Hospitalization for Contracted Gallbladder
A patient with a contracted gallbladder (gallbladder hydrops) presenting with gallstones and fever requires immediate hospitalization for urgent medical and surgical management. 1
Immediate Hospitalization Criteria
Patients with gallbladder hydrops, gallstones, and fever meet criteria for urgent hospital admission based on the following considerations:
- Systemic signs of infection (fever) combined with gallbladder pathology indicate acute cholecystitis or potential cholangitis, both requiring inpatient management 1
- The American College of Surgeons recommends immediate laboratory assessment including complete blood count, liver function tests, and inflammatory markers to evaluate severity of inflammation and sepsis 1
- Critical monitoring for cholangitis is essential, as the triad of fever, jaundice, and right upper quadrant pain requires urgent biliary drainage 1
Immediate Inpatient Management
Upon admission, the following interventions should be initiated:
- Broad-spectrum antibiotics must be started immediately upon diagnosis, prior to any surgical intervention 1
- Piperacillin/tazobactam is the preferred antibiotic regimen for unstable or critically ill patients with gallbladder hydrops and fever 1
- Early laparoscopic cholecystectomy within 1-3 days of diagnosis is the definitive treatment 1
- Intraoperative bile cultures should be obtained to guide targeted antibiotic therapy 1
High-Risk Features Requiring Hospitalization
Several factors make outpatient management inappropriate:
- Acute cholecystitis presents with right upper quadrant pain, fever, and leukocytosis, requiring supportive care and cholecystectomy 2
- Complications of gallstone disease include acute ascending cholangitis, a life-threatening condition requiring intravenous fluids, analgesia, antibiotics, and biliary drainage 2
- Diabetic patients require heightened vigilance due to increased risk of infection-related complications and potential conversion to open cholecystectomy 1
Common Pitfalls to Avoid
- Do not delay hospitalization in patients with fever and gallbladder pathology, as acute ascending cholangitis is life-threatening and requires immediate intervention 2
- Do not attempt outpatient management when systemic signs of infection are present, as biliary complications occur at significant rates and require urgent surgical intervention 3
- Gallbladder wall thickening (which occurs in hydrops) is associated with increased conversion rates to open surgery, increased complications, and longer hospital stays 4