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Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis

Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 317-323页

作者： Er-Zhen Chen Jie Huang Zhi-Wei Xu Jian Fei En-Qiang Mao Sheng-Dao Zhang Emergency Intensive Care Unit Ruijin Hospital School of Medicine Shanghai Jiaotong University Surgical Intensive Care Unit Ruijin Hospital School of Medicine Shanghai Jiaotong University

BACKGROUND: The effects of gangrenous cholecystitis (GC) and consequent surgical interventions on the clinical outcomes and prognosis of patients with severe acute pancreatitis are not clear. The present study was to characterize the clinical outcomes of patients with severe acute pancreatitis complicated with GC. METHODS: We retrospectively analyzed 253 consecutive patients hospitalized for acute pancreatitis in intensive care unit. Among them, 68 were diagnosed as having severe acute pancreatitis; 10 out of the 68 patients had GC. We compared these 10 patients with GC and 58 patients without GC. The indices analyzed included sepsis/septic shock, pancreatic encephalopathy, acute respiratory distress syndrome, acute renal failure, multiple organ dysfunction syndrome, and death. RESULTS: Specific CT images of GC in patients with severe acute pancreatitis included enlarged and high-tensioned gallbladder, wall thickening, lumenal emphysema, discontinuous and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P<0.01), pancreatic encephalopathy (50.0% vs 17.2%, P<0.05), acute respiratory distress syndrome (90.0% vs 41.4%, P<0.01), multiple organ dysfunction syndrome (70.0% vs 24.1%, P<0.01), acute renal failure (40.0% vs 27.6%, P<0.05), and death (40.0% vs 13.8%, P<0.05) were significantly higher in patients with GC than in those without ***: CT scans can help to identify early GC in patients with severe acute pancreatitis; early diagnosis and intervention for patients with GC can reduce morbidity and mortality.

关键词： severe acute pancreatitis gangrenous cholecystitis surgical intervention

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Laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports

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World Journal of Clinical Cases 2021年第14期9卷 3424-3431页

作者： Hiroyuki Inoue Toshiya Ochiai Hidemasa Kubo Yusuke Yamamoto Ryo Morimura Hisashi Ikoma Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectual University of MedicineKyoto 6028566Japan Department of Surgery North Medical Center Kyoto Prefectural University of MedicineKyoto 6292261Japan Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan

BACKGROUND gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious *** herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis,who safely underwent laparoscopic cholecystectomy(LC)and both demonstrated a good *** SUMMARY Case 1:An 89-year-old *** underwent abdominal contrast-enhanced computed tomography(CECT)due to abdominal pain and *** gallbladder wall indicated the absence of contrast enhancement,thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent *** her gallbladder demonstrated diffuse necrosis and it was also partly perforated,she was able to be discharged without any serious *** 2:A 91-year-old *** made an emergency visit with a chief complaint of abdominal *** CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder *** was diagnosed with gangrenous cholecystitis and underwent *** gallbladder had swelling and diffuse *** her preoperative blood culture was positive,she showed a good outcome following *** Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery,if an early diagnosis can be made and appropriate treatment can be carried out,then even very elderly individuals may be discharged without major complications.

关键词： gangrenous cholecystitis Laparoscopic cholecystectomy Elderly people Critical view of safety Tokyo guidelines 2018 Case report

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Necrotizing Fasciitis Secondary to Emphysematous cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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Surgical Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews College of Medicine-Phoenix University of Arizona Phoenix AZ USA Creighton University Arizona Health Education Alliance Phoenix AZ USA Department of Surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery Tyler TX USA Trauma Wound Care UT Health East Tyler TX USA Department of Surgery University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of Medicine and Nursing University of Texas Arlington TX USA Past Commanding General TXSG Medical Brigade Austin TX USA Surgical Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales Manager Miach Orthopedics Surgical Acute Account Manager 3M Minneapolis MN USA Clinical Professor of Surgery Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

关键词： Emphysematous cholecystitis gangrenous cholecystitis Cholecystocutaneous Fistula Necrotizing Fasciitis Sepsis

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