비결석성 급성 담낭염에 대한 임상적 고찰 = Clinical Analysis of Acute Acalculous Cholecystitis비결석성 급성 담낭염에 대한 임상적 고찰

다국어 초록 (Multilingual Abstract)

Acute acalculous cholecystitis is an acute inflammation of the gallbladder, in the absence of stone, and it comprises 4 to 8% of all cases of acute cholecystitis, and it has a tendency to occur after other disease, especially major trauma, burn or operation. Typical findings of pain, tenderness, and a mass in RUQ are infrequent, and the diagnosis rests on a high index of suspicion and ultrasonography. It has the highest mortality and morbidity of all benign conditions affecting the gallbladder, but its incidence is actually increasing due to increasing age of patients, more extensive and invasive therapeutic procedure, prolonged survival of gravely ill patients increasing the chances of initiation of the disease. Awareness of this disease, knowledge of its clinical features, and early surgical intervention are important facets of successful management. This study was done to determine the features of acute acalculous cholecystitis and to evaluate our experiences in its management at over the years 1976 to 1986. The results are summarized as follows; 1) Among 1,782 patients who needed cholecystectomy due to biliary tract disease, acute cholecystitis was found in 463 patients (26.3%), and acute acalculous cholecystitis comprised 8.9% (41 cases) of all cases of acute cholecystitis. 2) The sex ratio of male to female was 1:1.3, and the age of patients varied from 6 to 81 years, the average age was 50 years. 3) The most common clinical symptoms were RUQ pain which were observed in 35 cases (85.4%), and the most common physical findings were RUQ tenderness which were observed in 37 cases (90. 2%). 4) On laboratory examination, leukocytosis was found in 28 cases (68.3%) of all patients, and abnomalities in liver function test were observed in 22 cases (53.7%), among them alkaline phosphatase was most prominent. 5) Abdominal ultrasonography was used as an important diagnostic method in 23 cases (56.1%), and it revealed accuracy of 82.6%, and other procedures such as oral GR cholangiography, IV cholangiography and ERCP (Endoscopic retrograde cholangiopancreaticogram) were performed in 3 cases, but not dignostic. 6) Cholecystectomy was used as main procedure in 36 cases (87.8%), and supplemental procedures such as operative cholangiogram, T-tube choledochostomy were performed for passed stone in 31 cases in cholecystectomized patients. Cholecystostomy was performed in 5 cases (12.2%). 7) Gangrenous changes in gallbladder were observed in 15 cases (36.6%), and 8 cases of perforation were found among them. 8) Possible predisposing factors were observed in 22 cases (53.2%), and arrhythmia was most common among them (27.3%). 9) Acute acalculous cholecystitis developed in postoperative period were 5 cases; 2 cases after non-billary abdominal surgery, 2 cases after orthopedic surgery, 1 case after vascular surgery, and mean duration of symptoms were 19.4 days after operation, possible relationship between first meal after operation and onset of symptoms were observed in two cases. 10) Positive bile cultures were obtained in 20 cases, and E. coli was the most common one (49%), and positive blood cultures were obtained in 7 cases (43.8%), and K. pneumonia was the most common organism. Positive culture from both bile juice and blood were observed in 5 cases of 12 cases. 11) Salmonella typhi were cultured from bile juice in 4 cases, in addition, two cases of positive Widal test were observed. 12) Postoperative complications were observed in 12 cases (29.3%), and pneumonia was the most common one (58.3%), and postoperative mortality was in 5 cases (12.2%), and main cause of death was sepsis with ARDS. 13) Mean duration of symptoms were 8.7 days in patients with uneventful postoperative course, 13.4 days in patient with complicated postoperative course, 16.8 days in mortality cases. So, if a patient with predisposing factors such as postoperative state or major trauma shows high fever and abdminal signs, acute acalculous cholecystitis must be consi