|
Back to 2017 Posters
BILIARY DISEASE IN IMMUNOCOMPROMISED PATIENTS: A SINGLE CENTER RETROSPECTIVE ANALYSIS
Justin M. George*, Celia M. Divino, Marc Cohen, Stewart Whitney, Clementine Knight
Surgery, Mount Sinai School of Medicine, New York, NY
Introduction: Acute cholecystitis is a potentially life threatening disease process in immunocompromised patients. There is a sparsity in data on acute cholecystitis in immunocompromised patients, particularly in the management of acute acalculous cholecystitis. The purpose of this study is to determine the occurrence and management of calculous and acalculous acute cholecystitis in immunocompromised patients.
Methods: A single center’s database was queried for all patients with a diagnosis of acute cholecystitis from January 1, 2003 to September 30, 2016 with concomitant diagnosis of neutropenia, leukopenia, leukemia, or lymphoma. These cases subsequently underwent chart review. Data on demographics, diagnostic studies, and management were collected and analyzed.
Results: 4525 patients were diagnosed with acute cholecystitis during the study window. 122 patients were identified to be immunocompromised at time of diagnosis. 81 patients (66.4%) were found to have acute calculous cholecystitis while 41 patients (33.6%) were found to have acalculous cholecystitis. There was no significant difference between calculous and acalculous groups in age (62.4±16.6, 59.9±17.6, p=0.46), male gender (46.9%, 51.2%, p=0.65), use of percutaneous cholecystostomy tube (7.4%, 9.8%, p=0.66), laparoscopic cholecystectomy (71.6%, 61.0%, p=0.47), or open cholecystectomy (10.0%, 2.4%, p=0.25) (Table 1).
Discussion: While immunosuppression is commonly thought to be associated with acalculous cholecystitis, our data suggest the majority of acute cholecystitis in immunocompromised patients are calculous. Most patients in our series were treated with laparoscopic cholecystectomy with only 4 cases requiring conversion to open.
Conclusion: Calculous cholecystitis is more common than acalculous cholecystitis in immunocompromised patients. Both are often managed successfully with laparoscopic cholecystectomy with very low rates of conversion to open cholecystectomy.
Characteristics and management of immunocompromised patients with acute calculous and acalculous cholecystitis
| Characteristics | Total (n=122) | Calculous (n=81) | Acalculous (n=41) | p value | | Age (avg ± std) | 61.6±16.9 | 62.4±16.6 | 59.9±17.6 | 0.46 | | Male | 48.4% (59) | 46.9% (38) | 51.2% (21) | 0.65 | | TPN Use | 18.0% (22) | 16.0% (13) | 22.0% (9) | 0.42 | | Blood Transfusion | 36.1% (44) | 35.8% (29) | 36.6%(15) | 0.93 | | GVHD | 4.1% (5) | 3.7% (3) | 4.7% (2) | 0.76 | | CMV seropositivity | 11.5% (14) | 11.1% (9) | 12.2% (5) | 0.86 | | Percutaneous Cholecystostomy | 8.2% (10) | 7.4% (6) | 9.8% (4) | 0.66 | | Laparoscopic Cholecystectomy | 68.0% (83) | 71.6% (58) | 61.0% (25) | 0.47 | | Intraoperative Cholangiogram | 39.8% (33) | 36.2% (21) | 48.0% (12) | 0.70 | | Open Cholecystectomy | 7.4% (9) | 10.0% (8) | 2.4% (1) | 0.25 |
Back to 2017 Posters
|
