Treatment of acute cholecystitis after cardiovascular surgery

Abstract

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.

Clinical characteristics and management of acute cholecystitis after cardiovascular surgery

“…Pathological findings revealed gangrene in all patients. Ueno et al 1 also reported that gallbladder drainage for AC after CS was insufficient by itself. Furthermore, Rady et al 24 and Melloul et al 25 also reported that gallbladder drainage cannot be expected to be effective in gangrenous cholecystitis.…”

“…There are several risk factors for acute cholecystitis (AC), including a history of cardiovascular disease 1 . Some researchers have reported that the incidence rate of AC occurring after cardiovascular surgery (CS) is 0.5%‐6.0% and the mortality rate is 15%‐42% 2–9 .…”