The risks of emergency surgery for acute cholecystitis.

At the University Hospitals of Cleveland we have felt that a diagnosis of acute cholecystitis demands immediate hospitalization of the patient, but that definitive treatment should be on the ward rather than in the operating room. These patients are admitted to the surgical service in spite of this non-surgical attitude, for experience with this disease has convinced us that its course is not predictable and that a significant percentage of these patients will fail to improve even on intensive medical therapy. Once failure has become apparent, we have not hesitated to operate at any time of day or night on an emergency, off-schedule basis. It was hoped that most patients could be carried through an acute attack of cholecystitis without nonelective surgery; however, on reviewing our recent cases, we have found that approximately one-third of them have gone to the operating room as an emergency after medical treatment failed. This