Ürosepsise bagli gelisen akut akalkülöz kolesistit:
Iki vaka sunumu
Acute acalculous cholecystitis due to urosepsis: Two case reports
Özet
Akut akalkülöz kolesistit; sepsis, non-biliyer cerrahi operasyon, yanik, majör travma gibi risk faktörleri ile sik birliktelik gösteren mortalitesi yüksek bir komplikasyondur. Akut akalkülöz kolesistit hastalarinin klinik prezentasyonu tipik degildir ve genellikle fizik muayene taniya yardi mci olmaz. Bu hastalarin klinik bulgulari sepsis ve multipl organ yetmezligi bulgularina bagli gizlenebileceginden tanida gecikmeler olabilir. Akut akalkülöz kolesistit etiopatogenezinde farkli görüsler bulunmaktadir. Safra viskozitesinin artisi, staz ve ampulla ödemi ile artan intraluminal basinç yaninda, olusan hipotansiyon, mukozal iskemi ve sonuçta bakteriyel kolonizasyon nekroza neden olmaktadir. Yogun vasküler hasar nedeniyle minimal klinik semptom veren akut akalkülöz kolesistit vakalarinda hizli bir progresyon ile perforasyona kadar giden ciddi klinik tablo olusabilir. Tedavide hastanin genel durumuna, etkene ve altta yatan hastaliga göre medikal veya cerrahi dedavi seçenegi uygulanabilir. Özellikle sepsise sekonder akut akalkülöz kolesistit vakalarinda erken klinik süphe ve erken medikal tedavi iyi sonuç vermekte ve ek cerrahi travmadan hastayi korumaktadir.
Abstract
Frequently observed risk factors in acute acalculous cholecystitis are sepsis, non-biliary surgery, burns, major traumas, malignancies, and acute renal failure, and it has high mortality. Clinical presentation of acute acalculous cholecystitis patients is atypical and physical examination is usually not helpful for diagnosis. Delayed diagnosis is probable due to sepsis and multiple organ failure symptoms hiding clinical manifestations of the disease. There are several different opinions regarding the etiopathogenesis of acute acalculous cholecystitis. In the face of elevated intraluminal gallbladder pressure caused by ampullary edema and increased bile viscosity, hypotension may result in mucosal ischemia and necrosis with subsequent bacterial colonization. Because of the intensity of this vascular injury, it is possible that acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Especially in sepsis, secondary acute acalculous cholecystitis cases, early clinical suspicion and early medical treatment have a positive effect on the patient and protect them from additional surgical trauma.
