Acalculous Cholecystitis in Burn Patients: Is There a Role for Percutaneous Cholecystostomy?

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Key points

  • Plastic surgeons who take care of burn patients must be able to diagnose and treat sepsis, which can include acute acalculous cholecystitis (AAC).

  • AAC is uncommon in burn patients but is associated with high mortality, especially when there is a delay in diagnosis and treatment.

  • Percutaneous cholecystostomy can be performed for both diagnostic and therapeutic indications, with minimal morbidity, in burn patients.

  • Improved survival in burn patients with acute acalculous cholecytitis requires

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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References (33)

  • C.S. Hultman et al.

    The efficacy of percutaneous cholecystostomy in critically ill patients

    Am Surg

    (1996)
  • J.J. Laurila et al.

    Tight junction proteins in gallbladder epithelium: different expression in acute acalculous and calculous cholecystitis

    J Histochem Cytochem

    (2007)
  • J.J. Laurila et al.

    Histopathology of acute acalculous cholecystitis in critically Ill patients

    Histopathology

    (2005)
  • M. Vakkala et al.

    Cellular turnover and expression of hypoxic-inducible factor in acute acalculous and calculous cholecystitis

    Crit Care

    (2007)
  • M.K. Nag et al.

    The effect of lysolecithin on prostanoid and platelet-activating factor formation by human gallbladder mucosal cells

    Mediators Inflamm

    (1995)
  • M. Hirota et al.

    Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines

    J Hepatobiliary Pancreat Surg

    (2007)
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