From the Guidelines
Acute calculous cholecystolithiasis is a medical condition characterized by the sudden onset of inflammation of the gallbladder, caused by the presence of gallstones.
Key Characteristics
- It is typically marked by severe abdominal pain, especially in the right upper quadrant, nausea, vomiting, and fever 1.
- The condition often requires prompt medical attention and may be treated with antibiotics and pain management medications.
Diagnosis
- The diagnosis of acute cholecystitis is made on the basis of clinical features such as right upper quadrant pain, fever, and leukocytosis and is supported by findings from relevant imaging studies, such as ultrasound 1.
- Ultrasound is the investigation of choice in patients suspected of having acute cholecystitis, and it typically shows pericholecystic fluid, distended gall bladder, oedematous gallbladder wall, and gall stones 1.
Treatment
- Treatment is predominantly surgical, although the timing of surgery without evidence of gangrene or perforation has been under debate in recent years 1.
- Early cholecystectomy is a safe treatment for acute cholecystitis and generally results in shorter recovery time and hospitalization compared to delayed cholecystectomies 1.
- Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis, and it is the first choice for patients with acute cholecystitis where adequate resources and skill are available 1.
- Some risk factors may predict the risk for conversion to open cholecystectomy, including age >65 years, male gender, acute cholecystitis, thickened gallbladder wall, diabetes mellitus, and previous upper abdominal surgery 1.
- Cholecystostomy is a safe and effective treatment for acute cholecystitis in critically ill and/or with multiple comorbidities and unfit for surgery patients 1.
- Early diagnosis of gallbladder perforation and immediate surgical intervention may substantially decrease morbidity and mortality rates 1. Some key points to consider in the management of acute calculous cholecystolithiasis include:
- The importance of prompt diagnosis and treatment to prevent complications and improve outcomes 1.
- The use of a combination of clinical, laboratory, and imaging investigations to establish the diagnosis of acute cholecystitis 1.
- The role of laparoscopic cholecystectomy as a safe and effective treatment for acute cholecystitis, and the importance of considering the patient's overall health and risk factors when deciding on the timing and approach to surgery 1.
From the Research
Definition of Acute Calculous Cholecystolithiasis
- Acute calculous cholecystolithiasis, also known as acute calculous cholecystitis, is a condition in which the gallbladder becomes inflamed due to the presence of gallstones (cholelithiasis) 2.
- It is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions 3.
- The condition is characterized by inflammation of the gallbladder, which can lead to severe complications if left untreated.
Diagnosis and Treatment
- The diagnosis of acute calculous cholecystitis is based on a combination of clinical symptoms, laboratory tests, and imaging studies, such as abdominal ultrasound 4.
- The treatment of choice for acute calculous cholecystitis is early laparoscopic cholecystectomy, which should ideally be performed within 72 hours of symptom onset 3.
- The use of antimicrobial agents is indicated for high-risk patients, especially in the presence of gallbladder necrosis 3.
Comparison with Acalculous Cholecystitis
- Acute acalculous cholecystitis is a less common condition that occurs without the presence of gallstones 5, 6.
- Acalculous cholecystitis can be caused by various factors, including infectious agents, and can be fatal if not treated promptly 5, 6.
- The diagnosis and treatment of acalculous cholecystitis differ from those of calculous cholecystitis, and a high degree of clinical suspicion is necessary to make an accurate diagnosis 6.