Abstract
Acute acalculous cholecystitis (AAC) can occur in up to 18% of severely injured patients. Diagnosis is made by positive ultrasound findings of gallbladder sludge, hydrox, and wall thickening. There may also be recent-onset jaundice, positive ultrasound induced Murphy's sign, and unexplained sepsis. Mortality can be as high as 50%. Laparoscopic confirmation was obtained in six ICU trauma patients when omentum was drawn up over a distended gallbladder. Laparoscopic cholecystectomy (LC) was done by first directly decompressing the gallbladder through the fundus. This trocar was replaced by a 16 French Foley catheter passed through an Endoloop into the gallbladder and secured by tightening the loop around a cuff of gallbladder. Sepsis resolved in all cases. Only one required subsequent laparoscopic cholecystectomy. LC has a low morbidity and may be life saving during the early stages of AAC. It is not indicated in gangrene or perforation of the gallbladder.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Arnott RS (1994) Laparoscopy and acalculous cholecystitis (review). Aust N Z J Surg 64: 405–406
Boland GW, Lee MJ, Leung J, Mueller PR (1994) Percutaneous cholecystostomy in critically ill patients: early response and final outcome in 82 patients. Am J Roentgeol 164: 339–342
Brandt CP, Priebe PP, Jacobs DG (1994) Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis. Surg Endosc 8: 361–365
Glenn F, Becker CG (1982) Acute acalculous cholecystitis. Ann Surg 195: 131–136
Haicken BN (1992) Laparoscopic tube cholecystostomy. Surg Endosc 6: 285–288
Johlin FC Jr, Neil GA (1993) Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystostomy. Gastroenterol Endosc 39: 645–651
Laing FC, Federle MP, Jeffrey RB, Brown TW (1981) Ultrasonic evaluation of patients with acute right upper quadrant pain. Radiology 140: 449–455
McGahan JP, Lindfors KK (1988) Acute cholecystitis: diagnostic accuracy of percutaneous aspiration of the gallbladder. Radiology 167: 669–671
Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD, Ngo C, Radin DR, Halls JM (1985) Real time sonography in suspected acute cholecystitis: prospective evaluation of primary and secondary signs. Radiology 155: 767–771
Raunest J, Imhof M, Rauen U, Ohmann CH, Thon KP, Zürrig K-F (1992) Acute cholecystitis: a complication of severely injured intensive care patients. J Trauma 32: 433–440
Shirai Y, Tsukada K, Kawaguchi H, Ohkani T, Muto Y, Hakakeyama K (1993) Percutaneous transhepatic cholecystostomy for acute acalculous cholecystis. Br J Surg 80: 1440–1442
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yang, H.K., Hodgson, W.J.B. Laparoscopic cholecystostomy for acute acalculous cholecystitis. Surg Endosc 10, 673–675 (1996). https://doi.org/10.1007/BF00188528
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00188528