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Plastic surgeons who take care of burn patients must be able to diagnose and treat sepsis, which can include acute acalculous cholecystitis (AAC).
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AAC is uncommon in burn patients but is associated with high mortality, especially when there is a delay in diagnosis and treatment.
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Percutaneous cholecystostomy can be performed for both diagnostic and therapeutic indications, with minimal morbidity, in burn patients.
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Improved survival in burn patients with acute acalculous cholecytitis requires
Acalculous Cholecystitis in Burn Patients: Is There a Role for Percutaneous Cholecystostomy?
Section snippets
Key points
Methods
An institutional interventional radiology (IR) register was queried to identify all patients who had a percutaneous cholecystostomy tube placed over the last 10 years. Cross-referencing the IR database with the institutional American Burn Association (ABA) registry identified the burn-specific cohort. A post hoc review was performed on individual charts to extrapolate data for analysis.
Results
From 2004 to 2014, 21 critically ill burn patients had percutaneous cholecystostomy tubes placed by IR; 15 of the 21 patients had thermal injury, 4 patients had Stevens-Johnson syndrome/toxic epidermal necrolysis, and 2 patients had traumatic injuries with associated burns/degloving. Table 1 provides a summary of patient demographics; outcome measures, such as length of stay and mortality; and clinical response to PCT. The average age of the patients was 49 years old. Charleson comorbidity
Discussion
Throughout the literature, multiple studies have portrayed the mechanism for gallbladder inflammation at the cellular level. Laurila and other authors2, 9, 10 revealed histologic evidence leading to gallbladder epithelial damage, including leukocyte margination, increased lymphatic dilation, and bile infiltration in the gallbladder wall. Vakkala and colleagues11 were able to show that cell proliferation and apoptosis were increased in both AAC and calculous cholecystitis. Caclulous
Summary
Cholecystitis in critically ill patients remains a diagnostic dilemma and is associated with high in-hospital mortality. Clinicians should maintain a high index of suspicion in burn patients with sepsis of an unknown source. Even with prompt diagnosis and external drainage, however, there is no guarantee of response to treatment or impact on survival. Because a majority of the patients in the authors’ study did not respond to decompression, we concluded that some degree of hepatic
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Cited by (4)
Acute acalculous cholecystitis caused by SARS-CoV-2 infection: A case report and literature review
2022, International Journal of Surgery Case ReportsCitation Excerpt :Several studies have reported that ACE2 is a susceptible receptor for SARS-CoV-2, and ACE2 is highly expressed in cholangiocytes as well as type 2 alveolar cells of the lungs [4]. Additionally, ACE2 is highly expressed in the vascular endothelium, and the attachment of SARS-CoV-2 via ACE2 causes endotheliitis, leading to thromboembolism in multiple organs, including the gallbladder [7]. These findings suggest that the hepatobiliary system could be a potential target of SARS-CoV-2.
Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review
2019, Revista de Gastroenterologia de MexicoEosinophilic granulomatosis polyangiitis associated with acute acalculous cholecystitis
2021, BMJ Case ReportsOutcomes in the utilization of single percutaneous cholecystostomy in a low-income population
2017, International Journal of Environmental Research and Public Health