Cholecystitis after trauma.

BACKGROUND: The goal of this project was to investigate incidence, risk factors, histologic findings, and mortality rate of posttraumatic cholecystitis requiring surgical treatment.

METHODS: Retrospective analysis of all patients admitted to the intensive care unit of an urban trauma center between April 1998 and January 2005. Data from the hospital and intensive care documentation systems databases and patients' charts were reviewed. All patients with cholecystitis treated by cholecystectomy were selected for further study. Potential risk factors, diagnostic, and histologic findings were analyzed.

RESULTS: Cholecystitis was a fairly frequent finding in critically ill trauma patients (67 of 2,625 patients, 2.6%). Almost 10% of the patients with severe multiple injuries developed cholecystitis. Histologic findings showed a wide variation; three main diagnoses were established: acute acalculous cholecystitis (n = 28), chronic acalculous cholecystitis (n = 25), and cholecystitis with cholecystolithiasis (n = 13). Patients with acute acalculous cholecystitis and chronic acalculous cholecystitis were significantly younger and had significantly higher injury severity scores than patients with either cholecystitis with cholecystolithiasis or without cholecystitis. Noninvasive diagnostic tools such as ultrasonographic signs and laboratory data did not correlate with histologic diagnosis. Well-timed cholecystectomy within 24 hours after clinical suspicion lead to a 4.4% mortality rate in this group of patients.

CONCLUSION: Cholecystitis after trauma is not a uniform disease. Although trauma severity seems to play an important role in the development or exacerbation of acalculous cholecystitis or both, cholecystolithiasis may play a significant role in patients with moderate to minor trauma. Intensivists should be aware of this complication in critically ill trauma patients because it seems to occur more frequently than previously assumed. Diagnosis can only be made if clinical signs, laboratory data, and ultrasonographic findings are taken into consideration. If posttraumatic cholecystitis is treated in an early stage by cholecystectomy, mortality rate remains low.