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Acute galloping cholecystitis
Last reviewed: 23.04.2024
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[Causes of acute stone-free cholecystitis
The most common predisposing factors are critical conditions, such as large-volume extraviral surgery, multiple injuries, extensive burns, recent childbirth, severe sepsis, mechanical ventilation and ventilation, and parenteral nutrition. A severe form of the disease, associated with serious injuries and bacteremia, was observed during the Vietnam War.
The pathogenesis of the disease is unclear and, possibly, includes many links, but the significance of such factors as congestion of bile on the background of the pariet of the gallbladder, increase of its viscosity and lithogenicity, ischemia of the gallbladder is established. Emptying the gallbladder can be disturbed due to spasm of the sphincter of Oddi after the introduction of opiates. With shock, there is a decrease in blood flow in the vesicle artery.
Symptoms and Diagnosis of Acute Cholestatic Cholecystitis
Symptoms of acute acalculous cholecystitis should not differ from those in acute calculous cholecystitis (fever, leukocytosis and pain in the right upper quadrant of the abdomen), but the diagnosis is often difficult for a severe patient who is undergoing mechanical ventilation and prescribes narcotic analgesics.
In the blood, there may be an increase in the level of bilirubin and activity of alkaline phosphatase, indicating cholestasis. Holescintigraphy is less sensitive (40%) than with acute calculous cholecystitis, and is accompanied by a large number of false positive results. Ultrasound and CT can help in establishing the diagnosis, which allows visualization of the thickening of the gallbladder wall (more than 4 mm), peri-bubble fluid or subserous edema without ascites, intra-wall gas and mucosal detachment. Due to the difficulties associated with the diagnosis of acute acalculous cholecystitis, increased alertness is required, especially in patients with a high risk of developing the disease. Acute galloping cholecystitis is more common in men, accompanied by a 2-fold greater lethality than calculous, often complicated by gangrene and perforation of the gallbladder.
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Treatment of acute stone-free cholecystitis
An emergency cholecystectomy is shown, in the critical state of the patient, a percutaneous cholecystostomy may be under the control of ultrasound.