RESUMO
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Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos do Sistema Digestório , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/cirurgia , LaparotomiaAssuntos
Abdome Agudo , Hemoperitônio , Volvo Gástrico , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/cirurgia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Laparotomia , Pessoa de Meia-Idade , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Although index cholecystectomy is considered the treatment of choice for acute cholecystitis (AC), many hospital systems struggle to provide such a service. The aim of this study was to analyze the effect of failure to perform index cholecystectomy in patients presenting with acute cholecystitis. METHODS: Between June 2010 and December 2015, all patients presenting to one hospital with an initial attack of AC were enrolled into a prospective database. Patient's records were reviewed up until point of delayed cholecystectomy or for a minimum of 24 months after the initial presentation with AC. Recurrent AC was defined as early (<6 weeks from initial discharge) or late (>6 weeks from initial discharge). RESULTS: In total 998 patients presented with AC, 409 (41%) of whom were discharged without index cholecystectomy. Eighty-three (20%) patients presented with AC recurrence (ACR). Compared to the first AC episode, patients were more likely to present with grade III AC and suffer significantly greater morbidity (p < 0.05 for all comparisons). A prior history of biliary disease was associated with ACR (p = 0.002). ACR occurred early in 48 (58%) patients and delayed in 35 (42%) patients. CONCLUSIONS: Twenty percent of patients discharged without cholecystectomy after their first attack of ACR will develop recurrence within the first two years. Half of ACR will occur within 6 weeks. Patients who present with ACR are more likely to develop more severe AC and are likely to suffer greater morbidity as compared to their first attack.