Review Article

Acute Acalculous Cholecystitis Complicating Major Trauma: A Report of Five Cases

Authors: Nasim Ahmed, MD, FACS

Abstract

The purpose of this study was to identify the clinical characteristics of the patients in our institution who developed acute acalculous cholecystitis (AAC) after major trauma. Data of all trauma patients who developed AAC from January 2001 through June 2006 were analyzed. Five out of 1386 (0.3%) major trauma patients were diagnosed with AAC. One out of five patients had hypotension and shock and received vasopressor treatment. Prior to the diagnosis of AAC, all patients received ventilatory support, intravenous opioid analgesia, had pneumonia, and experienced tachycardia. No specific clinical characteristic was identified in patients with AAC; however, prolonged ventilatory support, pneumonia, use of opioids, and new onset arrhythmias were seen in the majority of patients.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Kalliafas S, Ziegler DW, Flancbaum L, et al. Acute acalculous cholecystitis: incidence, risk factors, diagnosis, and outcome. Am Surg 1998;64:471–475.
 
2.de Luna Vargas MA, Gonzalez-Ojeda A, Cardenas-Chavez O, et al. Acute acalculous cholecystitis in patients with severe trauma. Rev Gastroenterol Mex 1996;61:348–355.
 
3.Laurila J, Syrjala H, Laurila PA, et al. Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 2004;48:986–991.
 
4.Rady MY, Kodavatiganti R, Ryan T. Perioperative predictors of acute cholecystitis after cardiovascular surgery. Chest 1998;114:76–84.
 
5.Kelm C, Muhrer KH, Zimmermann T, et al. Acute stress-induced cholecystitis. Langenbecks Arch Chir 1991;376:143–146.
 
6.Flancbaum L, Majerus TC, Cox EF. Acute posttraumatic acalculous cholecystitis. Am J Surg 1985;150:252–256.
 
7.Pelinka LE, Schmidhammer R, Hamid L, et al. Acute acalculous cholecystitis after trauma: a prospective study. J Trauma 2003;55:323–329.
 
8.Raunest J, Imhof M, Rauen U, et al. Acute cholecystitis: a complication in severely injured intensive care patients. J Trauma 1992;32:433–440.
 
9.Johnson LB. The importance of early diagnosis of acute acalculous cholecystitis. Surg Gynecol Obstet 1987;164:197–203.
 
10.Demetriades D, Martin M, Salim A, et al. The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 2005;242:512–519.
 
11.Niderheiser DH. Acute acalculous cholecystitis induced by lysophosphatidyl choline. Am J Pathol 1986;124:559–563.
 
12.Lin KY-K. Acute acalculous cholecystitis: a limited review of the literature. Mt Sinai J Med 1986;53:305–309.
 
13.Glenn F. Acute cholecystitis following the surgical treatment of unrelated disease. Ann Surg 1947;126:411–420.
 
14.Thompson JW III, Ferris DO, Baggenstoss AH. Acute cholecystitis complicating operation for other diseases. Ann Surg 1962;155:489–494.
 
15.Savoca PE, Longo WE, Pasternak B, et al. Does visceral ischemia play a role in the pathogenesis of acute acalculous cholecystits? J Clin Gastroenterol 1990;12:33–36.
 
16.Cullen JJ, Maes EB, Aggrawal S, et al. Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis. Ann Surg 2000;232:202–207.
 
17.Becker CG, Dubin T, Glenn F. Induction of acute cholecystitis by activation of factor XII. J Exp Med 1980;151:81–90.