[Acute acalculous cholecystitis in patients with severe trauma]. / Colecistitis aguda acalculosa en el paciente con trauma grave.

BACKGROUND: The incidence of AAC on patients with traumatic lesions fluctuates between 0.5 to 5%, with mortality which varies between 7 and 75%. These values are determined by case reports or retrospective series. AIM: To determine the incidence of acute acalculous cholecystitis (AAC) in a number of patients with severe trauma and its clinical implications, as well as the risk factors that can favour the development of this pathology, evaluation of early morphological changes, surgical treatment and morbidity and mortality. PATIENTS AND METHODS: Prospective, observational, longitudinal and descriptive inferential study conducted from October 1994 to June 1995. Twenty eight consecutive adult patients with contusion severe trauma on at least two corporal regions were included. The severity of lesions was estimated with a physiologic scale (Revised Trauma Score = RTS) and an anatomic one (Injury Severity Score = ISS). All patients were submitted to ultrasound of the liver and biliary tract on their admittance and every 5 or 7 days for an early detection of sonographic changes or conclusive of AAC. Each patient was treated conveniently in accordance with his or her lesions. The patients were evaluated clinically, with laboratory exams, and for possible risk factors for the development of this pathology. MEASUREMENTS: Two Tailed Fisher's Exact Test for qualitative variables and Mann-Withney U Test for the quantitatives. RESULTS: Twenty one patients were male (75%) and 7 were female (25%), average age 45.5 years and an average observation period of 22.5 days. Seven of these patients (25%) developed sonographic changes starting the 9th day after admission, 4 were conclusive of AAC proved histologically, three of these underwent open cholecystectomy with no morbidity and mortality and improvement of their clinical conditions. The other patient died due to hypovolemia without having been offered surgical treatment. The risks factors with statistical significance were: Long in-hospital stay, fever, abdominal pain, elevation of alkaline phosphatase, hypoalbuminemia, use of parenteral nutritional support and nosocomial pneumonia (P = < 0.05). There was a marginal significance with the use of sedatives and analgesics. Global mortality was 18%. CONCLUSIONS: The incidence is more than the one previously informed and there was no mortality related the presence of AAC. The ultrasound easily detects the gallbladder morphological changes. There was no morbidity or mortality due to the cholecystectomy.