ASPECTS OF ETIOPATHOGENY AND CLINICAL AND EVOLUTIVE CHARACTERISTICS OF ACUTE ACALCULOUS CHOLECYSTITIS

Abstract

Objectives. Usual predisposing factors of acute acalculous cholecystitis are critical conditions, prolonged fasting, parenteral nutrition, sepsis. However, we notice an incidence of acute acalculous cholecystitis in several of our patients in the absence of these factors. This fact determined us to initiate this study. The aim of the study was to estimate the rate, clinical and evolutive characteristics of acute acalculous cholecystitis in order to identify the risk factors. Methods and materials. There were analyzed 142 cholecystectomized patients with acute cholecystitis. Acute acalculous cholecystitis was defined by: 1) absence of gallstones/biliary sludge at ultrasound examination; 2) intraoperative confirmation of acute acalculous cholecystitis; 3) diagnosis by morphological certification. The demographic, clinical and intraoperative parameters of the patients divided into 2 groups: I – acute acalculous cholecystitis and II – acute calculous cholecystitis were analyzed. Results. The acute acalculous cholecystitis criteria was met by 14 (9.9%) cases. The male/female ratio in acute acalculous cholecystitis was 11/3 compared to 49/79 in the group II (p<0.01). The mean age in the I and II groups was 48±2.3 and 57±1.2 years, respectively (p<0.05). Comorbidities were more frequent in acute acalculous cholecystitis – 78.6% compared to 32% in group II (p<0.001). Preoperative endoscopy showed evident duodeno-gastric reflux in almost all acute acalculous cholecystitis patients (71.4%), which indicates the role of intraduodenal pressure growth in its etiopathogeny. In 6 (42.9%) patients with acute acalculous cholecystitis, destructive forms with a fulminant course of inflammation were established during 72 hours. Conclusions. We can assume that the disruptions of the gastro-duodenal motility with elements of duodenostasis play a certain role in the development of non-calculous inflammation of the gallbladder. The rapid evolution of the inflammatory process in acute acalculous cholecystitis requires early surgical treatment.