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How is acute cholecystitis treated?
Last reviewed: 19.10.2021
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Non-drug treatment of acute cholecystitis in children
Abstinence from food intake is shown. If children of preschool age (up to 7 years) and school age with a catarrhal form of acute cholecystitis have a certain time without food, then an individual approach is necessary for patients of early age (up to 3 years). It is not excluded parenteral nutrition.
Drug treatment of acute cholecystitis in children
To stop the pain attack, use antispasmodic and analgesic drugs, in severe cases - promedol, pantopone. Pain can be eliminated by intravenous injection of 2-5 ml of 0.5% solution of novocaine diluted with glucose, or 0.9% solution of sodium chloride. Narynual blockade is effective. With the detoxification purpose, 5% glucose solution, mannitol, is administered. Haemodes.
A special place is occupied by antibacterial treatment of acute cholecystitis in children, although it is not always possible to determine etiologically significant microorganisms. When choosing a medicine, the degree of penetration of the antibiotic from the blood into the bile should be taken into account. With the normal patency of the bile ducts, antibiotics of the following groups go nicely into the bile: penicillins (azlocillin, mezlocillin, piperacillin), tetracyclines (doxycycline, tetracycline), macrolides (azithromycin, clarithromycin, roxithromycin, erythromycin), cephalosporins (ceftriaxone). The ratio of concentrations of these drugs in bile and blood is 5: 1 or more.
Good penetration into the bile is noted with the use of ampicillin, cephalosporins (cefazolin, cefamandol, cefoperazone), lincosamides (clindamycin, lincomycin), fluoroquinolones (ofloxacin), carbapenems (imipenem, meropenem), chloramphenicol. The content of antibiotics in bile can be 2-5 times higher than the concentration in the blood.
Other antibacterial agents (metronidazole) come from the blood in bile moderately, the concentration of the drug in biological media is almost equal.
Combined use of antimicrobial agents is important. Drugs of choice:
- ceftriaxone + metronidazole;
- cefoperazone + metronidazole.
The following combinations are considered an alternative regimen of antibiotic therapy:
- gentamicin (or tobramycin) + ampicillin + metronidazole:
- ofloxacin + metronidazole.
Antibiotics can not always stop the destructive process in the gallbladder, this circumstance predetermines the features of monitoring patients with acute cholecystitis with the involvement of a child surgeon.
[13], [14], [15], [16], [17], [18], [19], [20], [21]
Surgical treatment of acute cholecystitis in children
Phlegmonous and gangrenous acute cholecystitis is subject to surgical treatment. Treatment of patients with enzymatic acute cholecystitis is aimed at early decompression of the biliary tract. The latter is performed laparoscopically or by traditional surgical access.