ACUTE ACALCULOUS CHOLECYSTITIS FOLLOWING OPEN-HEART-SURGERY

We undertook a retrospective study designed to ascertain the frequency of acute acalculous cholecystitis (AAC) following open heart surgery. In the study period 1982-1990, 22 of 6393 patients following open hea rt surgery were recognized to have developed AAC, an incidence of 0.34 %. The majority of patients (16/22) presented within the first postope rative week. Vague right upper quadrant physical findings, nonspecific changes in the liver function chemistries and unexplained sepsis freq uently led to radiologic evaluations. Ultrasonography was the most val uable radiologic study, with a diagnosis sensitivity of 82%. Technetiu m cholescintography can serve as a useful adjunct when interpreted in the context of other clinical findings. Cholecystectomy was performed in 20 patients and cholecystostomy in two. Nine (41%) patients had gan grenous gallbladders with frank perforation in two. A specific preoper ative diagnosis was made in 19 patients (86%). Fifteen patients surviv ed for a mortality rate of 32%. In 12 of 15 survivors (80%), the diagn osis of AAC was established and laparotomy performed within 48 hours o f first clinical suspicion. Gangrene and perforation were seen in 87% of patients in whom surgery was delayed. AAC is a life-threatening con dition especially in critically ill patients. Experience suggests that early diagnosis and operative intervention are the key elements of tr eatment. Delay of operative management on the grounds of recent cardia c surgery is not justified.