Acute Cholecystitis and the Controversies of Treatment

Case Study

Abstract

Key Learning Points:

1. Acute cholecystitis is often a complication of gallstones disease

2. Most of patients with symptomatic gallstones disease are prone to further complications and cholecystectomy is indicated

3. Laparoscopic early cholecystectomy in acute cholecystitis is superior to delayed cholecystectomy in terms of symptom control, hospital stay and re-admissions, with similar morbidity and mortality and should be attempted in all cases of acute cholecystitis. Difficult cases should be managed by experienced surgeons, in advanced centers, and bail-out procedures should be attempted as per Tokyo guidelines.

4. Percutaneous cholecystostomy should only be used in patients unfit for surgery who fail to improve

5. The data available to support optimal antibiotical treatment is scarce, and local microbiology guidelines should be used.