Surgical Management of Acute Cholecystitis in Patients 65 Years of Age and Older

Abstract

The proportion of the population of the U.S. 65 years of age and over is increasing. Biliary tract disease is estimated to involve 15% of the adult population. A review of 12,200 patients treated surgically at one medical center reveals that 2401 (20%) had acute cholecystitis. There were 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths occurred in 665 patients 65 years of age and older, for a mortality rate of 9.8%. These elderly patients accounted for 69.9% of the deaths from acute cholecystitis. It is suggested that acute cholecystitis in patients 65 years of age and older may be prevented by a more aggressive surgical approach to cholelithiasis when those patients are younger. Indeed, the present improved methods of diagnosis and an awareness of gallstones by the public is resulting in many more patients seeking medical advice in the early years of the disease. On the basis of a review of an experience in the surgical treatment of acute cholecystitis two proposals are made concerning the management of patients 65 years of age and over. First, the operation should be performed with minimal delay following diagnosis, and such specific correction of physiologic impairment should be performed as is feasible. Second, the procedure to be performed on the elderly patient should be one that alleviates the present problem, and accomplished by imposing the minimal burden upon the patient.

Endoscopic Sphincterotomy of Intradiverticular Papilla in a Patient with Acute Pancreatitis and Obstructive Jaundice

“…The patient was having acute pancreatitis which is, in the opinion of some authors, a relative contraindication to ERCP; however, if the episode of pancreatitis is due to a calculus impacted in the ampulla of Vater, then ERCP and sphincterotomy may be a lifesaving procedure [8]. Cannulation of the papilla within the diverticulum has been considered to be a cause of technical difficulties [9,10] and to perform sphincterotomy within a duodenal diverticulum is also another difficulty with a significantly increased risk of perforation and bleeding [8,11,12].…”

“…The failure rate of ERCP with and without diverticulum has been a matter of controversy with some reports suggesting a higher failure rate in the presence of periampullary diverticulum [6][7][8][9]11,12] but a recent study is suggesting no difference [13].…”

“…They may cause some difficulties in endoscopic cannulation, especially when the papilla is situated inside or on the ridge of a diverticulum [5]. In the literature, different impressions and controversial views are expressed on the success rate for cannulation and endoscopic sphincterotomy of the papilla in the presence of diverticula (L) [6][7][8][9][10][11][12][13]. This is a case report of acute biliary pancreatitis due to gallstones with a papilla situated inside a large diverticulum.…”

Ultrasound-Guided Percutaneous Transhepatic Cholecystic Puncture and Suction for Acute Acalculous or Postoperative Cholecystitis

“…Therefore, cholecystectomy has been adopted widely for patients with this disease over many years. Morrow et al [7] and Glenn [8] mentioned that medical treatment was not effective in elderly patients with acute cholecystitis, and other investigators [9][10][11] also emphasized the im portance of cholecystectomy at an early stage of the dis ease. However, there is the question of whether or not cholecystectomy is needed at all for patients with AAC.…”

Ultrasound-Guided Percutaneous Cholecystostomy as an Initial Treatment for Acute Cholecystitis in Elderly Patients

“…As the incidence of gallstones increases with age, the proportion of elderly patients with acute cholecystitis increases [1]. Acute cholecystitis may atypically present itself in the elderly, thus causing diagnostic and therapeutic problems [2, 3, 4], and it is well recognized as a high-risk condition for morbidity and mortality.…”