Acute cholecystitis in the elderly

After a controlled randomized trial, the management of patients with acute cholecystitis was changed from delayed to early cholecystectomy. The results obtained in 125 consecutive patients some years before the trial and in 144 consecutive patients after the trial were compared. All patients were 70 years or older. The comparison confirmed that early cholecystectomy reduces morbidity and mortality. Early cholecystectomy for acute cholecystitis in the elderly is strongly recommended.     

Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly

BACKGROUND: The morbidity and mortality rates associated with acute cholecystitis are higher in the elderly. This study reports the results of treatment of acute cholecystitis in the elderly with emergency ultrasonographically guided percutaneous cholecystostomy followed by elective cholecystectomy after endoscopic treatment of any common bile duct stones diagnosed by percutaneous cholangiography. METHODS: From January 1989 to December 1998, 92 patients aged over 70 years were treated for acute gallstone cholecystitis. A group of 84 patients with ultrasonographic signs of severe cholecystitis or an American Society of Anesthesiologists score of II to IV were submitted to ultrasonographically guided percutaneous cholecystostomy. Transcatheter cholangiography was performed in all patients and endoscopic sphincterotomy was performed before operation in patients with common bile duct stones. After resolution of the acute phase and treatment of any associated diseases, patients were submitted to cholecystectomy. RESULTS: Cholecystostomy was performed successfully in 83 patients and permitted resolution of the acute attack in all after a mean period of 1.8 days. Cholangiography yielded a diagnosis of non-gallstone obstruction in one patient and common bile duct stones in 19 patients; preoperative endoscopic sphincterotomy and stone extraction was performed in 18 patients. Elective cholecystectomy was then performed in 70 patients with no deaths and a morbidity rate of 24 per cent. CONCLUSION: Combining emergency ultrasonographically guided percutaneous cholecystostomy, preoperative endoscopic treatment of common bile duct stones and subsequent elective cholecystectomy constitutes an optimal treatment regimen for acute gallstone cholecystitis in selected elderly patients with a mortality rate of zero in the authors' experience.     

急性结石性胆囊炎手术时机的探讨

目的: 探讨急性结石性胆囊炎急诊手术的可能性和优越性. 方法: 按李缨来分类方法把188例急性结石性胆囊炎急诊手术分为早期手术组(组Ⅰ,n=87)、延期手术组(组Ⅱ,n=62)和晚期手术组(组Ⅲ,n=39),并对手术时间、总并发症、胆囊壁有无坏死、平均医疗费用、死亡率和治疗结果进行统计学分析比较. 结果: 胆囊壁坏死晚期和延期,手术组明显高于早期手术组(P<0.05);平均医疗费用和死亡率,组Ⅲ高于组Ⅰ和组Ⅱ(P<0.05);组Ⅰ、组Ⅱ治疗结果明显优于组Ⅲ(P<0.05). 结论: 急性结石性胆囊炎急诊早期手术优于延期和晚期手术.急性胆囊炎发病后一周内均可进行安全的胆囊切除手术.病程超过一周者宜采取保守治疗,6~8周后行择期手术.     

Acute gallstone pancreatitis

BACKGROUND: In acute gallstone pancreatitis, the ideal point in time for laparoscopic cholecystectomy with special reference to the severity of the disease has been prospectively analyzed. METHODS: A total of 77 patients with biliary acute pancreatitis were admitted between November 1993 and July 1998 (37 men and 40 women; mean age, 63 years; median Apache II score, 13.3) and staged by contrast-enhanced computed tomography findings as having edematous or necrotizing disease. RESULTS: In 48 patients, laparoscopic cholecystectomy was found to be possible: 35 patients (73%) with mild and 13 patients (27%) with severe acute pancreatitis. The overall success rate was 79% (38 of 48 patients), with 85% (30 of 35 patients) and 62% (8 of 13 patients) having mild and severe disease, respectively. Median duration of time between onset of symptoms and surgery was 10 days (range, 4-19 days) in edematous and 14 days (range, 7-29 days) in necrotizing pancreatitis (p = 0.0353). Operating time (median, 80 min) and hospital stay (median, 5 days) were almost the same in both groups. Total morbidity was 8%, with no mortality. CONCLUSIONS: Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for biliary acute pancreatitis. In mild disease, this is performed safely within 7 days, whereas in severe disease, especially in extended pancreatic necrosis, at least 3 weeks should elapse because of an increased infection risk.     

Acute cholecystitis

Acute cholecystitis is a common cause of the acute abdomen. The diagnosis has been distinctly improved with the development of ultrasonography and hepatobiliary scanning over the past 20 years. The treatment is cholecystectomy, with early as opposed to delayed operation gaining increasing popularity nationwide. Acute acalculous cholecystitis and emphysematous cholecystitis are special features of acute cholecystitis occurring in more complicated cases and requiring diligence in diagnosis and great care in treatment.     

Acute cholecystitis

A review of 360 patients surgically treated for biliary conditions revealed 54 cases of acute cholecystitis. After a report on the aetiopathogenesis, epidemiology, pathological anatomy and clinical aspects of the condition, early surgical treatment as soon as the diagnosis has been confirmed by tests, is recommended.