The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach

被引:19
作者
Mencarini, Lara [1 ,2 ]
Vestito, Amanda [2 ]
Zagari, Rocco Maurizio [1 ,3 ]
Montagnani, Marco [1 ,2 ]
机构
[1] Univ Bologna, Dept Med & Surg Sci, Via Massarenti 9, I-40138 Bologna, Italy
[2] IRCCS Azienda Osped Univ Bologna, Gastroenterol Unit, I-40138 Bologna, Italy
[3] IRCCS Azienda Osped Univ Bologna, Esophagus & Stomach Organ Dis Unit, I-40138 Bologna, Italy
关键词
acute cholecystitis; early laparoscopic cholecystectomy; cholangitis; pancreatitis; choledocolithiasis; cholecystostomy; EUS gallbladder drainage; cholecystitis in pregnancy; cholecystitis in the elderly; cholecystitis in cirrhosis; DELAYED LAPAROSCOPIC CHOLECYSTECTOMY; GUIDED GALLBLADDER DRAINAGE; ACUTE CHOLANGITIS; NATURAL-HISTORY; PERCUTANEOUS CHOLECYSTOSTOMY; CONSERVATIVE TREATMENT; EFSUMB GUIDELINES; GALLSTONE DISEASE; CLINICAL-PRACTICE; MANAGEMENT;
D O I
10.3390/jcm13092695
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7-10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient's medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.
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页数:15
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