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Teaching Points
Teaching Points
- Ultrasound is of limited use since in intensive care unit patients it has low specificity 1; gallbladder abnormalities are frequently seen on ultrasound in intensive care patients who do not have suspected AAC. 2 This is also true of CT. 3 Cholescintigraphy is also associated with false negative and false positive results in suspected AAC 4
- Percutaneous cholecystostomy (PC) and drainage can be both diagnostic and therapeutic in AAC 5
saac
Suspected Acute Acalculous Cholecystitis (AAC)
- AAC is a complication of severe morbidity when primary diagnosis is not acute cholecystitis
- This is a serious condition that typically occurs in critically ill patients with severe comorbidities, usually in the intensive care environment. In this setting, AAC is difficult to diagnose
pc
Percutaneous Cholecystostomy (PC)
- Percutaneous cholecystostomy (PC) and drainage can be both diagnostic and therapeutic in AAC. Essentially, a successful 'trial of therapy' by PC is presumptive of the diagnosis of AAC. A subsequent delayed cholecystectomy may not be required
References
References
Date of literature search: February 2015
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Puc MM, Tran HS, Wry PW, Ross SE.
Ultrasound is not a useful screening tool for acute acalculous cholecystitis in critically ill trauma patients. Am
Surg. 2002;68(1):65-9. (Level III evidence).
View the reference
- Boland GW, Slater G, Lu DS, Eisenberg P, Lee MJ, Mueller PR.
Prevalence and significance of gallbladder abnormalities seen on sonography in intensive care unit patients. AJR
Am J Roentgenol. 2000;174(4):973-7. (Level III evidence).
View the reference
- Ahvenjarvi L, Koivukangas V, Jartti A, Ohtonen P, Saarnio J, Syrjala H, et al.
Diagnostic accuracy of computed tomography imaging of surgically treated acute acalculous cholecystitis in critically ill
patients. J Trauma. 2011;70(1):183-8. (Level III evidence).
View the reference
- Ziessman HA.
Nuclear medicine hepatobiliary imaging. Clin Gastroenterol Hepatol. 2010;8(2):111-6. (Review article).
View the reference
- Chung YH, Choi ER, Kim KM, Kim MJ, Lee JK, Lee KT, et al.
Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis? J Clin
Gastroenterol. 2012;46(3):216-9. (Level IV evidence).
View the reference
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