Hiatt J R, Kobayashi M R, Doty J E, Ramming K P
Department of Surgery, UCLA School of Medicine.
Am Surg. 1991 Dec;57(12):825-9.
Four patients with underlying diseases including multiple trauma, aortic graft infection, and complex fistulae developed acute acalculous cholecystitis with bile cultures positive only for Candida albicans. The primary site of the candida infection included urinary tract, gastrointestinal tract, and an aortic graft in one patient each and was undetermined in the trauma victim. All had received broad-spectrum antibiotics; three of the four were in the intensive care unit (ICU) with organ failure. Ultrasonography showed a thickened gallbladder wall in three patients and sludge in one. Hepato-iminodiacetic acid scans were nonvisualizing in these three patients. Operative findings included gangrenous cholecystitis in two patients and edematous cholecystitis in one. The fourth patient was treated with percutaneous cholecystostomy and interval cholecystectomy. The interval from the onset of symptoms to recognition of the need for operation was an average of 7 days. Two of the four patients died of ongoing sepsis. Candida cholecystitis is a life-threatening complication of critical surgical illness. Risk factors are similar to those for candida infection elsewhere and include antibacterial therapy, complex fistulae, disseminated malignancy, immunosuppression, and prolonged ICU stay. A high index of suspicion for this fungal pathogen and aggressive surgical therapy offer the only chance for a favorable outcome.
四名患有包括多发伤、主动脉移植感染和复杂瘘管等基础疾病的患者发生了急性非结石性胆囊炎，胆汁培养仅白色念珠菌呈阳性。念珠菌感染的主要部位在一名患者中分别为泌尿道、胃肠道和主动脉移植物，而在创伤患者中感染部位未确定。所有患者均接受了广谱抗生素治疗；四名患者中有三名因器官衰竭入住重症监护病房（ICU）。超声检查显示三名患者胆囊壁增厚，一名患者有胆囊泥沙样沉积物。这三名患者的肝胆亚氨基二乙酸扫描均未显影。手术所见包括两名患者为坏疽性胆囊炎，一名患者为水肿性胆囊炎。第四名患者接受了经皮胆囊造瘘术和择期胆囊切除术。从症状出现到认识到需要手术的平均间隔时间为7天。四名患者中有两名死于持续的败血症。念珠菌性胆囊炎是危重症外科疾病的一种危及生命的并发症。危险因素与其他部位念珠菌感染的危险因素相似，包括抗菌治疗、复杂瘘管、播散性恶性肿瘤、免疫抑制和长时间入住ICU。对这种真菌病原体保持高度怀疑并积极进行手术治疗是获得良好预后的唯一机会。
