Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
Background In medical practice , the tendency to remove an inflamed gallbladder is deeply rooted .
Cholecystectomy , however , is associated with relatively high complication rates , and therefore the decision whether or not to perform surgery should be well considered .
For some patients , the surgical risk – benefit profile may favour conservative treatment .
The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis .
Conservative treatment for acute cholecystitis: clinical and radiographic predictors of failure.
BACKGROUND Current treatment options for acute calculous cholecystitis include either early cholecystectomy , or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later . Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients . OBJECTIVE To identify clinical and radiographic factors leading to failure of conservative treatment . METHODS We prospect ively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis . Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy . Logistic regression analysis was performed to identify predictors for failure of conservative treatment . RESULTS The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis . Twenty-seven patients ( 26.2 % ) required PC . On univariate analysis , age above 70 years , diabetes , elevated white blood cell count , tachycardia ( > 100 beats/min ) at admission , and a distended gallbladder ( > 5 cm transverse diameter ) were found to be significantly more common in the PC group ( P < 0.001 ) . WBC was higher in the PC group throughout the initial 48 hours . On multivariate analysis , age above 70 ( odds ratio 3.6 ) , diabetes ( OR 9.4 ) , tachycardia at admission ( OR 5.6 ) , and a distended gallbladder ( OR 8.5 ) were predictors for cholecystostomy ( P < 0.001 ) . Age above 70 ( OR 5.2 ) and WBC $ 15,000 ( OR 13.7 ) were predictors for failure of conservative treatment after 24 and 48 hours ( P < 0.001 ) . CONCLUSIONS Age above 70 , diabetes , and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy . Persistently elevated WBC ( > 15,000 ) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis
Discussion Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe , especially in patients with mild disease .
Background In medical practice , the tendency to remove an inflamed gallbladder is deeply rooted .
Cholecystectomy , however , is associated with relatively high complication rates , and therefore the decision whether or not to perform surgery should be well considered .
For some patients , the surgical risk – benefit profile may favour conservative treatment .
The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis .