Acute cholecystitis -: A challenge for the Intensive Care Unit

Acute acalculous cholecystitis can be a complication of severe illness in patients who have undergone major surgery or have had extensive trauma. The incidence appears to have increased over the past 50 years. The aetiology is multi-factorial while the symptoms and signs, as seen in an Intensive Care Unit, are often less obvious and non-specific due to the use of analgesia and assisted ventilation. Patients and methods: This was a prospective study in patients who were admitted to a surgical Intensive Care Unit post-operatively or following major trauma who developed cholecystitis. The clinical results, laboratory analyses and diagnostic procedures were analysed and evaluated. Results: Even though there have been significant improvements in surgery, anaesthetics and Intensive Care Medicine the mortality of severly ill patients remains about 30%. The mortality of patients with cholecystitis is 8.5 %. Prompt surgery with cholecystectomy within 6 hours of diagnosis is crucial but in selected cases ultrasound guided cholecystostomy is necessary prior to cholecystectomy.