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Irish Journal of Medical Science Feb 2022In response to the outbreak of COVID-19 in Ireland, the government implemented a nationwide stay-at-home order, with the closure of all non-essential businesses. During...
PURPOSE
In response to the outbreak of COVID-19 in Ireland, the government implemented a nationwide stay-at-home order, with the closure of all non-essential businesses. During this period, there was a significant increase in supermarket expenditure. It has been shown that stress, anxiety and boredom are triggers for unhealthy eating habits. Fat consumption is a risk factor for both the development of gallstones and, additionally, the development of acute calculous cholecystitis. The aim of this study was to assess the incidence of acute calculous cholecystitis during the nationwide lockdown and compare it to the same period one year prior.
METHODS
A retrospective review of all emergency abdominal imaging performed during the first 5 weeks of the lockdown was completed using the hospital PACS (picture archiving and communication system). All cases of acute calculous cholecystitis were identified and compared with the same period 1 year prior.
RESULTS
Eighteen cases of acute calculous cholecystitis were identified from 24 March to 27 April 2020. Eleven cases were identified during the same period in 2019. This represented an increase of 63%. Non-COVID-19-related emergency presentations decreased during this period, and imaging of emergency presentations decreased by 24%. The rate of scans positive for acute cholecystitis more than doubled (p < 0.037).
CONCLUSION
A statistically significant increase in cases of acute calculous cholecystitis was observed during a nationwide lockdown during the COVID-19 pandemic. It is hypothesised that this is due to increased consumption of fatty foods during this period due to stress, anxiety and boredom.
Topics: COVID-19; Cholecystitis, Acute; Communicable Disease Control; Humans; Incidence; Pandemics; Retrospective Studies; SARS-CoV-2
PubMed: 33704626
DOI: 10.1007/s11845-021-02587-2 -
Canadian Journal of Surgery. Journal... May 2020The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed...
BACKGROUND
The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed guideline adherence at our academic centre and its impact on patient outcomes.
METHODS
This is a retrospective chart review of patients with acute calculous cholecystitis who underwent cholecystectomy at our institution between November 2013 and March 2015. Severity of cholecystitis was graded retrospectively if it had not been documented preoperatively. Compliance with the Tokyo Guidelines' recommendations on antibiotic use and time to operation was recorded. Cholecystitis severity groups were compared statistically, and logistic regression was used to determine predictors of complications.
RESULTS
One hundred and fifty patients were included in the study. Of these, 104 patients were graded as having mild cholecystitis, 45 as having moderate cholecystitis, and 1 as having severe cholecystitis. Severity was not documented preoperatively for any patient. Compliance with antibiotic recommendations was poor (18.0%) and did not differ by cholecystitis severity (p = 0.90). Compliance with the recommendation on time to operation was 86.0%, with no between-group differences (p = 0.63); it improved when an acute care surgery team was involved (91.0% v. 76.0%, p = 0.025). On multivariable analysis, comorbidities (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.19-1.85, p < 0.001) and conversion to laparotomy (OR 13.45, 95% CI 2.16-125.49, p = 0.01) predicted postoperative complications, while severity of cholecystitis, antibiotic compliance and time to operation had no effect.
CONCLUSION
In this study, compliance with the Tokyo Guidelines was acceptable only for time to operation. Although the poor compliance with recommendations relating to documentation of severity grading and antibiotic use did not have a negative affect on patient outcomes, these recommendations are important because they facilitate appropriate antibiotic use and patient risk stratification.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; British Columbia; Cholecystectomy; Cholecystitis, Acute; Clinical Audit; Female; Guideline Adherence; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult
PubMed: 32386475
DOI: 10.1503/cjs.002719 -
Revista Espanola de Enfermedades... Oct 2023The common treatment of acute cholecystitis due to cholestasis is percutaneous transhepatic gallbladder drainage (PTGBD) or EUS-guided gallbladder drainage (EUS-GBD)...
The common treatment of acute cholecystitis due to cholestasis is percutaneous transhepatic gallbladder drainage (PTGBD) or EUS-guided gallbladder drainage (EUS-GBD) or cholecystectomy. The new generation of direct vision endoscopy represented by Spy glass has successfully entered the gallbladder duct and gallbladder. On this basis, we apply similar direct visualization system for treatment.
Topics: Humans; Endosonography; Cholecystitis, Acute; Gallbladder; Cholecystectomy; Drainage; Endoscopy, Gastrointestinal; Treatment Outcome; Retrospective Studies
PubMed: 36633184
DOI: 10.17235/reed.2023.9432/2022 -
Gut and Liver Jul 2021Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical... (Review)
Review
Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid composition, increased nucleation of bile, and decreased motility of the gallbladder, contribute to the formation of biliary stones and the possibility of symptomatic cholelithiasis, which is an indication for surgical treatment. In addition to these predisposing factors for cholelithiasis, systemic effects and local anatomic consequences related to cirrhosis lead to anesthesiologic risks and perioperative complications in cirrhotic patients. Therefore, the treatment of the aforementioned biliary conditions in cirrhotic patients has become a challenging issue. In this review, we focus on cholecystectomy for cirrhotic patients and summarize the surgical indications, risk stratification, surgical procedures, and surgical outcomes specific to cirrhotic patients with symptomatic cholelithiasis.
Topics: Cholecystectomy; Cholecystitis; Cholecystitis, Acute; Gallstones; Humans; Liver Cirrhosis
PubMed: 32921635
DOI: 10.5009/gnl20052 -
Advances in Surgery Sep 2019
Review
Topics: Abdominal Injuries; Appendicitis; Cholecystitis, Acute; Digestive System Diseases; Emergencies; Female; Fetal Monitoring; Humans; Intestinal Obstruction; Postoperative Complications; Pregnancy; Pregnancy Complications; Radiography; Ultrasonography, Prenatal
PubMed: 31327444
DOI: 10.1016/j.yasu.2019.04.008 -
The Israel Medical Association Journal... May 2022The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. The fear of seeking medical attention to avoid the...
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare systems worldwide. The fear of seeking medical attention to avoid the possibility of being infected may have altered the course of some diseases.
OBJECTIVES
To describe our experience with the management of patients with acute cholecystitis during the pandemic at our medical center.
METHODS
We compared patients treated for acute cholecystitis between 1 March and 31 August 2020 (Group I) to patients admitted with the same diagnosis during the same months in 2019 (Group II). We evaluated demographics, presenting symptoms, laboratory and imaging findings at presentation, the disease's clinical course, management, and outcome.
RESULTS
Group I consisted of 101 patients and group II included 94 patients. No differences were noted for age (66 years, IQR 48-78 vs. 66 years, IQR 47-76; P = 0.50) and sex (57.4% vs. 51.1% females; P = 0.39) between the two groups. The delay between symptom onset and hospital admission was longer for Group I patients (3 days, IQR 2-7 vs. 2 days, IQR 1-3; P = 0.002). Moderate to severe disease was more commonly encountered in Group I (59.4% vs. 37.2%, P = 0.003). Group I patients more often failed conservative management (36% vs. 6%, P = 0.001) and had a higher conversion rate to open surgery (15.4% vs. 0%, P = 0.025).
CONCLUSIONS
Patients presenting with acute cholecystitis during the COVID-19 pandemic more often presented late to the emergency department and more showed adverse outcomes.
Topics: Aged; COVID-19; Cholecystitis, Acute; Disease Outbreaks; Female; Humans; Male; Middle Aged; Pandemics; Retrospective Studies
PubMed: 35598054
DOI: No ID Found -
Ugeskrift For Laeger Oct 2017Acute cholecystitis (AC) is mainly caused by stones in the gall bladder. Although cholescintigraphy has the highest sensitivity (97%) and specificity (94%) for AC,... (Review)
Review
Acute cholecystitis (AC) is mainly caused by stones in the gall bladder. Although cholescintigraphy has the highest sensitivity (97%) and specificity (94%) for AC, ultrasound is the most commonly used technique in confirming the diagnosis. Laparoscopic cholecystectomy is the recom-mended treatment of choice; however, in high-risk patients percutaneous gall bladder drainage is an attractive alter-native approach to avoid lesions to the common bile duct. To avoid serious bleeding incidences, it is imperative to pause anticoagulation therapy prior to gall bladder drainage.
Topics: Cholecystectomy; Cholecystitis, Acute; Contraindications, Procedure; Drainage; Humans; Magnetic Resonance Imaging; Radiography, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Ultrasonography, Interventional
PubMed: 29053098
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Oct 2022Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous... (Review)
Review
Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous drainage, depending on the patient’s condition. The symptoms of acute cholecystitis in older patients may be atypical and difficult to diagnose, causing delayed treatment. Clarifying the risk factors for delayed diagnosis among older patients could lead to early diagnosis and treatment of acute cholecystitis. This study aimed to explore the risk factors for delayed diagnosis of acute cholecystitis among rural older patients. Material and Methods: This retrospective cohort study included patients aged over 65 years diagnosed with acute cholecystitis at a rural community hospital. The primary outcome was the time from symptom onset to acute cholecystitis diagnosis. We reviewed the electronic medical records of patients with acute cholecystitis and investigated whether they were diagnosed and treated for the condition at the time of symptom onset. Results: The average ages of the control and exposure groups were 77.71 years (standard deviation [SD] = 14.62) and 80.13 years (SD = 13.95), respectively. Additionally, 41.7% and 64.1% of the participants in the control and exposure groups, respectively, were men. The logistic regression model revealed that the serum albumin level was significantly related to a time to diagnosis > 3 days (odds ratio = 0.51; 95% confidence interval, 0.28−0.94). Conclusion: Low serum albumin levels are related to delayed diagnosis of cholecystitis and male sex. The presence of abdominal pain and a high body mass index (BMI) may be related to early cholecystitis diagnosis. Clinicians should be concerned about the delay in cholecystitis diagnosis in older female patients with poor nutritional conditions, including low serum albumin levels, a low BMI, vague symptoms, and no abdominal pain.
Topics: Humans; Male; Female; Aged; Retrospective Studies; Delayed Diagnosis; Cholecystitis, Acute; Cholecystitis; Risk Factors; Anti-Bacterial Agents; Serum Albumin; Pain; Treatment Outcome
PubMed: 36295553
DOI: 10.3390/medicina58101392 -
Medicine Feb 2022Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter...
Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter removal. This study aimed to evaluate the role of endoscopic sphincterotomy and other risk factors in reducing the recurrence of cholecystitis.We retrospectively analyzed data from 1088 patients who underwent PTGBD for cholecystitis at Kyungpook National University Hospital, Republic of Korea, between January 2011 and April 2018.A total of 115 patients were enrolled in the study. The recurrence rate of cholecystitis was 17.4% (n = 20) during a median follow-up period of 1159 (range, 369-2774) days. Endoscopic biliary sphincterotomy did not significantly affect the recurrence rate of cholecystitis (P = .561). In multivariable analysis, cystic duct stones (P = .013) and PTGBD catheter migration before the prescheduled removal time (P = .002) were identified as independent risk factors for cholecystitis recurrence after PTGBD.To reduce post-PTGBD recurrence in cholecystitis, caution must be exercised to avoid inadvertent dislodging of the PTGBD catheter. In cases of cholecystitis with cystic duct stones, cholecystectomy should be considered only after careful assessment of postoperative risks. Instead, transluminal endoscopic gallbladder drainage could represent a promising option for the prevention of recurrent cholecystitis.
Topics: Catheters; Cholecystitis, Acute; Cholecystolithiasis; Cholecystostomy; Device Removal; Drainage; Gallbladder; Humans; Recurrence; Retrospective Studies; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 35119038
DOI: 10.1097/MD.0000000000028767 -
The Journal of Infection Jan 2020Guidelines for antibiotic treatment of acute cholecystitis are based on studies using culture techniques for microbial identification. Microbial culture has well...
OBJECTIVES
Guidelines for antibiotic treatment of acute cholecystitis are based on studies using culture techniques for microbial identification. Microbial culture has well described limitations and more comprehensive data on the microbial spectrum may support adjustments of these recommendations. We used next generation sequencing to conduct a thorough microbiological characterization of bile-samples from patients with moderate and severe acute cholecystitis.
METHODS
We prospectively included patients with moderate and severe acute cholecystitis, undergoing percutaneous or perioperative drainage of the gall bladder. Bile samples were analyzed using both culture and deep sequencing of bacterial 16S rRNA and rpoB genes and the fungal ITS2-segment. Clinical details were evaluated by medical record review.
RESULTS
Thirty-six patients with moderate and severe acute cholecystitis were included. Bile from 31 (86%) of these contained bacteria (29) and/or fungi (5) as determined by sequencing. Culture identified only 40 (38%) of the 106 microbes identified by sequencing. In none of the 15 polymicrobial samples did culture detect all present microbes. Frequently identified bacteria often missed by culture included oral streptococci, anaerobic bacteria, enterococci and Enterobacteriaceae other than Klebsiella spp. and Escherichia coli.
CONCLUSIONS
Culture techniques display decreased sensitivity for the microbial diagnostics of acute cholecystitis leaving possible pathogens undetected.
Topics: Bacteria; Cholecystitis, Acute; Fungi; High-Throughput Nucleotide Sequencing; Humans; Prospective Studies; RNA, Ribosomal, 16S
PubMed: 31586461
DOI: 10.1016/j.jinf.2019.09.015