[The intensive care gallbladder--a transient phenomenon or a problem requiring therapy?].

Acute acalculous cholecystitis (AAC) is a well-known complication in postoperative and severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit between January 1, 1989 and June 30, 1990 were clinically and sonographically screened for this condition at defined time-intervals. A clinical and sonographical follow-up was performed annually (1991-1993). Trauma scoring was performed according to the Injury Severity Score (ISS) and Polytrauma Score (PTS). AAC was defined as a combination of hydrops of the gallbladder, an increased mural thickness (> 3.5 mm) and the demonstration of sludge. We were able to demonstrate this diagnostic triad in 8 out of 45 patients (18%). As a consequence early elective cholecystectomy was performed in one patient. The remaining patients were treated conservatively. Incidence of AAC in severely traumatized patients is probably higher than figures so far published suggest. The systematic search for this condition using serial sonographic examinations and defined sonomorphological criteria may select individual cases for elective cholecystectomy. Ultrasound is a reliable method of early detection and follow-up of this complication. Trauma and following intensive care therapy induce a lithogenetic factor, developing gallstone disease in 27% of patients within an 2-3-year interval.