Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Gallstone Disease 603

complications at a rate of 1% to 2% per year); decision to perform

cholecystectomy individualized based on surgical candidacy and

patient’s preference

Acute Cholecystitis & Choledocholithiasis

■emergent biliary decompression with ERCP in patients with obstruc-

tive cholangitis

■prompt surgery indicated once the diagnosis of acute cholecystitis

is made

■concomitant choledocholithiasis may need a preoperative ERCP for

stone extraction; alternatively, intraoperative cholangiography can

be performed to confirm choledocholithiasis followed by laparo-

scopic or open CBD exploration or a postoperative ERCP

specific therapy

Special Situations

■acalculous cholecystitis occurs in 5%–10% of patients with

acute cholecystitis; predisposing factors to acalculous cholecysti-

tis include TPN, major surgery, critical illness, extensive trauma, or

burn-related injury

■cytomegalovirus and cryptosporidia can result in cholecystitis in

severely immunocompromised patients

follow-up

n/a

complications and prognosis

Complications

■Biliary colic

■Acute cholecystitis

■Chronic cholecystitis

■Emphysematous cholecystitis

■Hydrops of the gallbladder

■Small bowel obstruction (gallstone ileus)

■Gastric outlet obstruction (Bouveret’s syndrome)

■Acute biliary pancreatitis

■Acute suppurative/obstructive cholangitis

■Empyema and/or gangrene

■Perforation of the gallbladder

■Gallbladder cancer