Colecistitis aguda como causa de muerte tras cirugía por estenosis del canal lumbar

Revista de Ortopedia y Traumatología 06/2007; 51(3). DOI: 10.1016/S0482-5985(07)75543-8

ABSTRACT Post-surgical acute cholecystitis has been described mainly as a complication of major abdominal or thoracic surgery sometimes associated with musculoskeletal surgery. In spine surgery it has been related to large-scale procedures such as the correction of deformities in adults.
The most frequently mentioned risk factors are hydric restriction, fever, hemolytic phenomena, multiple blood transfusions, nutritional disorders, certain drugs (anesthetics, codeine. atropine, meperidine, morphine) and hemodynamic alterations. The risk is especially high when several of the factors above co-occur in a single patient subjected to a physically stressful situation like surgery.
Diagnosis of acute postoperative cholecystitis is often challenging since the condition is often marked by the initial surgical procedure. Symptoms like fever, leucocytosis and abdominal pain after a favorable immediate post-op should put us on guard.
Sonographic confirmation and the quick implementation of appropriate treatment are the only way of reducing the high death toll of this complication.

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    ABSTRACT: When acute cholecystitis follows orthopaedic operations, the disease is frequently obscure and fulminating, with rapid progress to gangrene and perforation of the gallbladder, which may be fatal. Three cases are reported and the literature is reviewed. Various aspects of the disorder are discussed. It is important that orthopaedic surgeons should be aware of the condition in order to be able to make an early diagnosis and so prevent a lethal outcome.
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    ABSTRACT: 1.1. Postoperative acute cholecystitis is not necessarily a disease of advancing age; it may be seen more frequently in the older age groups only because of the greater incidence of major surgery in older persons.2.2. Acute noncalculous cholecystitis occurring postoperatively or as a complication of severe injury may arise from causes different from acute cholecystitis in the uninjured patient [4–6].3.3. Dehydration, narcotic therapy, and fever, with resultant increased viscosity of the bile, may predispose to acute cholecystitis.4.4. Multiple blood transfusions with increased biliary secretion of blood breakdown products may be an important factor in the etiology of post-traumatic acute cholecystitis.5.5. Sepsis may predispose to acute cholecystitis.6.6. The finding of right upper quadrant pain in postoperative or injured patients must suggest the diagnosis of acute cholecystitis. We have noted the development of right upper quadrant pain with jaundice in patients other than those described in this report. These cases have been treated by medical means and may represent acute cholecystitis not progressing to gangrenous gallbladder demanding surgery.7.7. The period between the eighth and sixteenth day after injury appears to be the period of greatest risk for the development of post-traumatic acute noncalculous cholecystitis.
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