Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies

Charles Treinen, Daniel Lomelin, Crystal Krause, Matthew R Goede, Dmitry Oleynikov

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.

Original languageEnglish (US)
Pages (from-to)421-427
Number of pages7
JournalLangenbeck's Archives of Surgery
Volume400
Issue number4
DOIs
StatePublished - May 26 2015

Fingerprint

Acalculous Cholecystitis
Acute Cholecystitis
Critical Illness
Cholecystostomy
Laparoscopic Cholecystectomy
Cholecystectomy
Databases
Comorbidity
Cystic Duct
Cholecystitis
Information Storage and Retrieval
PubMed
General Anesthesia

Keywords

  • Acute acalculous cholecystitis
  • Laparoscopic cholecystectomy
  • Open cholecystectomy
  • Percutaneous cholecystostomy

ASJC Scopus subject areas

  • Surgery

Cite this

Acute acalculous cholecystitis in the critically ill : risk factors and surgical strategies. / Treinen, Charles; Lomelin, Daniel; Krause, Crystal; Goede, Matthew R; Oleynikov, Dmitry.

In: Langenbeck's Archives of Surgery, Vol. 400, No. 4, 26.05.2015, p. 421-427.

Research output: Contribution to journalReview article

Treinen, Charles ; Lomelin, Daniel ; Krause, Crystal ; Goede, Matthew R ; Oleynikov, Dmitry. / Acute acalculous cholecystitis in the critically ill : risk factors and surgical strategies. In: Langenbeck's Archives of Surgery. 2015 ; Vol. 400, No. 4. pp. 421-427.
@article{931108f4309d4c52914b0c56b0bc001b,
title = "Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies",
abstract = "Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.",
keywords = "Acute acalculous cholecystitis, Laparoscopic cholecystectomy, Open cholecystectomy, Percutaneous cholecystostomy",
author = "Charles Treinen and Daniel Lomelin and Crystal Krause and Goede, {Matthew R} and Dmitry Oleynikov",
year = "2015",
month = "5",
day = "26",
doi = "10.1007/s00423-014-1267-6",
language = "English (US)",
volume = "400",
pages = "421--427",
journal = "Langenbeck's Archives of Surgery",
issn = "1435-2443",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - Acute acalculous cholecystitis in the critically ill

T2 - risk factors and surgical strategies

AU - Treinen, Charles

AU - Lomelin, Daniel

AU - Krause, Crystal

AU - Goede, Matthew R

AU - Oleynikov, Dmitry

PY - 2015/5/26

Y1 - 2015/5/26

N2 - Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.

AB - Purpose: Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. Materials and methods: This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. Results: LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. Conclusions: We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.

KW - Acute acalculous cholecystitis

KW - Laparoscopic cholecystectomy

KW - Open cholecystectomy

KW - Percutaneous cholecystostomy

UR - http://www.scopus.com/inward/record.url?scp=84929844237&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929844237&partnerID=8YFLogxK

U2 - 10.1007/s00423-014-1267-6

DO - 10.1007/s00423-014-1267-6

M3 - Review article

C2 - 25539703

AN - SCOPUS:84929844237

VL - 400

SP - 421

EP - 427

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

SN - 1435-2443

IS - 4

ER -