Acute alithiasic cholecystitis in patients in intensive care: an integrative review

Abstract

Introduction: Acute allitiasis cholecystitis (AAC) is an inflammation of the gallbladder without the presence of gallstones. It is predominant in post-operative conditions, in trauma patients, or in those admitted to intensive care units (ICU) because of a serious illness. The pathophysiology of AAC, despite being associated with some known factors, is not well elucidated, which hinders the development of preventive, diagnostic, and therapeutic actions, thus leading to an increase in the number of cases of death. Objective: To review and synthesize available knowledge on acute allitiasis cholecystitis in intensive care patients. Methods: This is an integrative review of literature in PubMed, VHL and Web of Science databases using the descriptors: "acalculous cholecystitis", "Intensive Care", "Intensive Care", "Gallbladder Inflammation" and "Diagnosis". Initially, 60 articles were selected, without time limitation, in Portuguese and/or English, complete and free. After analysis, 10 articles met the proposed objective. Results: From the studies a prevalence of acute acalculous cholecystitis was demonstrated in male patients and aged 45 - 73 years. The most common reason for admission to intensive care was pneumonia, infections and trauma, having a median interval of 11 days for diagnosis of acute acalculous cholecystitis after admission to intensive care and a median length of stay of 26.5 days. It was observed that the influence of the duration of use of total parenteral nutrition, analgesics, mechanical ventilation, vasoactive drugs, and shock time were factors that contributed to the development of the disease. Conclusion: For the treatment of cholecystitis althiasis, laparoscopic cholecystectomy was indicated in patients with adequate clinical conditions and percutaneous cholecystostomy in those with worse clinical conditions because it is less aggressive than open or laparoscopic cholecystectomy.