Die Intensivgallenblase als Schockorgan

Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn (AöR), Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Der Chirurg (Impact Factor: 0.57). 02/2013; 84(3). DOI: 10.1007/s00104-012-2358-y
Source: PubMed


Acute acalculous cholecystitis (AAC) represents a severe disease in critically ill patients. The pathogenesis of acute necroinflammatory gallbladder disease is multifactorial and intensive care unit (ICU) patients show multiple risk factors. In addition AAC is difficult to diagnose because of the vague physical and non-specific technical findings. Only the combination of clinical and technical findings including the challenging physical examination of critically ill patients, laboratory results and ultrasound or computed tomography (CT) scan, will lead to the diagnosis. The condition of AAC has a rapid progress to gallbladder necrosis, gangrene and perforation and these complications are reflected in the high morbidity and mortality rates, therefore, therapy should be promptly initiated. If there are no clinical contraindications for an operative approach cholecystectomy is the definitive treatment and both open and laparoscopic procedures have been used. In unstable, critically ill patients percutaneous cholecystostomy should be immediately performed. In addition, transpapillary endoscopic drainage is also possible if there are contraindications for percutaneous cholecystostomy. Patients who fail to improve or deteriorate following interventional drainage should be reconsidered for cholecystectomy. Due to the fact that more than 90 % of patients treated with percutaneous cholecystostomy showed no recurrence of symptoms during a period of more than 1 year, it is still unclear if percutaneous cholecystostomy is the definitive treatment of AAC for unstable patients or if delayed cholecystectomy is still necessary.

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    ABSTRACT: Laparoscopic cholecystectomy has recently been accepted as the standard treatment for acute cholecystitis patients. The major role of percutaneous transhepatic gallbladder drainage has been temporarily stabilizing the patient's acute debilitating condition prior to cholecystectomy. However, there have not been any evidence-based treatment guidelines for acute cholecystitis patients. In this article, the author restates the role of percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis in the era of minimally invasive medicine.
    06/2013; 2(1):47–49. DOI:10.1016/j.gii.2013.04.002

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