Acute Acalculous Cholecystitis in Neurological Patients; Clinical Review, Risk Factors, and Possible Mechanism

Backgrounds Acute acalculous cholecystitis (AAC) has rarely been reported and has not been fully investigated in patients with severe neurological conditions that can cause changes in consciousness. Delays in diagnosis of AAC may increase the severity of this condition. The aim of this study was to investigate the clinical features and possible mechanisms of AAC in neurological patients. Methods Among the patients with neurological conditions admitted to our hospital between March 2007 and September 2018, the medical records of 52 patients who underwent cholecystectomy after being diagnosed with cholecystitis were reviewed retrospectively. Data regarding age, sex, neurological conditions, Glasgow Coma Scale (GCS) on admission, past medical history, time from admission to the onset of AAC, initial symptoms or signs of AAC, and fasting period were investigated. Results The mean age of the 52 patients (36 male, 16 female) was 67.1±14.4. The mean GCS was 10. The neurological conditions were intracerebral hemorrhage, subarachnoid hemorrhage, subdural hematoma, intraventricular hemorrhage, epidural hematoma, cerebral infarction, cerebral abscess, and hypoxic brain damage. The mean time interval between the onset of AAC and admission was 22.5 days and the mean fasting period was 8.1 days. Conclusion AAC may be a significant complication in patients with neurological conditions. It is important to identify symptoms and signs of AAC, accurately diagnose the AAC, particularly in long-term stay at intensive care unit (ICU), a long period of fasting, state of hypotension or hypoperfusion, high positive end-expiratory pressure (PEEP) ventilation.