Chronic cholecystitis natural history, complications and prognosis: Difference between revisions
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Revision as of 19:14, 2 June 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Natural History
Cholecystitis presents with abdominal pain, which is not relieved by antacids and postural changes, and lasts longer than 6 hours. It is sometimes preceded by attacks of biliary pain (due to gall stones). Fever may not be a prominent symptom at the time of presentation, but can be seen if untreated or complicated by infections. Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in a span of 7 - 10 days. The remaining cases can progress to complications and cause severe morbidity and mortality.
Complications
Major Complications of cholecystectomy[1]
- Abscess
- Ascending cholangitis
- Bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
- Bile leak ("biloma")
- Bleeding (liver surface and cystic artery most common sites)
- Deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)
- Hernia
- Organ injury (intestine and liver at highest risk, especially if gallbladder through inflammation has become adherent/scarred to other organs (e.g. transverse colon)
- Pancreatitis
- Perforation or rupture
- Wound infection
Gangrenous cholecystitis
Gangrenous cholecystitis is a more common complication of acute cholecystitis that occurs in up to 30% of cases. It occurs following severe inflammation that interrupts the blood flow to the gallbladder. It is potentially more life threatening because the dead tissues are vulnerable to secondary severe infections, which can spread to become sepsis. The known risk factors are male gender, age above 50 years, leukocytosis (White Blood Cell count greater than 17 × 109/L), diabetes and cardiovascular diseases[2]. Ultrasonography is usually the first-line imaging modality for the evaluation of clinically suspected acute cholecystitis. However, CT serves as a better tool in evaluation of gangrenous cholecystitis.
Its mortality rate is as high as 22% since it can lead to gallbladder perforation, abscess formation and peritonitis. So once suspected, an emergency cholecystectomy is done to reduce the morbidity and mortality due to its life threatening complications[3].
Gallbladder perforation
Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality. [4]
Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. It can happen at the neck from pressure necrosis of an impacted calculus, or at the fundus. It can result in a local abscess, or perforation into the general peritoneal cavity; if the bile, is infected diffuse peritonitis supervenes readily and rapidly. Death can result. [4]
A retrospective study looked at 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis. Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a cholecystectomy. Two patients died and 6 patients had further complications. The morbidity and mortality rates were 37.5% and 12.5%, respectively in the present study. The authors of this study suggests that early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.[4]
Prognosis
Uncomplicated cholecystitis has a favorable prognosis. Complicated cases can be treated successfully with surgery and they usually do well.[5]
References
- ↑ "www.ncbi.nlm.nih.gov" (PDF). Retrieved 2012-08-20.
- ↑ Bennett, GL.; Rusinek, H.; Lisi, V.; Israel, GM.; Krinsky, GA.; Slywotzky, CM.; Megibow, A. (2002). "CT findings in acute gangrenous cholecystitis". AJR Am J Roentgenol. 178 (2): 275–81. doi:10.2214/ajr.178.2.1780275. PMID 11804880. Unknown parameter
|month=ignored (help) - ↑ Grant, RL.; Tie, ML. (2002). "False negative biliary scintigraphy in gangrenous cholecystitis". Australas Radiol. 46 (1): 73–5. PMID 11966592. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E (2006). "Diagnosis and treatment of gallbladder perforation". World J. Gastroenterol. 12 (48): 7832–6. PMID 17203529.
- ↑ "Acute cholecystitis: MedlinePlus Medical Encyclopedia". Retrieved 2012-08-20.