Clinicoetiopathological studies of acute cholecystitis

Abstract

Background:Acute cholecystitis is a common cause of acute abdomen and a frequently encountered surgical emergency. It constitutes about 10% of acute abdomen. Gallstones are the most common biliary and digestive disease leading to hospitalisation. About 95% of the patients with cholecystitis are calculus cholecystitis and the remaining 5% of the patients are acalculus cholecystitis. This is a descriptive study and the objective of the study is to find the various modes of clinical presentation, different etiological factors and various pathological of acute cholecystitis in the RIMS Hospital, Imphal, Manipur,India.

Methods: Detailed history of the 100 cases was taken from the patient and examined clinically for their complaints suggestive of gallbladder disease. All the cases were then subjected to a battery of investigations. Operations were performed in all the cases through standard Kocher’s subcostal incision. Cholecystectomy was accomplished either by cystic duct or fundus first techniques or by combination of both. The specimens removed were sent for histopathological examination for final diagnosis.

Results:Majority of' the patients (45%) in the age group of 41-60 years, suffered from acute cholecystitis. Female predominance over the male counterpart was seen in the present study with female comprising 72% and male 28% only. Only 10% of the cases had a family history suggestive of gallstone disease. The remaining 90% of the cases did not have any family history suggestive of gall stone disease.

Conclusions:In most of the cases gallstones are the cause of acute cholecystitis. Patients suspected of having acute cholecystitis should be admitted to hospital immediately for the first line treatments including fasting, intravenous fluids, and analgesia. The first line treatment should be followed by Surgery (cholecystectomy) within 24 – 48 hours of admission (early). Even though open cholecystectomy was performed in this study, Laparoscopic cholecystectomy is the gold standard and operation of choice. The present work will give a reference value for other workers to know the disease spectrum of acute cholecystitis in this part of the region.