Diagnosis of acute cholecystitis in septic patients

Introduction

The aim of this retrospective observational study was to evaluate the usefulness of clinical, laboratory and imaging findings in the diagnosis of acute cholecystitis (AC) in septic patients.

Methods

Twelve out of 1,248 patients were included in the study. The patients had no intra-abdominal pathology on admission. Mean age was 59.08 (16.14) years. The most common ICU admission diagnosis was trauma (7/12). On admission, mean APACHIE II score was 17.916 (5.74) and SOFA score was 8.083 (3.369). On the day of diagnosis, SOFA score was 13 (4.03). Mean length of stay in the ICU before the diagnosis was 32.35 (13.76) days. Diagnosis was based on clinical, laboratory, U/S and C/T criteria. Confirmation of the diagnosis was performed with an operative procedure: open cholecystectomy (n = 8), laparoscopy (n = 2), percutaneous cholecystostomy (n = 2).

Results

Twelve of 1,248 patients (0.96%) developed clinical, laboratory and imaging findings of AC. The AC was confirmed by an operative procedure in eight out of 12 patients (0.64%), one calculus and seven acalculus. The mortality was 62.5%. Necrotic areas of the gallbladder wall existed in three patients. Clinical diagnostic findings were: tenderness in the right upper quadrant of the abdomen and positive Murphy in 16.66%; temperatures over 38.5°C in 50%; leucocytosis in 58.33%; metabolic acidosis in 50%; elevation of ALT in 50% and AST in 66.66%; bilirubin >1.17 mg/dl in 91.66%; and an increase of alkaline phosphatase in 100% of patients with confirmed AC. There was one false negative 8% and three false positive 75% and one true negative 25% ultrasonography. The most common U/S finding was gallbladder distention (n = 8) 66.66% and sludge (n = 8) 66.66%. Respectively, there were two false negative 25% and two false positive 50% C/T scans. Two patients underwent diagnostics laparoscopies that were true negative.

Conclusions

There is not a specific diagnostic test for AC in trauma septic patients. Laparoscopy at the bedside in the ICU is an accurate and safe diagnostic tool.