Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis

• Published in: Hepatobiliary & pancreatic diseases international Vol. 12; no. 3; pp. 317 - 323
• Main Authors: Chen, Er-Zhen, Huang, Jie, Xu, Zhi-Wei, Fei, Jian, Mao, En-Qiang, Zhang, Sheng-Dao
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.06.2013
• Subjects: acute; Acute Disease; Adult; Aged; cholecystitis; Cholecystitis - diagnosis; Cholecystitis - etiology; Cholecystitis - mortality; Cholecystitis - surgery; Early Diagnosis; Endocrinology & Metabolism; Female; Gallbladder - pathology; Gallbladder - surgery; Gangrene; gangrenous; gangrenous cholecystitis; Gastroenterology and Hepatology; Humans; intervention; Male; Middle Aged; pancreatitis; Pancreatitis - complications; Pancreatitis - diagnosis; Pancreatitis - mortality; Pancreatitis - surgery; Predictive Value of Tests; Retrospective Studies; severe; severe acute pancreatitis; Severity of Illness Index; surgical; surgical intervention; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; gangrenous cholecystitis; severe acute pancreatitis; surgical intervention
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(13)60050-8

BACKGROUND: The effects of gangrenous cholecystitis (GC) and consequent surgical interventions on the clinical outcomes and prognosis of patients with severe acute pancreatitis are not clear. The present study was to characterize the clinical outcomes of patients with severe acute pancreatitis complicated with GC. METHODS: We retrospectively analyzed 253 consecutive patients hospitalized for acute pancreatitis in intensive care unit. Among them, 68 were diagnosed as having severe acute pancreatitis; 10 out of the 68 patients had GC. We compared these 10 patients with GC and 58 patients without GC. The indices analyzed included sepsis/septic shock, pancreatic encephalopathy, acute respiratory distress syndrome, acute renal failure, multiple organ dysfunction syndrome, and death. RESULTS: Specific CT images of GC in patients with severe acute pancreatitis included enlarged and high-tensioned gallbladder, wall thickening, lumenal emphysema, discontinuous and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P<0.01), pancreatic encephalopathy (50.0% vs 17.2%, P<0.05), acute respiratory distress syndrome (90.0% vs 41.4%, P<0.01), multiple organ dysfunction syndrome (70.0% vs 24.1%, P<0.01), acute renal failure (40.0% vs 27.6%, P<0.05), and death (40.0% vs 13.8%, P<0.05) were significantly higher in patients with GC than in those without GC.CONCLUSION: CT scans can help to identify early GC in patients with severe acute pancreatitis; early diagnosis and intervention for patients with GC can reduce morbidity and mortality.