Acute acalculous cholecystitis complicating aortic aneurysm repair.

In a series of 374 consecutive abdominal aortic aneurysmal repairs, the incidence of acute acalculous cholecystitis was 1.1 per cent. This complication occurred in only one of 352 patients (0.3 per cent) after elective aneurysmorraphy, as compared with three of 22 (13.6 per cent) after emergency repair of a ruptured aneurysm. This difference proved highly significant (p = 0.0001). All of the patients who had postoperative acute cholecystitis after aortic aneurysmal repair had acalculous disease. A mortality rate of 50 per cent was noted for this complication. Technetium cholescintigraphy proved the most valuable diagnostic study when acute cholecystitis was suspected.

The significance of clostridial isolates in intra-abdominal sepsis.

In order to evaluate the significance of clostridial species in intra-abdominal infections, the bacteriology records of three hospitals were reviewed during a period of five years. Included in this report were 41 patients from whom clostridial species were recovered from specimens of free peritoneal fluid, abscess cavities or bile. Seven patients died for a mortality rate of 17.1 per cent. Most patients had polymicrobial infections of which clostridial organisms were one of the several anaerobes isolated. Clostridium perfringens was the single most frequently noted species, identified in 23 of the patients, but it was not associated with a different mortality rate than was observed for the other clostridial species. Clostridial bacteremia was uncommon and demonstrated in only one patient. The mean age of the patients was 56.4 years; 56.2 for males and 56.8 for females. Neither age nor sex of the patient influenced the likelihood of survival. The source of the clostridial isolates--bile, abscess cavity or free peritoneal fluid--had no effect upon the outcome. Several underlying conditions were responsible for the intraperitoneal clostridial organisms identified in this series. Only mesenteric infarction proved significantly predictive of a fatal result. Antibiotic coverage specifically directed against clostridia did not influence survival.