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: 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.
    The American Journal of Surgery 07/1970; 119(6):729-32. DOI:10.1016/0002-9610(70)90249-7 · 2.41 Impact Factor
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    Annals of Surgery 05/1962; 155:489-94. DOI:10.1097/00000658-196204000-00002 · 7.19 Impact Factor
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    ABSTRACT: Sixty-three patients, 49 men and 14 women, developed acute cholecystitis without gallbladder stones. Only eight patients had a history suggestive of gallbladder disease. In 17 patients cholecystitis developed in the postoperative period, and cholecystitis occurred in 7 patients who had extensive trauma. The signs and symptoms did not differ markedly from those found when acute cholecystitis is associated with cholelithiasis. Pain and tenderness in the right upper abdominal quadrant, vomiting, abdominal distention, decreased bowel sounds, jaundice and fever were common. Thirty (47.6 percent) gallbladder specimens had gangrene, and perforation occurred in five instances. Bacteria were cultured from 28 of 43 bile specimens. E. coli was the most common organism. A high incidence of acalculous gallbladders is found when acute cholecystitis occurs in the postoperative period or after trauma and in children. Decreased blood flow to the gallbladder, cystic duct obstruction and concentrated bile are necessary to produce experimental cholecystitis. These factors are probably necessary in humans also. Decreased gallbladder perfusion caused by shock, congestive heart failure and arteriosclerosis probably contributed to the development of acute acalculous cholecystitis in these patients.
    The American Journal of Surgery 03/1981; 141(2):194-8. DOI:10.1016/0002-9610(81)90155-0 · 2.41 Impact Factor