The Role of Antibiotic Treatment in Patients With Acute Mild Cholecystitis - A Prospective Randomized Controlled Trial

Launched by HADASSAH MEDICAL ORGANIZATION · Nov 11, 2007

Keywords

ClinConnect Summary

Cholelithiasis and inflammatory biliary tract disease constitute a major health problem in western countries. Acute cholecystitis is the third major cause of emergency admission to a surgical ward and its incidence increases with increasing age. Acute cholecystitis is defined as acute inflammation of the gallbladder which is commonly caused by gallstones which are impacted in the cystic duct. The treatment of acute cholecystitis varies between different medical centers around the world. In some hospitals, mainly in the US, the most common treatment is early laparoscopic cholecystectomy with...

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Eligibility criteria

• Inclusion Criteria:
• Patients with the diagnosis of mild acute cholecystitis that meet the following:
• 1. Sonographic (or CT) findings:
• • 1. cholelithiasis or sludge and
• • 2. wall thickening \> 4 mm, and
• • 3. positive sonographic Murphy sign,
• • 4. distended gallbladder (optional)
• • 5. pericystic fluid (optional)
• 2. Additional one of the following:
• • 1. epigastric or RUQ pain
• • 2. fever \> 38.0
• • 3. WBC \> 10,000
• Exclusion criteria:
• • 1. Age - less than 18 or above 70
• • 2. Pregnant females
• • 3. Unconsentable patients
• • 4. NYHA \> 3
• • 5. Use of steroids or immunosuppression
• • 6. Onset of typical abdominal pain for over than 72 hours
• • 7. Hemodynamic instability
• • 8. Fever \> 39 or chills
• • 9. Palpable inflammatory RUQ mass
• • 10. Presence of peritonitis on physical examination
• • 11. WBC \> 18,000
• • 12. Diastase \> 200 (NL 20-100)
• • 13. Bilirubin \> 85 (X5 the norm)
• • 14. Multi organ failure