Factors effecting the complications in the natural history of acute cholecystitis

Background/Aims: Gangrenous cholecystitis, empyema, gallbladder perforation , and biliary peritonitis are severe complications of acute cholecystitis a ssociated with increased morbidity and mortality. This study aimed to evalu ate perioperative factors associated with complications of acute cholecysti tis. Methodology: Between January 1993 and October 2000, we performed cholecyste ctomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultras ound, operative and microbiological findings, morbidity and mortality. Results: There were 305 cases (83%) of acute uncomplicated cholecystitis, 2 6 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladd er, 12 (3.3%) of gallbladder perforation, and 2 (0.5%) emphysematous cholec ystitis. Risk factors for complicated cholecystitis included male gender, a dvanced age, associated diseases, temperature above 38 degreesC, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystec tomy was attempted on 36 patients (11.8%) with uncomplicated and seven pati ents (11.1%) with complicated acute cholecystitis. The conversion rate to o pen cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicate d cases. There were no differences in operative complications between compl icated and uncomplicated cases, however, length of hospital stay, postopera tive morbidity and mortality were significantly higher in complicated cases . Conclusions: Sex (male), advanced age, presence of associated disease, high temperature (>38 degreesC) and leukocytosis are all remarkable risk factor s inducing complications in acute cholecystitis. Laparoscopic cholecystecto my can be performed with success in uncomplicated cases.