Korean J Crit Care Med.  2017 May;32(2):190-196. 10.4266/kjccm.2016.00857.

Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage

• Yang NR
• Hong KS
• Seo EK

• KMID: 2384044
• DOI: http://doi.org/10.4266/kjccm.2016.00857

Abstract

BACKGROUND
Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%-5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC.
METHODS
We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3℃, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC.
RESULTS
Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024).
CONCLUSIONS
AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.

Keyword

cholecystectomy; cholecystitis; intensive care units; prognosis; retrospective studies; subarachnoid hemorrhage

MeSH Terms

Acalculous Cholecystitis
Aneurysm*
Aspartame
Body Temperature
C-Reactive Protein
Cerebrovascular Disorders
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis
Cholecystitis, Acute*
Critical Care
Critical Illness
Diabetes Mellitus
Diagnosis
Fasting
Fever*
Hospitalization
Humans
Incidence
Intensive Care Units
Leukocyte Count
Prognosis
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage*
Urinary Bladder
Vital Signs
Aspartame
C-Reactive Protein

Reference

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