Acute cholecystitis as a complication in surgical patients.

Acute cholecystitis after operation or trauma is associated with reported mortalities of 10% to 50%. During a 16-year period at the Mayo Clinic, Rochester, Minn, 75 such patients were examined, eight of whom had traumatic injuries. The incidence of this complication was approximately one for every 10,000 surgical procedures. In contrast with acute cholecystitis that occurs de novo, elderly men who had other antecedent complications seemed to be at an increased risk. Also, acalculous cholecystitis with associated gangrene and perforation of the gallbladder was more commonly encountered. The diagnosis is difficult to establish in patients who have had recent abdominal operations and is based on physical signs and symptoms, although cholescintigraphy will be of value in future cases. The most common treatment is cholecystectomy. Clinicians must maintain a high index of suspicion and carefully examine any surgical patient in whom abdominal pain or unexplained fever develops. Once the diagnosis is confirmed, early operative intervention is indicated.