Diagnosis and Treatment of Acute Acalculous Cholecystitis after Abdominal Operation

Abstract

Objective To investigate the cause, clinical characteristics, diagnosis and treatment of acute calculous cholecystitis after abdominal operation. Methods From January 2012 to January 2017, clinical data of 20 patients with acute calculous cholecystitis who underwent abdominal operation were retrospectively analyzed. Results Two patients only developed mild tenderness on the upper abdomen without peritonitis signs, and the ultrasound indicated edema of gallbladder wall was not serious without effusion around the gallbladder, and these two patients improved after receiving conservative treatments of anti-infection and microcirculation correction. Seven patients received PTGD temporarily as they were aged and in critical conditions, one patient received cholecystectomy under laparotomy due to unsatisfactory drainage effect; one patient died of complications of infectious shock and respiratory failure; and the other five patients received cholecystectomy under laparoscopy three months after their conditions stabilized. All the rest 11 patients received cholecystectomy directly, of whom, three patients received laparotomy, eight patients underwent laparoscopic surgery and three of them converted to open surgery due to serious abdominal adhesion. Two patients additionally received common bile duct exploration and T tube drainage as they were suspected of perforation of common bile duct. Conclusion Acute acalculous cholecystitis after abdominal operations is caused by multiple factors, which is easily confused with complications of primary diseases, leading to misdiagnosis or missed diagnosis. In addition, as acute acalculous cholecystitis could devolop multiple organ failure, the optimal treatment approach should be early identified and early diagnosis and reasonable surgical resection might be performed based on patients’ tolerability. Key words: Acalculous Cholecystitis; Laparotomy; Diagnostic Techniques and Procedures