Authors: Yasutoshi Kimura, Tadahiro Takada, Yoshifumi Kawarada...

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.

Topics: Abdominal Pain; Cholangitis; Cholecystitis, Acute; Cholecystolithiasis; Female; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Recurrence; Tokyo

PubMed: 17252293
DOI: 10.1007/s00534-006-1152-y

Review

Authors: Seung Ok Lee, Sung Kyun Yim

Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.

Topics: Anti-Bacterial Agents; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Drainage; Electrolytes; Gallbladder; Humans

PubMed: 29791985
DOI: 10.4166/kjg.2018.71.5.264

Randomized Controlled Trial

Authors: Charlotte S Loozen, Hjalmar C van Santvoort, Peter van Duijvendijk...

OBJECTIVE

To assess whether laparoscopic cholecystectomy is superior to percutaneous catheter drainage in high risk patients with acute calculous cholecystitis.

DESIGN

Multicentre, randomised controlled, superiority trial.

SETTING

11 hospitals in the Netherlands, February 2011 to January 2016.

PARTICIPANTS

142 high risk patients with acute calculous cholecystitis were randomly allocated to laparoscopic cholecystectomy (n=66) or to percutaneous catheter drainage (n=68). High risk was defined as an acute physiological assessment and chronic health evaluation II (APACHE II) score of 7 or more.

MAIN OUTCOME MEASURES

The primary endpoints were death within one year and the occurrence of major complications, defined as infectious and cardiopulmonary complications within one month, need for reintervention (surgical, radiological, or endoscopic that had to be related to acute cholecystitis) within one year, or recurrent biliary disease within one year.

RESULTS

The trial was concluded early after a planned interim analysis. The rate of death did not differ between the laparoscopic cholecystectomy and percutaneous catheter drainage group (3% 9%, P=0.27), but major complications occurred in eight of 66 patients (12%) assigned to cholecystectomy and in 44 of 68 patients (65%) assigned to percutaneous drainage (risk ratio 0.19, 95% confidence interval 0.10 to 0.37; P<0.001). In the drainage group 45 patients (66%) required a reintervention compared with eight patients (12%) in the cholecystectomy group (P<0.001). Recurrent biliary disease occurred more often in the percutaneous drainage group (53% 5%, P<0.001), and the median length of hospital stay was longer (9 days 5 days, P<0.001).

CONCLUSION

Laparoscopic cholecystectomy compared with percutaneous catheter drainage reduced the rate of major complications in high risk patients with acute cholecystitis.

TRIAL REGISTRATION

Dutch Trial Register NTR2666.

Topics: APACHE; Aged; Cholecystectomy, Laparoscopic; Cholecystitis; Drainage; Female; Humans; Male; Netherlands; Postoperative Complications; Severity of Illness Index; Treatment Outcome

PubMed: 30297544
DOI: 10.1136/bmj.k3965

Exploring the causal relationships between cholelithiasis, cholecystitis, cholecystectomy, and gastroesophageal reflux disease: a bidirectional two-sample Mendelian randomization study.

Authors: Huahang Lin, Runda Lu, Qixin Shang...

BACKGROUND

Biliary disorders and gastroesophageal reflux disease (GERD) frequently coexist. However, precise linkages between these conditions remain to be clarified.

METHODS

Univariable Mendelian randomization (MR), Bayesian weighted MR (BWMR) along with multivariable MR approaches were conducted using genetic instruments to evaluate the causality involving biliary disorders and GERD. Furthermore, an investigation was conducted on the potential mediating roles of biliary disorders (or GERD), on the linkage involving BMI and GERD (or biliary disorders).

RESULTS

Univariable MR analyses revealed significant causal effects of genetically predicted cholelithiasis [odds ratio (OR)=1.04, P =0.0001], cholecystitis (OR=1.06, P =0.0004), and cholecystectomy (OR=2.56, P =1.05×10 -6 ) on GERD. These findings were replicated in the FinnGen cohort and were also confirmed by BWMR and multivariable MR analyses. Additionally, mediation analyses demonstrated that cholelithiasis and cholecystitis acted as partial mediators, linking BMI causally to GERD. Conversely, GERD exhibited causal effect on cholelithiasis (OR=1.52, P =9.17×10 -30 ) and cholecystitis (OR=1.90, P =3.32×10 -28 ), which remained significant after BWMR and multivariable MR analyses. Mediation analyses further revealed significant mediating effect of GERD on how BMI influenced cholelithiasis/cholecystitis.

CONCLUSION

Our study elucidates the bidirectional causal linkages involving cholelithiasis, cholecystitis, cholecystectomy, and GERD. These results highlight the significance of GERD risk assessment in individuals suffering from biliary diseases and vice versa.

Topics: Humans; Cholelithiasis; Cholecystitis; Mendelian Randomization Analysis; Gastroesophageal Reflux; Cholecystectomy; Male; Female; Bayes Theorem; Middle Aged

PubMed: 39093866
DOI: 10.1097/JS9.0000000000001992

Authors: Giuseppe Famularo, Pier Luigi Spada

Topics: Aged, 80 and over; COVID-19; COVID-19 Nucleic Acid Testing; Cholecystitis; Cholecystolithiasis; Drainage; Humans; Male

PubMed: 33588314
DOI: 10.1016/j.clinre.2021.101635

Review

Authors: Grant Sanders, Andrew N Kingsnorth

Topics: Ambulatory Surgical Procedures; Cholangitis; Cholecystectomy, Laparoscopic; Cholecystitis; Colic; Forecasting; Gallbladder Neoplasms; Gallstones; Humans; Incidental Findings; Jaundice; Medical History Taking; Pancreatitis; Postoperative Complications

PubMed: 17690370
DOI: 10.1136/bmj.39267.452257.AD

Authors: Dongmei Sun, Shih-Han Susan Huang

Topics: Aged, 80 and over; Anti-Bacterial Agents; Cholecystitis; Color; Female; Gallbladder; Humans; Methylene Blue; Tomography, X-Ray Computed; Urine

PubMed: 29483332
DOI: 10.1503/cmaj.171498

Authors: N Eriguchi, S Aoyagi, T Tamae...

Seven cases of xanthogranulomatous cholecystitis are presented, and their clinicopathological appearance is described. Three men and 4 women with xanthogranulomatous cholecystitis, aged 53-72 years old, were reviewed. Five patients had had previous attacks of acute cholecystitis lasting from 3 weeks to 6 months. Abdominal ultrasonography was performed in all patients, and computed tomography in 5 patients. Cholelithiasis and sludge were present in all patients. The gallbladder wall was thickened in all patients. On computed tomography, one patient showed no abnormal finding, and 4 patients had abnormal findings such as increased wall thickness and irregularity, and pericholecystic abnormalities. A diagnosis of gallbladder carcinoma was made preoperatively in 1 patient. During laparotomy, the gallbladders in all patients showed signs of chronic cholecystitis, and cholecystectomies were performed. Histological findings showed xanthogranulomatous cholecystitis, and 4 patients had stones in the gallbladder wall. Despite the characteristic histologic appearance of xanthogranulomatous cholecystitis, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm. We report here 7 cases of xanthogranulomatous cholecystitis and review the literature.

Topics: Aged; Cholecystitis; Female; Humans; Male; Middle Aged

PubMed: 11680937
DOI: 10.2739/kurumemedj.48.219

Review

Authors: N K Wee, W S C Cheong, H M Low...

INTRODUCTION

Acute cholecystitis (AC) is a common problem encountered in surgical practice. This occurs due to obstruction of the cystic duct by calculi resulting in inflammation of the gallbladder. Increasingly, contrast enhanced computed tomography (CECT) and Magnetic Resonance Imaging (MRI) scans are being used for assessment. While the imaging features of AC are well recognized and extensively described in the literature, radiological features of the rarer complications related to AC such as pseudoaneurysm formation and gallbladder volvulus are less well known. We aim to describe these rarer findings in our pictorial review, to better educate the clinician and radiologist, such that timely diagnoses can be reached, and relevant management can be affected.

METHODS

A collection of cases showing the common acute gallbladder pathologies and complications such as acute cholecystitis, gangrenous cholecystitis, emphysematous cholecystitis, haemorrhagic cholecystitis, Mirizzi's syndrome, gallbladder perforation and abscess formation, were collected between July 2016 and March 2018 at two different medical institutions in Singapore. In addition, rarer cases of gallbladder volvulus and vascular complications such as cystic artery pseudoaneurysms and vessel erosions, were also followed up.

RESULTS

The CT and MRI imaging features of these conditions were discussed, with key diagnostic imaging features emphasized.

CONCLUSION

Acute gallbladder pathologies are commonly encountered in day-to-day radiology practice. Knowledge of the rarer gallbladder pathologies and their key imaging features will help the radiologist, in particular, the on call radiologist in training, improve diagnostic accuracy and allow for timely management.

Topics: Cholecystitis; Cholecystitis, Acute; Humans; Magnetic Resonance Imaging; Singapore; Tomography, X-Ray Computed

PubMed: 34508378
DOI: No ID Found

Authors: Gokhan Ongen, Omer Fatih Nas, Fuat Aksoy...

BACKGROUND

Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications.

PURPOSE

To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods.

MATERIAL AND METHODS

We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated.

RESULTS

A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group ( = 0.03). Murphy finding and diabetes status were similar between the two groups ( = 0.086 and  = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients ( = 0.045); with no significant difference in cases of complicated cholecystitis ( = 0.499).

CONCLUSION

Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.

Topics: Humans; Male; Female; Middle Aged; Aged; Aged, 80 and over; Pandemics; Cholecystitis, Acute; Cholecystitis; Comorbidity; Diabetes Mellitus

PubMed: 36412110
DOI: 10.1177/02841851221137048