tokyo guidelines flow charts were useful for Grade I and II severity, but in the cases with Grade III, upfront cholecystectomy could be suitable in some patients. CONCLUSIONS The proportions of severity grade and mortality of acute acalculous cholecystitis were found to be similar to those of acute cholecystitis, and laparoscopic cholecystectomy is recommended as an effective treatment option. (UMIN000047631).
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Affiliation(s)
- Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Gastroenterological Surgery, Miyagi Cancer Center, Natori, Japan
| | - Masanori Akada
- Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Kenji Shimizu
- Department of Surgery, Iwate Prefectural Iwai Hospital, Ichinoseki, Japan
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | | | - Junko Izai
- Department of Surgery, Saka General Hospital, Shiogama, Japan
| | - Hiroki Kajioka
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
- Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bozic D, Ardalic Z, Mestrovic A, Bilandzic Ivisic J, Alicic D, Zaja I, Ivanovic T, Bozic I, Puljiz Z, Bratanic A. Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:5. [PMID: 38276039 PMCID: PMC10817550 DOI: 10.3390/medicina60010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Antonio Mestrovic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Josipa Bilandzic Ivisic
- Department of Gastroenterology, General Hospital of Sibenik-Knin County, Stjepana Radica 83, 22000 Sibenik, Croatia;
| | - Damir Alicic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Ivan Zaja
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- University Department of Health Studies, University of Split, Rudjera Boskovica 35, 21000 Split, Croatia
| | - Tomislav Ivanovic
- Department of Abdominal Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Ivona Bozic
- Department of Rheumatology and Immunology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Zeljko Puljiz
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Andre Bratanic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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Filippi L, Urso L, Schillaci O, Evangelista L. Hepato-Biliary Imaging in an Acute Setting: Is There a Role for Nuclear Medicine? Semin Nucl Med 2023; 53:777-785. [PMID: 37270331 DOI: 10.1053/j.semnuclmed.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Nuclear medicine (NM) is not commonly considered as a first-line imaging modality in hepato-biliary (HB) emergencies. The aim of this review is to provide an update on the potential of NM for the imaging of HB emergencies. 99mTc-HIDA scintigraphy showed high diagnostic accuracy for acute cholecystitis, thus being particularly useful in patients at high-risk for surgery due to comorbidities and with no clear findings at US or CT. Although limitedly explored, White blood cell (WBC) scan might have a role in case of acute pancreatitis, especially for the imaging of pancreatic leukocyte infiltration and the prediction of pancreatic necrosis. Scientific literature on 18F-FDG-PET/CT in HB acute disease mainly consists of case reports or case series, describing incidental findings in oncological PET/CT scans. In patients with obstructive jaundice, PET/CT has been proposed to disclose and characterize occult tumoral etiology. Further studies are needed to evaluate the clinical usefulness of the various NM approaches in HB acute settings, particularly with respect to the emerging new technologies (eg, PET/MRI) and radiopharmaceuticals.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Luca Urso
- Department of Nuclear Medicine - PET/CT Center, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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Yamahata H, Yabuta M, Rahman M. Retrospective comparison of clinical outcomes of ultrasound-guided percutaneous cholecystostomy in patients with and without coagulopathy: a single center's experience. Jpn J Radiol 2023; 41:1015-1021. [PMID: 37029879 DOI: 10.1007/s11604-023-01422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To compare the complication rate and clinical outcomes for percutaneous cholecystostomy (PC) in patients with or without coagulopathy. MATERIALS AND METHODS We retrospectively reviewed electronic medical chart of patients who underwent ultrasound-guided PC with a 8.5-F drainage tube for acute cholecystitis between November 2003 and March 2017. We divided the patients into two groups: patients with coagulopathy (international normalized ratio > 1.5 or platelet count < 50 × 109/L or with a history of anticoagulant medication in preceding 5 days) and patients without coagulopathy. Duration of drainage, duration of hospital stay, 30-day mortality and complication rates were compared between these two groups. Student's t test, Chi-square test or Fisher's exact test was used for bivariate analyses. Age, age-adjusted Charlson Comorbidity Index (ACCI) and sepsis-adjusted complication rates were also compared. RESULTS In total, 141 patients had PC (mean age was 73.3 years [SD 13.3]; range 33-96 years; 94 men and 47 women). Fifty-two patients (36.9%) had coagulopathy and 89 patients (63.1%) were without any history of coagulopathy. Hemorrhagic complication rate was 3.5% (5 out of 141 patients, including 4 with coagulopathy and 1 without). One patient with coagulopathy died due to the hemorrhage. Duration of drainage was longer in patients with coagulopathy than patients without coagulopathy (20.0 days vs. 14.8 days; P = 0.033). No significant difference was observed with regard to duration of hospital stay (32.3 days vs. 25.6 days; P = 0.103) and 30-day mortality (7.7% vs. 1.1%; P = 0.062). The overall complication rate did not significantly differ (9.6% and 11.2%; P = 0.763), nor did age, ACCI or sepsis-adjusted complications. CONCLUSION Clinical outcomes and complications rates after PC did not statistically differ between patients with and without coagulopathy, but there was a tendency of higher risk of hemorrhage in coagulopathy patients. Therefore, the indication of this procedure should be carefully determined.
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Affiliation(s)
- Hayato Yamahata
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
| | - Minoru Yabuta
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Mahbubur Rahman
- Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
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Do YA, Yoon CJ, Lee JH, Choi WS, Lee CH. Percutaneous cholecystostomy as a definitive treatment for acute acalculous cholecystitis: clinical outcomes and risk factors for recurrent cholecystitis. Br J Radiol 2023; 96:20220943. [PMID: 37300804 PMCID: PMC10321265 DOI: 10.1259/bjr.20220943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE To investigate the outcomes of percutaneous cholecystostomy (PC) as a definitive treatment for acute acalculous cholecystitis (AAC) and to identify the risk factors for cholecystitis recurrence after catheter removal. METHODS Between January 2008 and December 2017, 124 patients who had undergone PC as definitive treatment for moderate or severe AAC. The initial clinical success, complications, and recurrent cholecystitis after PC removal were retrospectively assessed. Twenty-one relevant variables were analyzed to identify risk factors for recurrent cholecystitis. RESULTS Clinical effectiveness was achieved in 107 patients (86.3%) at 3 days and in all patients (100%) at 5 days after PC placement. Six Grade 2 adverse events occurred, including catheter dislodgement (n = 3) and clogging (n = 3), which required catheter exchange. The PC catheter was removed in 123 patients (99.2%), with a median indwelling duration of 18 days (range 5-116 days). During the follow-up period (median, 1624 days; range, 40-4945 days), five patients experienced recurrent cholecystitis (4.1%). The cumulative recurrence rates were 3.3%, 4.1%, and 4.1% at 6 months, 1 year, and 5 years, respectively. Multivariate analysis revealed that an age-adjusted Charlson comorbidity index (aCCI)≥7 positively correlated with recurrence (OR, 1.97; 95% confidence interval, 1.07-3.64; p = 0.029). CONCLUSIONS Definitive PC is a safe and effective treatment option for patients with AAC. The PC catheters can be safely removed in most patients. An aCCI≥7 was a risk factor for cholecystitis recurrence after catheter removal. ADVANCES IN KNOWLEDGE 1. Percutaneous cholecystostomy (PC) is a safe and effective as a definitive treatment in patients with acute acalculous cholecystitis (AAC).2. PC can be safely removed after recover from AAC in the majority of patients (99.2%) with low rate of recurrence of cholecystitis (4.1%).3. Age-adjusted Charlson comorbidity index ≥7 was a risk factor for recurrence of cholecystitis after PC removal.
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Affiliation(s)
- Yoon Ah Do
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | | | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chong-ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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9
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Salajegheh F, Shafieipour S, Najminejad Z, Pourzand P, Nakhaie M, Jahangiri S, Sarmadian R, Gilani A, Rukerd MRZ. HAV-induced acalculous cholecystitis: A case report and literature review. Clin Case Rep 2023; 11:e7254. [PMID: 37113636 PMCID: PMC10127462 DOI: 10.1002/ccr3.7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Hepatitis A virus (HAV) has some life-threatening extrahepatic complications, such as acute acalculous cholecystitis (AAC). We present HAV-induced AAC in a young female, based on clinical, laboratory, and imaging findings, and conduct a literature review. The patient became irritable, which progressed to lethargy, as well as a significant decline in liver function, indicating acute liver failure (ALF). She was immediately managed in the intensive care unit with close airway and hemodynamic monitoring after being diagnosed with ALF (ICU). The patient's condition was improving, despite only close monitoring and supportive treatment with ursodeoxycholic acid (UDCA) and N-acetyl cysteine (NAC).
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Affiliation(s)
- Faranak Salajegheh
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Sara Shafieipour
- Physiology Research Center, Institute of NeuropharmacologyKerman University of Medical SciencesKermanIran
| | - Zohre Najminejad
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical Sciences KermanKermanIran
| | - Pouria Pourzand
- School of MedicineZahedan University of Medical SciencesZahedanIran
| | - Mohsen Nakhaie
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
| | - Samaneh Jahangiri
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Roham Sarmadian
- Infectious disease research centerArak University of Medical SciencesArakIran
| | - Abolfazl Gilani
- Department of pediatric surgeryTehran university of Medical SciencesTehranIran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
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10
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Nugent JP, Li J, Pang E, Harris A. What's new in the hot gallbladder: the evolving radiologic diagnosis and management of acute cholecystitis. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:31-46. [PMID: 35230497 DOI: 10.1007/s00261-022-03451-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
Abstract
Acute cholecystitis (AC) is a common condition and its incidence is rising. New technologies have advanced the imaging diagnosis of AC, providing more structural and functional information as well as allowing the radiologist to distinguish AC from mimics and identify complications from both the disease and its management. Dual energy CT aids in detecting gallstones and gallbladder wall enhancement, which helps to diagnose AC and identify its complications. Similarly, contrast-enhanced and non-contrast perfusion ultrasound techniques improve detection of abnormal gallbladder wall enhancement. Advances in MR imaging including hepatobiliary contrast agents aid in characterizing post-cholecystectomy complications such as bile leaks. Newer interventional techniques have also expanded the suite of options for minimally invasive management. Lumen apposing metal stents provide more options for conservative treatment in non-surgical candidates and are compared to a standard percutaneous cholecystostomy. Radiologists should be familiar with these advanced imaging methods and intervention techniques and the value they can bring to the diagnosis and management of AC.
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Affiliation(s)
- James P Nugent
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada.
| | - Jessica Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Emily Pang
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
| | - Alison Harris
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, V5Z 1M9, Canada
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Dargham TB, Moumneh MB, Atallah C, Zaghal A. A scoping review on acute gastrointestinal surgical complications in immunocompromised pediatric patients. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management.
Main body
This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions.
Conclusion
Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.
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Šimunić M, Cambj Sapunar L, Ardalić Ž, Šimunić M, Božić D. Safe and effective short-time percutaneous cholecystostomy: A retrospective observational study. Medicine (Baltimore) 2022; 101:e31412. [PMID: 36343031 PMCID: PMC9646577 DOI: 10.1097/md.0000000000031412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The introduction of percutaneous cholecystostomy (PCT) has shifted the paradigm in treatment of acute calculous and acalculous cholecystitis. PCT has high success and low complication rates, but there are still unresolved issues regarding the duration of the procedure. The aim of our study is to determine the characteristics and outcome of patients treated with short-term PCT drainage. Patients who were admitted to the Department of gastroenterology and the Department of Abdominal Surgery at the University Hospital Center Split under the diagnosis of acute cholecystitis and who were treated with the PCT, in a period between January 2015 and January 2020, were retrospectively included in the study. During that timeframe we identified 92 patients and have analyzed their characteristics and clinical outcomes. The statistical analysis included the Kaplan-Meier method for calculating survival curves for grades 2 and 3, the log-rank test for testing the difference between survival rates of grade 2 and 3 patients, and logistic regression to determine variables that affected the outcome of our patients. According to the Tokyo guidelines, most of the patients (74, 80.43%) met the criteria for grade 2 cholecystitis, and the minority had grade 1 (9, 9.78%) and grade 3 (9, 9.78%) cholecystitis. The average drainage duration was 10.1 ± 4.8 (3-28) days. We identified mild complications in 6 cases. Nine patients (10%) had lethal outcome. The mortality in the largest group of patients with grade 2 cholecystitis was 5.48% and as high as 71.43% in patients with grade 3 cholecystitis. The complication rate was 6.5%. One quarter of gallbladder aspirates showed a ciprofloxacin resistance. Short-time PCT lasting approximately 10 days can be used safely and effectively for the treatment of patients with acute cholecystitis.
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Affiliation(s)
- Miroslav Šimunić
- Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
| | - Liana Cambj Sapunar
- Department of Diagnostic and Interventional Radiology, University Hospital Split, Split, Croatia
| | - Žarko Ardalić
- Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
| | - Marin Šimunić
- Department of Haematology, University Hospital Split, Split, Croatia
| | - Dorotea Božić
- Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
- *Correspondence: Dorotea Božić, Department of Gastroenterology and Hepatology, University Hospital Split, Spinčićeva 1, Split, Croatia (e-mail: )
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Acute acalculous cholecystitis in hospitalized patients in intensive care unit: study of 5 cases. Heliyon 2022; 8:e11524. [DOI: 10.1016/j.heliyon.2022.e11524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/10/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:1886-1895. [DOI: 10.1007/s00268-022-06566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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15
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Chen BQ, Chen GD, Xie F, Li X, Mao X, Jia B. Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study. BMC Surg 2021; 21:439. [PMID: 34961498 PMCID: PMC8713395 DOI: 10.1186/s12893-021-01411-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC. MATERIALS AND METHODS The study population comprised 44 patients (median age 76 years; range 31-94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC. RESULTS Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61-1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5-60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21-582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08-2.17; P = 0.018) was independently associated with 60-day mortality after PC. CONCLUSIONS Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes.
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Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
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Huang R, Patel DC, Kallini JR, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Percutaneous Cholecystostomy Tube for Acute Cholecystitis: Quantifying Outcomes and Prognosis. J Surg Res 2021; 270:405-412. [PMID: 34749121 DOI: 10.1016/j.jss.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Percutaneous cholecystostomy tubes (PCT) are utilized in the management of acute cholecystitis in patients deemed unsuitable for surgery. However, the drive for these decisions and the outcomes remain understudied. We sought to characterize the practices and utilization of PCT and evaluate associated outcomes at an urban medical center. METHODS Patients undergoing PCT placement over a 12-y study period ending May 2019 were reviewed. Demographics, clinical presentation, labs, imaging studies, and outcomes were abstracted. The primary and secondary outcomes were 30-d mortality and interval cholecystectomy, respectively. RESULTS Two hundred and four patients met inclusion criteria: 59.3% were male with a median age of 67.5 y and a National Surgical Quality Improvement Program (NSQIP) risk of serious complication of 8.0%. Overall, 57.8% of patients were located in an intensive care unit setting. The majority (80.9%) had an ultrasound and 48.5% had a hepatobiliary iminodiacetic acid scan. The overall 30-d mortality was 31.9%: 41.5% for intensive care unit and 18.6% for ward patients (P < 0.01). Of patients surviving beyond 30 d (n = 139), the PCT was removed from 106 (76.3%), and a cholecystectomy was performed in 55 (39.6%) at a median interval of 58.0 d. A forward logistic regression identified total bilirubin (Adjusted Odds Ratio: 1.12, adjusted P < 0.01) and NSQIP risk of serious complication (Adjusted Odds Ratio: 1.16, adjusted P < 0.01) as the only predictors for 30-d mortality. CONCLUSIONS Patients selected for PCT placement have a high mortality risk. Despite subsequent removal of the PCT, the majority of surviving patients did not undergo an interval cholecystectomy. Total bilirubin and NSQIP risk of serious complication are useful adjuncts in predicting 30-d mortality in these patients.
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Affiliation(s)
- Raymond Huang
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Deven C Patel
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph R Kallini
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ashley M Wachsman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Daniel R Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward H Phillips
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
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Fu Y, Pang L, Dai W, Wu S, Kong J. Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review. Dig Dis 2021; 40:468-478. [PMID: 34657038 DOI: 10.1159/000520025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations. KEY MESSAGE Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder. SUMMARY Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.
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Affiliation(s)
- Yantao Fu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liwei Pang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Choi W, Gwon DI, Kim JW, Kim JH, Shin JH, Ko GY, Hur J. Percutaneous cholecystostomy for acute cholecystitis after stent insertion in patients with malignant biliary obstruction: clinical outcomes of 107 patients. Acta Radiol 2021; 63:1315-1322. [PMID: 34623186 DOI: 10.1177/02841851211041816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The outcome of percutaneous cholecystostomy (PC) in malignant patients with acute cholecystitis (AC) after biliary stent insertion has not been investigated in a large group. PURPOSE To evaluate the clinical outcomes of PC for AC after stent insertion in patients with malignant biliary obstruction. MATERIAL AND METHODS From April 2007 to February 2019, 107 patients (57 men, 52 women; mean age = 67.5 years; age range = 27-93 years) who had undergone PC for AC after biliary stent insertion were retrospectively evaluated. Of the 107 patients, 86 underwent biliary stent insertion by the endoscopic approach and the remaining 21 patients by the percutaneous approach. All patients were classified into three groups: those with stent-induced AC; those with cancer-induced AC; and those with AC without mechanical cause (biliary stent, GB stone, or cancer invasion). The mean survival time, recurrence rate, symptom improvement, and cystic duct patency in each patient group were analyzed. RESULTS Stent-induced AC (n = 40, 37.4%) developed with a mean onset time of six days (range = 0-14 days), AC without mechanical cause (n = 27, 25.2%), 87 days (range = 15-273 days), and cancer-induced AC (n = 40, 37.4%), 137 days (range = 15-447 days) after stent insertion. Symptom resolution and significant improvement in laboratory test values were achieved in 95 patients (88.8%) within four days after PC. CONCLUSION PC is a technically safe and effective method for the treatment of AC after biliary stent insertion in patients with malignant biliary obstruction.
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Affiliation(s)
- Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Ábrahám S, Tóth I, Benkő R, Matuz M, Kovács G, Morvay Z, Nagy A, Ottlakán A, Czakó L, Szepes Z, Váczi D, Négyessy A, Paszt A, Simonka Z, Petri A, Lázár G. Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre. Surg Endosc 2021; 36:2850-2860. [PMID: 34415432 PMCID: PMC9001534 DOI: 10.1007/s00464-021-08573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.
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Affiliation(s)
- Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Szeged, Hungary. .,Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Centre, Semmelweis u. 8., 6725, Szeged, Hungary.
| | - Illés Tóth
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary.,Central Pharmacy Department, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy and Emergency Care Department, University of Szeged, Szeged, Hungary
| | | | - Zita Morvay
- Radiology Department, University of Szeged, Szeged, Hungary
| | - András Nagy
- Radiology Department, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - András Négyessy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - András Petri
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Abstract
PURPOSE OF REVIEW The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill. RECENT FINDINGS Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing. SUMMARY Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.
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Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Ann Surg 2020; 272:3-23. [PMID: 32404658 DOI: 10.1097/sla.0000000000003791] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS Literature reviews were conducted for 18 key questions across 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS Consensus was reached on 17 of 18 questions by the guideline development group and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSIONS These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
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Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surg Endosc 2020; 34:2827-2855. [PMID: 32399938 DOI: 10.1007/s00464-020-07568-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS Literature reviews were conducted for 18 key questions across six broad topics around cholecystectomy directed by a steering group and subject experts from five surgical societies (SAGES, AHPBA IHPBA, SSAT, and EAES). Evidence-based recommendations were formulated using the GRADE methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS Consensus was reached on 17 of 18 questions by the Guideline Development Group (GDG) and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSION These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
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Er S, Berkem H, Özden S, Birben B, Çetinkaya E, Tez M, Yüksel BC. Clinical course of percutaneous cholecystostomies: A cross-sectional study. World J Clin Cases 2020; 8:1033-1041. [PMID: 32258074 PMCID: PMC7103974 DOI: 10.12998/wjcc.v8.i6.1033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.
AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.
METHODS The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients’ demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.
RESULTS Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score (P = 0.0001) and WBCC (P = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.
CONCLUSION For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
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Affiliation(s)
- Sadettin Er
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Hüseyin Berkem
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Sabri Özden
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Birkan Birben
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Erdinç Çetinkaya
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Mesut Tez
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Bülent Cavit Yüksel
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
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Abstract
Although cholecystectomy is generally recommended for acute acalculous cholecystitis (AAC) treatment, non-surgical management can be considered in patients at a high risk for surgery. This study compared outcomes of surgical and non-surgical management and analyzed the long-term outcomes of AAC patients managed non-surgically.We retrospectively analyzed 89 patients diagnosed with AAC between January 1, 2007 and April 30, 2014. These patients were divided into 2 groups: non-surgical (n = 41) and surgical (n = 48). Non-surgical management methods were percutaneous cholecystostomy (PC, n = 14) and antibiotics only (n = 27). The non-surgical group was followed up for >3 years after treatment.The mean age was slightly higher in the non-surgical group than in the surgical group without significant difference. The prevalence of cerebrovascular accident in the non-surgical group was significantly higher than that in the surgical group (26.8% vs 8.3%, P = .020). Mean hospital stay was not statistically different between two groups. The surgical group had a significantly higher incidence of posttreatment complications than the non-surgical group (18.8% vs 2.4%, P = .015). During the mean follow-up of 5.7 years, AAC recurred in 4 (9.8%) patients in the non-surgical group. Three patients underwent cholecystectomy, 1 was treated with antibiotics, and no recurrence-related death occurred. The recurrence rate of AAC was not different between PC and antibiotics only groups (14.3% vs 7.4%, P = .596).Recurrence was observed in 9.8% of AAC patients treated non-surgically and the outcome in the non-surgical group was not inferior to that in the surgical group.
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Reppas L, Arkoudis NA, Spiliopoulos S, Theofanis M, Kitrou PM, Katsanos K, Palialexis K, Filippiadis D, Kelekis A, Karnabatidis D, Kelekis N, Brountzos E. Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy. AJR Am J Roentgenol 2020; 214:206-212. [PMID: 31573856 DOI: 10.2214/ajr.19.21685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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Affiliation(s)
- Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Theofanis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Degroote T, Chhor V, Tran M, Philippart F, Bruel C. Cholécystite aiguë de réanimation. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
La cholécystite aiguë de réanimation (0,2 à 1 % des patients) est liée à des facteurs de risque spécifiques (jeûne, nutrition parentérale, ventilation mécanique) et systémiques (instabilité, brûlures graves, catécholamines) conduisant à des phénomènes d’ischémie-reperfusion de la paroi vésiculaire, à l’origine d’une cholécystite classiquement alithiasique. Toutefois, les données récentes retrouvent une participation lithiasique dans 50%des cas environ. Il s’agit d’une maladie grave dont le diagnostic est difficile et la mortalité élevée (40 %). Chez ces patients graves, aucun critère clinicobiologique ne permet un diagnostic de certitude. L’imagerie du patient de réanimation peut être prise à défaut par les anomalies fréquemment retrouvées en réanimation ; les signes les plus évocateurs sont un épaississement pariétal vésiculaire supérieur à 4 mm, un hydrocholécyste ou un défaut de rehaussement de la paroi au scanner. Le traitement en urgence repose sur une antibiothérapie à large spectre ciblée sur les germes digestifs et nosocomiaux ainsi que sur une optimisation hémodynamique. La cholécystectomie (laparoscopique, voire sous-costale) représente le traitement de référence en empêchant la récidive. Mais la gravité des patients amène souvent à envisager une solution moins lourde que la chirurgie avec un drainage de la vésicule. Le drainage par voie percutanée est l’alternative de choix en raison de sa disponibilité et de son efficacité, il existe toutefois un risque théorique de récidive à l’ablation du drain, surtout en cas de cholécystite lithiasique. Le drainage interne par voie endoscopique (transpapillaire ou transdigestif) est une possibilité prometteuse, mais réservée à l’heure actuelle aux centres experts.
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George J, Cohen M, Whitney S, Fennern E, Divino C. Biliary Disease in Immunocompromised Patients: a Single-Center Retrospective Analysis. J Gastrointest Surg 2019; 23:1589-1592. [PMID: 30635828 DOI: 10.1007/s11605-018-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/28/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute cholecystitis is a life-threatening disease process in immunocompromised patients. The purpose of this study is to determine the incidence, clinical course, and management of calculous and acalculous acute cholecystitis in immunocompromised patients. METHODS A single center's database was queried for all patients with a diagnosis of acute cholecystitis from January 1, 2003 to September 30, 2016 with concomitant diagnosis of neutropenia, leukopenia, leukemia, or lymphoma. These cases subsequently underwent chart review. Data on demographics, diagnostic studies, and management were collected and analyzed. RESULTS There were 4525 patients diagnosed with acute cholecystitis during the study window. One hundred twenty patients were identified to be immunocompromised at time of diagnosis. Seventy-nine patients (65.8%) had acute calculous cholecystitis while 41 patients (34.2%) had acalculous cholecystitis. There were no significant demographic differences between calculous and acalculous groups. There was similar use of percutaneous cholecystostomy tube (7.6%, 9.8%, p = 0.69), laparoscopic cholecystectomy (70.9%, 61.0%, p = 0.27), and open cholecystectomy (10.3%, 2.4%, p = 0.13) in both calculous and acalculous groups. DISCUSSION While immunosuppression is commonly thought to be associated with acalculous cholecystitis, our data suggest the majority of acute cholecystitis in immunocompromised patients are calculous. Most patients in our studies were managed successfully with laparoscopic cholecystectomy with acceptably low complication rates. CONCLUSION Calculous cholecystitis is more common than acalculous cholecystitis in immunocompromised patients. Both are often managed successfully with laparoscopic cholecystectomy with very low rates of conversion to open cholecystectomy.
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Affiliation(s)
- Justin George
- Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA
| | - Marc Cohen
- Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA
| | - Stewart Whitney
- Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA
| | - Erin Fennern
- Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA
| | - Celia Divino
- Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA.
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Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience. Wideochir Inne Tech Maloinwazyjne 2019; 14:516-525. [PMID: 31908697 PMCID: PMC6939213 DOI: 10.5114/wiitm.2019.84704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/16/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative. Aim To retrospectively evaluate the indications, technical features, efficacy, complications, patients’ development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection. Material and methods Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years. Results Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment. Conclusions Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.
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Schlottmann F, Gaber C, Strassle PD, Patti MG, Charles AG. Cholecystectomy Vs. Cholecystostomy for the Management of Acute Cholecystitis in Elderly Patients. J Gastrointest Surg 2019; 23:503-509. [PMID: 30225792 DOI: 10.1007/s11605-018-3863-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data comparing outcomes following cholecystectomy and cholecystostomy tube placement (CTP) in elderly patients are lacking. We aimed to compare the post-procedural outcomes between cholecystectomy and CTP in elderly patients with acute cholecystitis. METHODS We performed a retrospective, population-based analysis using the National Inpatient Sample for the period 2000-2014. Patients ≥ 65 years old admitted with a primary diagnosis of acute cholecystitis and who underwent either cholecystectomy or CTP during their hospitalization were included. Multivariable linear and logistic regression models were used to analyze post-procedural complications, mortality, length of stay, and total charges. The effect of procedure type on patient outcomes, stratified by acalculous and calculous cholecystitis, was also performed. RESULTS A total of 200,915 patients were included, of which 7516 underwent CTP and 193,399 underwent cholecystectomy. The median age of patients undergoing CTP and cholecystectomy was 80 (IQR 73-87) and 75 (IQR 70-81), respectively. Patients undergoing CTP were more likely to have post-procedural infection (OR 2.25; 95% CI 2.07, 2.45), bleeding (OR 1.28; 95% CI 1.19, 1.37), and inpatient mortality (OR 9.27; 95% CI 7.95, 10.81). On average, CTP patients stayed 1.25 days longer (95% CI 1.14, 1.37) in hospital after the procedure. The benefits of cholecystectomy were consistent in patients with acalculous and calculous cholecystitis. CONCLUSIONS Elderly patients with both acalculous and calculous acute cholecystitis managed with CTP have higher incidences of post-procedural morbidity and mortality, and longer post-procedure length of hospital stay, as compared to cholecystectomy. Unless prohibitive surgical risks exist, elderly patients with acute cholecystitis should undergo cholecystectomy.
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Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
| | - Charles Gaber
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Medicine, |University of North Carolina, Chapel Hill, NC, USA
| | - Anthony G Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
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Abstract
Acalculous cholecystitis is a life-threatening gallbladder infection that typically affects the critically ill. A late diagnosis can have devastating outcomes because of the high risk of gallbladder perforation if untreated. The diagnosis is not straightforward as Murphy’s sign is difficult to illicit in the critically ill and many imaging findings are either insensitive or non-specific. This article reviews the current imaging literature to improve the interpretation of findings. Management involves a percutaneous cholecystostomy, surgical cholecystectomy, or more recently an endoscopically placed metal stent through the gastrointestinal tract into the gallbladder. This article reviews the current literature assessing the outcomes of each treatment option and suggests a protocol in determining the modality of choice on the basis of patient population. Specifically, endoscopic ultrasound-guided gallbladder drainage is a novel drainage approach for patients who are poor candidates for surgery and obviates the need for a percutaneous drain and all its complications. It has promising results but has caveats in its uses.
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Affiliation(s)
- Bryan Balmadrid
- Department of Gastroenterology, University of Washington Harborview Medical Center Campus, Seattle, USA
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