| Acute acalculous cholecystitis: a review. | |
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MedLine Citation:
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PMID: 19747982 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Although recognized for more than 150 years, acute acalculous cholecystitis (AAC) remains an elusive diagnosis. This is likely because of the complex clinical setting in which this entity develops, the lack of large prospective controlled trials that evaluate various diagnostic modalities, and thus dependence on a small data base for clinical decision making. AAC most often occurs in critically ill patients, especially related to trauma, surgery, shock, burns, sepsis, total parenteral nutrition, and/or prolonged fasting. Clinically, AAC is difficult to diagnose because the findings of right upper-quadrant pain, fever, leukocytosis, and abnormal liver tests are not specific. AAC is associated with a high mortality, but early diagnosis and intervention can change this. Early diagnosis is the crux of debate surrounding AAC, and it usually rests with imaging modalities. There are no specific criteria to diagnose AAC. Therefore, this review discusses the imaging methods most likely to arrive at an early and accurate diagnosis despite the complexities of the radiologic modalities. A pragmatic approach is vital. A timely diagnosis will depend on a high index of suspicion in the appropriate patient, and the combined results of clinical findings (admittedly nonspecific), plus properly interpreted imaging. Sonogram (often sequential) and hepatic iminodiacetic acid scans are the most reliable modalities for diagnosis. It is generally agreed that cholecystectomy is the definitive therapy for AAC. However, at times a diagnostic/therapeutic drainage via interventional radiology/surgery may be necessary and life-saving, and may be the only treatment needed. |
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Authors:
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Jason L Huffman; Steven Schenker |
Publication Detail:
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Type: Journal Article; Review Date: 2009-09-10 |
Journal Detail:
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Title: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Volume: 8 ISSN: 1542-7714 ISO Abbreviation: Clin. Gastroenterol. Hepatol. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-02-04 Completed Date: 2010-04-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101160775 Medline TA: Clin Gastroenterol Hepatol Country: United States |
Other Details:
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Languages: eng Pagination: 15-22 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Internal Medicine, Division of Gastroenterology and Nutrition, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA. huffmanj2@uthscsa.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acalculous Cholecystitis
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diagnosis*,
epidemiology,
mortality,
surgery* Case Management* Humans |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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