Cholecystitis

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- 5-10% of cases of cholecystitis
- usually occurs in critically ill patients
- associated with trauma, surgery, burns, prolonged TPN, prolonged use of narcotics
- incidence rising
- late complication of AIDS

- unclear
- functional obstruction of cystic duct occurs. Multiple factors have been invoked : viscous bile, decreased cystic artery perfusion, bacterial colonization, inflammation and reflux of pancreatic juice

- similar to those of acute calculous cholecystitis but many of the signs are masked by other illnesses/drugs in ICU setting
- localized signs of peritonitis and palpable gall-bladder strongly suggestive of diagnosis

- US, CT or hepatobiliary radionucleide cholescintigraphy are accurate for diagnosis. Latter is least sensitive

- traditional treatment: surgical cholecystotomy or, for patients with extensive gangrenous changes, cholecystectomy
- 2 alternative approaches: percutaneous radiologic drainage or endoscopic transpapillary drainage. Latter more technically demanding but can be performed in patients with coagulopathy and marked ascites

- 50% develop gangrenous changes of GB
- 8-15% perforate
- mortality rates with surgery 17-66%

© Charles Gomersall December 1999

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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