Stress cholecystitis

Acute acalculous cholecystitis, or stress cholecystitis, is a complication of severely traumatized patients that has been relatively neglected by surgeons in previous years. It can be caused by many factors that might occur singly or in combination in severe trauma patients. The symptoms and signs are usually lost in the clinical picture of a polytrauma patient. It is usually diagnosed sonographically. The gold standard of treatment is cholecystectomy. In our study, 30 polytrauma patients were included. Their injury severity score (ISS) ranged between 25 and 40, with a mean of 31. Patients with underlying gall-bladder disease were excluded. Acute acalculous cholecystitis was diagnosed sonographically in 4 patients (13.3%) by the sonomorphologic triad of thickening of the gall-bladder wall, hydrops, and the presence of biliary sludge. The full triad was usually detected on the twelfth day of admission. Two of the triad patients were subjected to cholecystectomy, and the diagnosis was histopathologically confirmed. Major blood loss and shock were common factors in stress cholecystitis patients. In conclusion, stress cholecystitis can be easily diagnosed sonographically, especially when the latter is serially performed. The disease should be kept in mind during the posttraumatic and postoperative course.