Acute cholecystitis: complications
Last reviewed: 23.04.2024
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- The empyema of the gallbladder is a purulent inflammation of the gallbladder, accompanied by the accumulation of a significant amount of pus in its cavity;
Attachment of the infection against the background of the remaining obturation of the cystic duct can lead to empyema of the gallbladder. Sometimes empyema is complicated by endoscopic papillosphincterotomy, especially if stones remain in the duct.
Symptoms correspond to the pattern of intra-abdominal abscess (fever, muscle strain of the anterior abdominal wall, pain), but in elderly patients they can be blurred.
Surgical treatment in combination with antibiotics is accompanied by a high percentage of postoperative septic complications. An effective alternative is percutaneous cholecystostomy.
- Aubianus abscess.
- Perforation of the gallbladder. Acute calculous cholecystitis can lead to transmural necrosis of the gallbladder wall and its perforation. Perforation occurs due to the pressure of the stone on the necrotic wall or the rupture of dilated infected Rokitansky-Ashot sines.
Usually a rupture occurs along the bottom - the least vascularized area of the gallbladder. Breakthrough of the contents of the gallbladder into the free abdominal cavity is rarely observed, usually spikes with adjacent organs and abscesses are formed. A breakthrough into the hollow organ adjacent to the gallbladder ends with the formation of an internal gallbladder fistula.
Symptoms of perforation include nausea, vomiting, and pain in the right upper quadrant of the abdomen. In half the cases, palpable formation is detected in this area, fever is found with the same frequency. Complication often remains unrecognized. CT and ultrasound help to identify fluid in the abdominal cavity, abscesses and concrements.
There are three clinical variants of perforation of the gallbladder.
- Acute perforation with bile peritonitis. In most cases, there is no history of cholelithiasis. Concomitant conditions - vascular insufficiency or immunodeficiency (atherosclerosis, diabetes, collagen, use of corticosteroids or decompensated cirrhosis of the liver). It should be first of all to exclude this diagnosis in immunocompromised patients (for example, in AIDS patients) with an acute abdomen. The prognosis is poor, mortality is about 30%. Treatment includes large doses of antibiotics, infusion therapy, traditional or percutaneous removal / drainage of the gangrenous gallbladder, drainage of abscesses.
- Subacute perforation with a cavernous abscess . The history of cholelithiasis is noted, the clinical picture is intermediate between variants 1 and 3.
- Chronic perforation with the formation of an entero-fistula, for example, with the colon.
- peritonitis;
- mechanical jaundice;
- cholangitis;
- bile fistula (external or internal);
- acute pancreatitis.
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