A CLINICAL EVALUATION OF THE SEVERITY AND THERAPEUTIC STRATEGIES OF POSTOPERATIVE ACUTE CHOLECYSTITIS

Twenty-two patients with postoperative acute cholecystitis seen in the department from 1980 to 1992 were divided into two groups by the severity of the condition, namely, mild and severe groups, and compared for the clinical features of the disease. Eleven patients had severe postoperative acute cholecystitis and some of them also had serious complications other than cholecystitis after surgery for the primary disease. This disease was common in the old. Severe cholecystitis was more frequently found in patients with cardiovascular disease as the primary disease than in patients with gastrointestinal carcinoma. Five of the eleven patients with severe cholecystitis died. The mortality was 50% in each patient group undergoing cholecystectomy, cholecystotomy or conservative treatment. Only one patient who underwent PTGBD had a healed lesion. Most patients with mild cholecystitis healed with conservative treatment. It is important to evaluate the severity early on and employ less invasive therapy including PTGBD, because severe postoperative acute cholecystitis often develops in patients with severe other complications after surgery for the primary disease or compromised hosts such as aged people.