Acute cholecystitis, biliary obstruction, and biliary leakage

Ziessman, Harvey A.

doi:10.1016/s0001-2998(03)00032-1

Cited by 45 publications

(24 citation statements)

References 119 publications

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“…Acute calculus cholecystitis is defined as acute inflammation of the gallbladder, commonly caused by gallstones impacted in the cystic duct [3,4]. In most cases, the inflammatory process is initially sterile; however, bactibilia with microorganisms of the Enterobacteriaceae family, enterococci, or more rarely anaerobes occurs in 9 to 72 % of the patients [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial

et al. 2012

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Background Current recommendations for treating acute calculus cholecystitis include the use of intravenous antibiotics, although these recommendations were never tested scientifically. The aim of this study was to evaluate the role of intravenous antibiotic therapy in patients with mild acute calculus cholecystitis. Methods In this prospective, randomized controlled trial, 84 patients with a diagnosis of mild acute calculus cholecystitis were randomly assigned to supportive treatment only or supportive treatment with intravenous antibiotic treatment (42 patients in each arm). Patients were followed through their index admission and until delayed laparoscopic cholecystectomy was performed. Results The two study groups did not differ in their demographic data or in the clinical presentation and disease severity. Analysis was conducted on the intent‐to‐treat basis. Patients in the intravenous antibiotics arm resumed a liquid diet earlier (1.7 vs. 2.2 days, p = 0.02) but did not significantly differ in resumption of regular diet (2.8 vs. 3.2 days, p = 0.16) or hospital length of stay (LOS) (3.9 vs. 3.8 days, p = 0.89). Patients in the intravenous antibiotics arm had rates of percutaneous cholecystostomy tube placement (12 vs. 5 %, p = 0.43), readmissions (19 vs. 13 %, p = 0.73), and perioperative course similar to those not receiving antibiotics. The overall hospital LOS, including initial hospitalization and subsequent cholecystectomy, was similar for both groups (5.6 vs. 5.1 days, p = 0.29). Eight (19 %) patients in the supportive arm were crossed over to the intravenous antibiotic arm during the index admission. Conclusions Intravenous antibiotic treatment does not improve the hospital course or early outcome in most of the patients with mild acute calculus cholecystitis.

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Section: Introductionmentioning

confidence: 99%

Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial

et al. 2012

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“…An area of signal corresponding to gallbladder constitutes a normal scan and failure to opacify the gallbladder is highly sensitive and specific for acute calculous cholecystitis due to cystic duct obstruction. In AAC, cholescintigraphy has a sensitivity of 79% and a specificity of 87% [47]. False-negative results may occur because of cystic duct patency; false-positive results may occur because of fasting, liver disease, or total parenteral nutrition [48].…”

Section: Opinion Statementmentioning

confidence: 99%

Acute acalculous cholecystitis

Owen¹,

Jain

2005

Curr Treat Options Gastro

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Acute acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones. Patients are usually critically ill with atherosclerotic heart disease, recent trauma, burn injury, surgery, or hemodynamic instability. The presentation of acute acalculous cholecystitis may be insidious, characterized by unexplained fever, leukocytosis, hyperamylasemia, or abnormal aminotransferases, and patients often lack right upper quadrant tenderness. Diagnostic evaluation includes ultrasonography, computerized tomography, and cholescintigraphy. Given the high mortality of untreated disease, definitive treatment consists of cholecystectomy or, in poor surgical candidates, cholecystostomy. Endoscopic therapy with nasobiliary drainage and lavage is an effective treatment option in patients unable to tolerate surgery or cholecystostomy.

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“…If a HIDA scan is performed, there is intravenous injection of Technetium-99 m labelled radiotracer, typically following by prompt hepatic uptake 1. If there is biliary excretion and the gallbladder fails to uptake tracer within 1 h, the diagnosis of acute cholecystitis is made and the appropriate clinical action can be taken.…”

Section: Introductionmentioning

confidence: 99%

“…A secondary finding of acute cholecystitis, associated with a non-visualised gallbladder is known as the ‘hot rim’ sign 2. It is defined as a peripherally enhancing rim surrounding a photopenic gallbladder fossa 1–3…”

Section: Introductionmentioning

confidence: 99%