Acute acalculous cholecystitis--a clinical-pathological disease spectrum.
S Afr J Surg
; 37(4): 99-104, 1999 Nov.
Article
in En
| MEDLINE
| ID: mdl-10701340
ABSTRACT
OBJECTIVE:
To assess the influence of disease setting on clinical and pathological features of acute acalculous cholecystitis (AAC).DESIGN:
Analysis of prospectively accumulated clinical data. Blinded histopathological review. LOCATION OF STUDY Tygerberg Hospital, Western Cape. PATIENTS Fifty-seven consecutive patients with AAC treated over a 9-year period. MAIN OUTCOMEMEASURES:
Clinical, ancillary and pathological features of AAC in each of 3 arbitrarily designated types. Type I (N = 24) occurred in patients hospitalised for trauma or critical illness. Patients with type II disease (N = 20) presented primarily with symptoms of acute cholecystitis. Type III AAC (N = 13) was associated with non-calculous gallbladder outflow obstruction.RESULTS:
Type I AAC was associated with the highest mortality rate (45.8%), occurred predominantly in males (75%) and was diagnosed pre-operatively in 50% of patients. Acute ischaemic cholecystitis was the most frequent histological diagnosis (66.7%). Only 1 death (5%) was associated with type II AAC despite patients being older, and all but 2 patients (10%) having chronic underlying disease. Acute cholecystitis was diagnosed pre-operatively in 90% of patients. Thirteen patients (65%) were males. Acute-on-chronic cholecystitis was the most frequent histological diagnosis (50%), followed by acute ischaemic cholecystitis in 30%. Type III was associated with an intermediate mortality rate (23.1%) and was the type most seldom diagnosed pre-operatively (15.4%). Histological findings reflected the nature and duration of underlying obstructive pathology.CONCLUSION:
The circumstances in which AAC occurs appear to be associated with distinct clinical-pathological variants of the disease. Their recognition could serve to enhance understanding of this challenging condition.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cholecystitis
Type of study:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
S Afr J Surg
Year:
1999
Document type:
Article
Publication country:
SOUTH AFRICA
/
SUDAFRICA
/
ZA
/
ÁFRICA DO SUL