Acute acalculous cholecystitis due to urosepsis: Two case reports

Öz

Frequently observed risk factors in acute acalculous cholecystitis are sepsis, non-biliary surgery, burns, major traumas, malignancies, and acute renal failure, and it has high mortality. Clinical presentation of acute acalculous cholecystitis patients is atypical and physical examination is usually not helpful for diagnosis. Delayed diagnosis is probable due to sepsis and multiple organ failure symptoms hiding clinical manifestations of the disease. There are several different opinions regarding the etiopathogenesis of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Because of the intensity of this vascular injury, it is possible that acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Especially in sepsis, secondary acute acalculous cholecystitis cases, early clinical suspicion and early medical treatment have a positive effect on the patient and protect them from additional surgical trauma.

Anahtar Kelimeler

• Acute acalculous cholecystitis, sepsis, urosepsis

Ürosepsise bağlı gelişen akut akalkülöz kolesistit: İki vaka sunumu

Öz

Akut akalkülöz kolesistit; sepsis, non-biliyer cerrahi operasyon, yanık, majör travma gibi risk faktörleri ile sık birliktelik gösteren mortalitesi yüksek bir komplikasyondur. Akut akalkülöz kolesistit hastalarının klinik prezentasyonu tipik değildir ve genellikle fizik muayene tanıya yardı mcı olmaz. Bu hastaların klinik bulguları sepsis ve multipl organ yetmezliği bulgularına bağlı gizlenebileceğinden tanıda gecikmeler olabilir. Akut akalkülöz kolesistit etiopatogenezinde farklı görüşler bulunmaktadır. Safra viskozitesinin artışı, staz ve ampulla ödemi ile artan intraluminal basınç yanında, oluşan hipotansiyon, mukozal iskemi ve sonuçta bakteriyel kolonizasyon nekroza neden olmaktadır. Yoğun vasküler hasar nedeniyle minimal klinik semptom veren akut akalkülöz kolesistit vakalarında hızlı bir progresyon ile perforasyona kadar giden ciddi klinik tablo oluşabilir. Tedavide hastanın genel durumuna, etkene ve altta yatan hastalığa göre medikal veya cerrahi dedavi seçeneği uygulanabilir. Özellikle sepsise sekonder akut akalkülöz kolesistit vakalarında erken klinik şüphe ve erken medikal tedavi iyi sonuç vermekte ve ek cerrahi travmadan hastayı korumaktadır.

Anahtar Kelimeler

• Akut akalkülöz kolesistit, sepsis, ürosepsis

Kaynakça

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