Colecistitis alitiásica. Certeza diagnóstica por ultrasonido. Mauricio de la Fuente Lira, Jorge Manuel Catrip Torres. a 0. Read. Times was read the article. Caso clínico. Chica de 18 años. AP: TDAH (Tto: lisdexanfetamina 70 mg/día) Colecistitis aguda alitiásica. Inflamación de la vesícula, sin. Introducción: la colecistitis aguda alitiásica (CAA) se da con mayor frecuencia en pacientes críticos, en el periodo postoperatorio inmediato, tras traumatismos o.
|Published (Last):||26 December 2011|
|PDF File Size:||13.40 Mb|
|ePub File Size:||9.26 Mb|
|Price:||Free* [*Free Regsitration Required]|
A not so rare disease. Hospital Regional Universitario Carlos Haya. Acute acalculous cholecystitis AAC occurs more frequently in critically ill patients, in the immediate postoperative period, after trauma or extensive burns.
It has a high rate of morbidity and mortality. Ischemia, infection and vesicular stasis are determinants in its pathogenesis. Retrospective study including all cases of AAC diagnosed in our pediatric intensive care unit between January and December We included 7 patients, all associated with viral or bacterial infection. All of them suffered from abdominal pain, mainly localized in the right upper quadrant, jaundice and dark urine.
Abdominal ultrasound showed thickening and alitiasida of the gallbladder wall in all cases. The outcome was satisfactory without surgery in all patients. The clinical presentation is oligosymptomatic within severe systemic diseases. Tiene una alta tasa de morbimortalidad. Todos debutaron con dolor abdominal localizado en hipocondrio derecho, ictericia y coluria.
Colecistitis – Síntomas y causas – Mayo Clinic
It usually akitiasica within systemic bacterial gram-negative or anaerobic or viral EBV, hepatotropic virus Regarding clinical manifestations 4,5it is required a high suspicion, since the onset of unexplained fever, jaundice or vague abdominal discomfort in a critically ill patient, often intubated and sedated, may be the only track 6,7.
AAC handling depends on the time of diagnosis, and thus in early stages of the disease exclusive medical treatment may be sufficient 8reserving cholecystectomy for patients with vesicular gangrene or perforation 9. Our goal is to review the cases of AAC in our pediatric center and compare with the existing literature.
Retrospective review of hospital records of pediatric patients under colecustitis years diagnosed with AAC in our hospital from January to December We collected epidemiological age and sexclinical underlying disease and alitiadica characteristicsdiagnostic special emphasis on ultrasound and therapeutic drugs employed, complications data after informed consent was obtained.
Ultrasound studies reviewed by two radiologists in all children who met clinical criteria. Ultrasonographic diagnostic criteria 8,11 were divided into major gallbladder wall thickening over 3.
Adiagnosis was considered positive if it included either a minimum of two major criteria or one major and two minor criteria, in the appropriate clinical setting. Seven patients were included Table I: The ultrasound showed wall thickening and hypervascularity in the absence of lithiasis in all cases without pericholecystic fluid. Treatment was conservative with fluid therapy, parenteral nutrition, analgesia and antibiotics, adding vitamin K, lactulose and ursodeoxycholic acid in the patient with ALL and in neonates.
The most used combination of antibiotics was third generation cephalosporin and antianaerobe agents mainly metronidazole. The evolution was satisfactory without surgery in all patients.
Meaning of “colecistitis” in the Spanish dictionary
As for the typical age of presentation, according to Imamoglu 8it predominates at school age mean 7. AAC has been associated with intercurrent infections, metabolic disorders, vascular problems, burns, injuries and malignancies in children. AND Micrococcus cholecystitiswhich showed only one previous case of acute gallstone cholecystitis by Kocuria kristinae, belonging to genus Micrococcusa 56year old Chinese woman.
It must be also pointed out the case of the AAC as colecistitiis complication of systemic brucellosis, since only 21 alitiaeica have been described to date after a Alitiazica search from towith one pediatric patient, being, therefore, our case number 22 worldwide, the second pediatric patient The clinical presentation of the AAC is variable, and depends on the predisposing conditions 13, In all of our aligiasica sonographic criteria were met: Conservative alitiasiac would be adequate hemodynamic stabilization, suppression of drugs that might hinder the gallbladder emptying, fluid therapy, parenteral nutrition, analgesia and use of antibiotics active on gram negative, anaerobes and Enterococciwhich in turn reach therapeutic concentrations in the biliary tract.
So, all of our patients were treated conservatively, adding vitamin K, lactulose and ursodeoxycholic acid in cklecistitis patient with ALL and in neonates who attended E. According to the data of our study and the literature reviewed, we draw several conclusions: Although the AAC is a rare entity in children, it must be considered by the pediatrician among the causes of abdominal pain, especially in critically ill children that are often intubated and sedated, with detection of vague abdominal discomfort, fever and jaundice besides, and where the source of infection is not entirely clear.
Ultrasound is the most reliable method for diagnosis Fig.
In children, conservative treatment is effective in solving this disease, although it does require close clinical, analytical and ultrasound monitoring, able to detect complications. Glenn F, Becker CG. Acalculous cholecystitis in children.
J Pediatr Surg ; Acute acalculous cholecystitis in a teenager with hepatitis A viral infection: Braz J Infect Dis ; Am J Gastroenterol ; Clinical features of acute acalculous cholecystitis.
J Clin Gastroenterol ; Does this patient have acute cholecystitis? New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci ; Acute acalculous cholecystitis in children: Owen CC, Jain R. Curr Treat Options Gastroenterol ;8: Acute alitiaisca cholecystitis associated with acute hepatitis B infection.
COLECISTITIS – Definition and synonyms of colecistitis in the Spanish dictionary
Int J Infect Dis ; Septic shock and hypofibrinogenemia predict a fatal outcome in childhood acute acalculous cholecystitis. Acute acalculus cholecystitis and hepatitis caused by Brucella melitensis. J Infect Dev Ctries ; 4: J Clin Gastroenterol ; Huffman JL, Schwenker S.
Clin Gastroenterol Hepatol ;8: Spontaneous course and incidence of complications in patients without stones. Case reports Retrospective review of hospital records of pediatric patients under 14 years diagnosed with AAC in our hospital from January to December Discussion As for the typical age of presentation, according to Imamoglu 8it predominates at school age mean 7.