Chronic cholecystitis natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Natural History
Cholecystitis presents with a abdominal pain lasting greater than 6 hours which is not relieving by antacids and postural changes. It is preceded by few attacks of biliary pain ( due to gall stones). Fever may not be a prominent symptom at the time of presentation, but can seen if untreated or complicated by infections. Untreated cholecystitis resolves spontaneously in half of the uncomplicated cases without surgery in span of 7 - 10 days. Remaining cases progress to complications and cause severe morbidity and mortality.
Complications
Major Complications of cholecystectomy
- Perforation or rupture
- Ascending cholangitis
- Bile leak ("biloma")
- Bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
- Abscess
- Wound infection
- Bleeding (liver surface and cystic artery most common sites)
- Hernia
- Organ injury (intestine and liver at highest risk, especially if gallbladder through inflammation has become adherent/scarred to other organs (e.g. transverse colon)
- Deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)
- Pancreatitis
Gall bladder perforation
Gall bladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality. [2]
Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. It can happen at the neck from pressure necrosis of an impacted calculus, or at the fundus. It can result in a local abscess, or perforation into the general peritoneal cavity; if the bile, is infected diffuse peritonitis supervenes readily and rapidly. Death can result. [2]
A retrospective study looked at 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis. Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a cholecystectomy. Two patients died and 6 patients had further complications. The morbidity and mortality rates were 37.5% and 12.5%, respectively in the present study. The authors of this study suggests that early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.[2]
Prognosis
Uncomplicated cholecystitis has a favorable prognosis. Complicated cases can be treated successfully with surgery and they usually do well.[3]
References
- ↑ "www.ncbi.nlm.nih.gov" (PDF). Retrieved 2012-08-20.
- ↑ 2.0 2.1 2.2 Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E (2006). "Diagnosis and treatment of gallbladder perforation". World J. Gastroenterol. 12 (48): 7832–6. PMID 17203529.
- ↑ "Acute cholecystitis: MedlinePlus Medical Encyclopedia". Retrieved 2012-08-20.