Laparoscopic cholecystostomy for acute acalculous cholecystitis |
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Authors: | H K Yang W J B Hodgson |
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Institution: | (1) Institute for Minimally Invasive Surgery, St. Agnes Hospital, 303 North Street, Suite 103, 10605 White Plains, NY, USA;(2) Section of Gastrointestinal and Colorectal Surgery, Department of Surgery, New York University, The Brooklyn Hospital Center, 121 DeKalb Avenue, 11201 Brooklyn, NY, USA |
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Abstract: | Acute acalculous cholecystitis (AAC) can occur in up to 18% of severely injured patients. Diagnosis is made by positive ultrasound findings of gallbladder sludge, hydrox, and wall thickening. There may also be recent-onset jaundice, positive ultrasound induced Murphy's sign, and unexplained sepsis. Mortality can be as high as 50%. Laparoscopic confirmation was obtained in six ICU trauma patients when omentum was drawn up over a distended gallbladder. Laparoscopic cholecystectomy (LC) was done by first directly decompressing the gallbladder through the fundus. This trocar was replaced by a 16 French Foley catheter passed through an Endoloop into the gallbladder and secured by tightening the loop around a cuff of gallbladder. Sepsis resolved in all cases. Only one required subsequent laparoscopic cholecystectomy. LC has a low morbidity and may be life saving during the early stages of AAC. It is not indicated in gangrene or perforation of the gallbladder. |
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Keywords: | Acalculous cholecystitis Laparoscopic cholecystostomy |
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