GALLBLADDER DISTENSION AS RISK FACTOR FOR ACALCULOUS CHOLECYSTITIS - WHAT IS THE INFLUENCE OF INTENSIVE-CARE

The incidence of acute acalculous cholecystitis (AAC) is increasing an d associated mortality is high. Biliary stasis and sludge formation ar e probably important factors in the pathogenesis of this disease. No d ata concerning the dynamics of these changes in the early phase of int ensive care therapy are available. The gallbladders of 20 patients tre ated after major abdominal surgery in the surgical intensive care unit (SICU) with mechanical ventilation and without enteral feedings were therefore observed sonographically during the first 5 postoperative da ys in a prospective observational study. 20 patients treated on a regu lar ward after major abdominal surgery also not receiving any enteral nutrition served as control group. 24 hours after admission to the int ensive care unit and on all subsequent days of observation the gallbla dders of the patients in the SICU-group were significantly larger than in the control group. Sludge also appeared earlier and more frequentl y in the gallbladders of the SICU-patients. Lack of enteral feedings a lone cannot explain these results. Positive-pressure ventilation and m edications used in SICU are most likely responsible for the observed d ifferences. Besides the necessity to make the diagnosis of AAC as earl y as possible, it appears to be worthwile to investigate measures of p rophylaxis. Since gallbladder distension in patients treated in SICU c an be already observed on the first postoperative day it seems to be r easonable to initiate a regimen of prophylactic measures (e.g. with ch olecystokinin or ceruletid) early in the course of ICU-therapy.