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The American Surgeon Jul 2020
Review
Topics: COVID-19; Cholecystitis, Acute; Clinical Decision-Making; Coronavirus Infections; Female; Humans; Pandemics; Pneumonia, Viral; Practice Guidelines as Topic
PubMed: 32683947
DOI: 10.1177/0003134820939881 -
Surgical Endoscopy May 2014Host factors and therapy characteristics predispose cancer patients to a high risk of acute cholecystitis. Management of cholecystitis is often difficult given complex... (Review)
Review
BACKGROUND
Host factors and therapy characteristics predispose cancer patients to a high risk of acute cholecystitis. Management of cholecystitis is often difficult given complex decision making involving the underlying cancer, possible interruption of treatment, and surgical fitness of the patient.
METHODS
A management pathway was developed for cholecystitis in cancer patients which incorporated patient-specific survival and risks of recurrence. Estimates were obtained from a multistage systematic review. A decision tree with a lifetime horizon was constructed to compare conventional strategies [conservative treatment (CT), percutaneous cholecystostomy (PC) and definitive cholecystectomy (DC)] with the new pathway (NP). The decision tree was optimized for highest estimated survival. Sensitivity analyses were performed.
RESULTS
In low surgical risk patients with cancer-specific survival of 12 months, the NP yielded estimated survivals of 11.9 versus 11.8 (CT) versus 11.8 (PC) versus 11.9 months for the DC arm. For high-risk patients, the estimated survival was 11.6 (NP), 9.9 (DC), 11.4 (PC), and 11 (CT) months, respectively. The decision to perform a DC at 6 weeks after a PC was optimum in patients expected to survive 24 months (23.2 months from the NP) or with a shorter expected survival but a high recurrence risk (>20 %). Model estimates were robust in sensitivity analyses.
CONCLUSIONS
Incorporation of the surgical risk and the risk of recurrent cholecystitis, while balancing the patient-specific survival and the impact of antineoplastic therapy in the management of cholecystitis yields improved survival. This work provides measures to evaluate surgical judgment, and can augment the physician-patient decision making.
Topics: Cholecystectomy; Cholecystitis, Acute; Cholecystostomy; Disease Management; Humans; Neoplasms
PubMed: 24687416
DOI: 10.1007/s00464-013-3344-2 -
The New England Journal of Medicine Jun 2008
Review
Topics: Adult; Anti-Bacterial Agents; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cholelithiasis; Female; Gallbladder; Humans; Practice Guidelines as Topic; Radionuclide Imaging; Ultrasonography
PubMed: 18579815
DOI: 10.1056/NEJMcp0800929 -
Abdominal Radiology (New York) Jan 2023Acute cholecystitis (AC) is a common condition and its incidence is rising. New technologies have advanced the imaging diagnosis of AC, providing more structural and... (Review)
Review
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.
Topics: Humans; Endosonography; Drainage; Cholecystitis, Acute; Cholecystostomy; Treatment Outcome
PubMed: 35230497
DOI: 10.1007/s00261-022-03451-2 -
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 -
Journal of the Chinese Medical... Feb 2020Currently, evidence regarding the strategies of antibiotic use in patients with acute cholecystitis after receiving percutaneous cholecystostomy is limited. Hence, we...
BACKGROUND
Currently, evidence regarding the strategies of antibiotic use in patients with acute cholecystitis after receiving percutaneous cholecystostomy is limited. Hence, we aimed to investigate the outcomes in patients with inoperable acute cholecystitis receiving narrow or broad-spectrum antibiotics after percutaneous cholecystostomy.
METHODS
A total of 117 patients receiving percutaneous cholecystostomy were categorized into moderate and severe acute cholecystitis defined by the Tokyo guideline and then divided into group A (narrow-spectrum antibiotic use) and group B (broad-spectrum antibiotic use). The clinical outcomes and complications were analyzed.
RESULTS
In moderate acute cholecystitis (n = 80), group A patients (n = 62) had similar early recurrent rate (11.3% vs 16.7%; p = 0.544) and a shorter length of hospital stay (13.4 ± 8.6 vs 18.6 ± 9.4 days; p = 0.009) as compared with group B patients (n = 18). No in-hospital mortality occurred in moderate acute cholecystitis. In severe acute cholecystitis (n = 37), both groups had similar length of hospital stay (16.3 ± 12.2 vs 20.9 ± 9.5 days; p = 0.051), early recurrent rate (0% vs 16.7%; p = 0.105), and in-hospital mortality rate (5.3% vs 16.7%; p = 0.340). Although group B patients with severe cholecystitis had higher serum levels of alkaline phosphatase (Alk-P) and higher proportion of underlying malignancy, American Society of Anesthesiologists (ASA) class IV and septic shock, the clinical outcomes were not inferior to patients in group A.
CONCLUSION
In moderate acute cholecystitis after percutaneous cholecystostomy, patients receiving narrow-spectrum antibiotics have comparable clinical outcomes as those treated with broad-spectrum antibiotics. However, in severe acute cholecystitis, broad-spectrum antibiotics might still be necessary to rescue these patients.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cholecystitis, Acute; Cholecystostomy; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 31868860
DOI: 10.1097/JCMA.0000000000000244 -
The Journal of Infection Aug 2005Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of... (Review)
Review
OBJECTIVES
Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear.
METHODS
We conducted a retrospective review of all cases of acute cholecystitis between 1996 and 2001 at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis. A MEDLINE search for guidelines for antibiotic use in acute cholecystitis was conducted.
RESULTS
The number of cases of acute cholecystitis was 79. The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis.
CONCLUSIONS
The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cholecystectomy; Cholecystitis, Acute; Enterococcus; Escherichia coli; Evidence-Based Medicine; Female; Humans; Lebanon; Male; Middle Aged; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Surveys and Questionnaires
PubMed: 16038763
DOI: 10.1016/j.jinf.2004.11.007 -
Journal of Hepato-biliary-pancreatic... Nov 2019Acute cholecystitis (AC) after cardiovascular surgery (CS) tends to have a serious postoperative course; however, there are few reports of AC after CS. In this study, we...
BACKGROUND
Acute cholecystitis (AC) after cardiovascular surgery (CS) tends to have a serious postoperative course; however, there are few reports of AC after CS. In this study, we investigated the clinical features of AC after CS.
METHOD
Of 26 patients who underwent surgery for AC after CS between 2001 and 2018 were investigated. Of these patients, the severity of AC, onset time, surgical outcomes, and postoperative pathological findings were evaluated.
RESULTS
Grade III accounted for 46% (12/26) of the AC after CS patients. Gallbladder drainage did not produce sufficient outcomes in all CS cases. The postoperative hospital days of AC after CS were extended (31/21 days, P = 0.07) and the postoperative pathologic findings revealed a higher rate of gangrenous cholecystitis (88/41%, P < 0.01) than the control group. With regard to the incidence of postoperative complications, there were no differences between CS and the control group (23/24%). The mortality rate of AC after CS was 12%.
CONCLUSION
Because more than 80% of CS cases involved pathologically gangrenous cholecystitis, it may be necessary to perform early surgery for AC after CS, even when the severity of AC is Grade III.
Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Surgical Procedures; Cholecystectomy; Cholecystitis, Acute; Female; Humans; Male; Middle Aged
PubMed: 31532906
DOI: 10.1002/jhbp.672 -
Geriatrics & Gerontology International Mar 2016Acute cholecystitis is a medical complication that can develop in the postoperative period after hip surgery. However, few studies have examined this complication in...
AIM
Acute cholecystitis is a medical complication that can develop in the postoperative period after hip surgery. However, few studies have examined this complication in elderly patients. Our aim was therefore to evaluate the incidence and clinical manifestations of acute cholecystitis after hip fracture in elderly patients.
METHODS
Medical records and radiological studies of patients aged older than 65 years who underwent hip surgery for femoral neck or intertrochanteric fractures at a single hospital from April 2003 to March 2013 were reviewed retrospectively. We analyzed the type of cholecystitis (acalculous or calculous), clinical manifestations, fracture type (neck or trochanteric fracture), age, sex, body mass index, type of surgery, time to surgery, time from surgery to onset of acute cholecystitis and the timing of ambulation in acute cholecystitis cases.
RESULTS
There were nine confirmed acute cholecystitis cases among 1211 hip fractures; thus, the incidence of acute cholecystitis within 2 months after hip fracture surgery was 0.74%.
CONCLUSIONS
The incidence of acute cholecystitis was higher than we expected, and this condition can lead to more serious problems if overlooked. Acute cholecystitis as a medical complication after hip fracture was underestimated in previous studies. Furthermore, acute cholecystitis should be considered as a complication of hip fracture, not hip surgery, in the elderly. The present study does not imply that hip fracture causes acute cholecystitis, although elderly hip fracture patients are in an extremely debilitated state and are prone to developing acute cholecystitis.
Topics: Aged; Aged, 80 and over; Cholecystitis, Acute; Female; Hip Fractures; Humans; Incidence; Male; Retrospective Studies
PubMed: 25810136
DOI: 10.1111/ggi.12483 -
Cirugia Y Cirujanos 2021Situs inversus totalis (SIT) is an autosomal recessive congenital disorder. Acute cholecystitis is a diagnosis challenge in patients with SIT.
INTRODUCTION
Situs inversus totalis (SIT) is an autosomal recessive congenital disorder. Acute cholecystitis is a diagnosis challenge in patients with SIT.
CLINICAL CASE
A 26-year-old female who presented with atypical gallbladder colic. Assessed by Surgery, concluding diagnosis of acute cholecystitis and SIT. Laparoscopic cholecystectomy was performed.
DISCUSSION
SIT is a rare congenital pathology, defined by the transposition of thoracic and abdominal viscera. Most patients are asymptomatic and they're discovered incidentally. The SIT goes far beyond the paradigm of treatments and surgical techniques.
CONCLUSIONS
The pathology turns into a behavior modification for surgical treatment, however, it is possible to carry them out successful procedure.
Topics: Abdomen; Adult; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Female; Humans; Situs Inversus
PubMed: 34762629
DOI: 10.24875/CIRU.20000906