Acute cholecystitis as a complication in surgical patients
R. M. Devine, M. B. Farnell and P. Mucha Jr
Acute cholecystitis after operation or trauma is associated with reported
mortalities of 10% to 50%. During a 16-year period at the Mayo Clinic,
Rochester, Minn, 75 such patients were examined, eight of whom had
traumatic injuries. The incidence of this complication was approximately
one for every 10,000 surgical procedures. In contrast with acute
cholecystitis that occurs de novo, elderly men who had other antecedent
complications seemed to be at an increased risk. Also, acalculous
cholecystitis with associated gangrene and perforation of the gallbladder
was more commonly encountered. The diagnosis is difficult to establish in
patients who have had recent abdominal operations and is based on physical
signs and symptoms, although cholescintigraphy will be of value in future
cases. The most common treatment is cholecystectomy. Clinicians must
maintain a high index of suspicion and carefully examine any surgical
patient in whom abdominal pain or unexplained fever develops. Once the
diagnosis is confirmed, early operative intervention is indicated.
