Summary
Acute posttraumatic and postoperative cholecystitis is a serious and life-threatening complication with mortality rates ranging from 10 to 50%. The pathogenesis is multifactorial: possible reasons are blood transfusions, dehydration, narcotics, shock and positive endexpiratory pressure (PEEP). Between 1980 and 1990 12 patients underwent surgery for acute cholecystitis. Six of them suffered from a so-called acute acalculous cholecystitis. Two patients died postoperatively. The symptoms are that of a “common” cholecystitis with leukocytosis, fever, abdominal distension and upper right abdominal pain. Sonography is a good method to establish the diagnosis and helps in the decision for cholecystectomy. Clinicians must remember the possibility of an acute cholecystitis in any surgical patient developing abdominal pain or unexplained fever.
Zusammenfassung
Die akute posttraumatische and postoperative Streβcholezystitis weist eine Letalität zwischen 10% and 50% auf. Die Pathogenese ist multifaktoriell: Bluttransfusionen, Dehydratation, positiver endexpiratorischer Druck, Narkotika, Schock werden als mögliche Ursachen diskutiert. Zwischen 1980 and 1990 wurden 12 Patienten mit diesem Krankheitsbild operiert. Bei 6 Patienten handelte es sich um eine sogenannte akalkulöse Cholezystitis. 2 Patienten verstarben postoperativ. Die Klinik entspricht der einer “gewöhnlichen” Cholezystitis, mit rechtsseitigen Oberbauchbeschwerden, Leukozyten, Fieber, Abwehrspannung. Sonographisch ist die Verdachtsdiagnose frühzeitig zu bestätigen and die Entscheidung zur Cholezystitis in Verbindung mit der Klinik, zu stellen. Wichtig ist es, bei entsprechender Klinik an die Möglichkeit der akuten postoperativen/posttraumatischen Cholezystitis zu denken and die Symptome nicht der vorhergehenden Operation zuzuschreiben.
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Kelm, C., Muhrer, K.H., Zimmermann, T. et al. Die akute Streβholezystitis. Langenbecks Arch Chir 376, 143–146 (1991). https://doi.org/10.1007/BF00250338
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DOI: https://doi.org/10.1007/BF00250338