Acute Calcular Cholecystitis in Diabetic Patients: A Ten-Year Experience in a Tertiary Center

Abdel Rahman Abdel Aal, Consultant, Gaby Jabbour, Resident, Wanis Ibrahim, Consultant, Ibnouf Sulieman, Fellow, Zia Aftab, Consultant, Ayman Ahmed, Consultant, Mahmood Al-Dhaeri, Resident, Musab Murad, Resident. Hamad Medical Corporation

Introduction: Acute cholecystitis is most commonly caused by cystic duct obstruction from stones (calculous cholecystitis); only 10% of acute cholecystitis is acalcular, developing in absence of stone.  Risk factors for cholecystitis  include increasing age, female sex, obesity or rapid weight loss, drugs, and pregnancy. Numerous studies have described increased morbidity and mortality of acute cholecystits in diabetic patients. Qatar is among the countries with high prevalence of diabetes.

The aim of this study was to determine the rate of complications and surgical oucomes of acute calcular cholecystits among  patients with diabetes mellitus in a country with high prevalenec of diabetes.

Methods: This is a retrospective study of adult diabetic patients, admitted with acute calcular cholecystitis, at Hamad General Hospital during the period from January 1st, 2004 to December 31st 2013.

Results: During the period from 01/01/2004 to 31/12/2013, a total of 113 diabetic patients were admitted with acute calcular cholecystitis at Hamad General Hospital. Males and females constituted 57% and 43% these patients respectively. Mean age at time of presentation was 57 years. Abdominal pain was the most common presenting symptom (in 97.3% of patients) followed by fever (84.1%). Although abdominal tenderness was the most common detected clinical sign (in 85.6%), Murphy’s sign was positive in only 33.3%. Majority of patients were receiving oral medications for diabetes (71%) prior to presentation. About 9.3% of patients were newly discovered to have diabetes on presentation. The average HbA1C at presentation was 7.7%. The most common ultrasonpgraphic findings were distended gallbladder (72%), wall thickening (71%) and detection of peri-cholecystic fluid (68%). Biliary tree dilation was seen in only 13% of patients.  40 patients were treated conservatively, and 73 were operated: Laproscopic cholecystectomy was the most commonly used surgical treatment (70 cases: 96%) with conversion rate of 4% (3 cases). Average operative time was 98 minutes. Intra-operatively, 3 cases (4.1%) were found to have gall bladder gangrene. The complications were distributed as follows: 1 case of bowel injury (1.4%), 1 case of wound infection (1.4%), and 2 cases of abdominal collection (2.7%). No mortality was seen in our series. Average hospital stay was 3.8 days.

Conclusion: Our study revealed that the rate of complications of acute calcular cholecystitis and its surgery is relatively lower than what was published in previous reports.

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