Complications of Acute Cholecystitis in Elderly Patients

Abstract

Acute cholecystitis is a pathological condition involving cholelithiasis with acute pain lasting 4 to 6 hours or clinical manifestation with prolonged biliary colic, accompanied by fever, laboratory evidence of inflammation or cholestasis. The frequency of acute cholecystitis in patients up to 50 years of age is about 6%, while in patients over 50 is up to 21%. 5-10% of all cases are about acalculous cholecystitis. In a ten-year period, between 2006-2015, 424 patients diagnosed with acute cholecystitis over the age of 60 were hospitalized in the Second Department of Surgery. Of these patients, 291 are women and 133 are men. Complications were recorded in 296 of all hospitalized patients. There are no typical clinical symptoms in most of the patients and only a prevalence of vague general complaints with a single expression of right-sided abdominal weight and history of cholelithiasis. The atypical clinical manifestation is expressed most often with a rapid progression to complicated forms of acute cholecystitis - hydrops, empyema, gangrene, perivesical and/or subhepatic abscess, cholangitis, perforation. About 75% of these patients suffer from concomitant diseases (cardiovascular, respiratory, neurological, diabetes, etc.). Added to that, the acute cholecystitis proceeds unpredictably with a high risk of developing complications - 40-77% chance of perforation of the gall bladder, and also with a high frequency of mortality - 7-8% develop biliary sepsis. The gold standard in the treatment of acute cholecystitis is laparoscopic cholecystectomy but it is still not performed routinely everywhere, because of the controversy regarding timing and surgical approach to patients with acute cholecystitis. Based on the prevalence of complicated forms of acute cholecystitis and comorbidity in the elderly patients, the treatment requires open cholecystectomy in earlier periods.