Classification of acute cholecystitis:etiopathogenetic principles of construction

Abstract

Aim of study is to suggest a scientifically based pathogenetic classification of acute cholecystitis, corresponding to the classical R. Virchow triad “etiology, pathogenesis, outcome”.
 Materials and methods.Comparative assessment of the classical classifications by H. Kehr (1907), L. Aschoff (1909), S. P. Fedorov (1934) and modern disease schemes, combining the signs of the three ones, is conducted.
 Results and discussion.The proposed improved classification of acute cholecystitis (AC) corresponds to research principles, taking into account the etiology, pathogenesis and predicted outcome of the disease. There are 4 groups of AC variants:
 I — Acute calculous cholecystitis with all options and combinations (cholangitis, choledocholithiasis, Opie syndrome — papillary ileus, Mirizzi syndrome, Bouveres — acute gallstone ileus, hemobilia (80–85%)).
 II — Acute non-calculous cholecystitis without stones (8–15%) — no obstruction of the cystic duct of the gallbladder.
 III —Special AC forms. The dominant factors are enzymatic, vascular, non-productive anaerobic microflora, stress factors (severe injury, burns or surgery, childbirth). These forms require urgent surgeries and occur in 2–15% of all cases of AC destructive forms.
 IV — Специфические формы ОХ.Specific AC forms. Caused by specific microflora: typhoid, salmonella, dysentery, and parasitic (opisthorchosis, alveococcosis, amebiasis, ascariasis, less often — giardiasis). Rare forms are characteristic of endemic zones and in violation of generally accepted sanitary standards.
 Conclusion.Use of ultrasound, CT, SCT, MRI, endoscopic and endovascular interventions allows to diagnose almost all the AC various forms in the pre-operative period and individualize therapeutic and surgical tactics by taking into account the possible outcome. The proposed pathogenetic classification of AC can serve as a scheme for general practitioners, physicians, surgeons, anesthesiologists, and intensive care workers.