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Acute calculous cholecystitis: Difference between revisions
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Even though the infection is not necessarily bacterial, antibiotics are used in the acute phase (in Norway ampicillin + gentamycin + metronidazole is used). If the patient is really ill or antibiotics are insufficient to clear the infection, we must achieve source control by gallbladder drainage or emergency surgery. Gallbladder drainage can be achieved percutaneously or endoscopically (with ERCP). | Even though the infection is not necessarily bacterial, antibiotics are used in the acute phase (in Norway ampicillin + gentamycin + metronidazole is used). If the patient is really ill or antibiotics are insufficient to clear the infection, we must achieve source control by gallbladder drainage or emergency surgery. Gallbladder drainage can be achieved percutaneously or endoscopically (with ERCP). | ||
The definitive treatment for acute calculous cholecystitis is laparoscopic subtotal cholecystectomy, to prevent both complications and recurrence. There are two approaches to the timing of cholecystectomy, early surgery (during the same hospital admission) and delayed surgery (elective surgery after 6+ weeks). | The definitive treatment for acute calculous cholecystitis is laparoscopic subtotal [[cholecystectomy]], to prevent both complications and recurrence. There are two approaches to the timing of cholecystectomy, early surgery (during the same hospital admission) and delayed surgery (elective surgery after 6+ weeks). | ||
In most cases, we opt for early surgery. In complicated cases, one may opt for delayed surgery. This allows the inflammation to heal, making surgery less risky. | In most cases, we opt for early surgery. In complicated cases, one may opt for delayed surgery. This allows the inflammation to heal, making surgery less risky. | ||