Acute cholecystitis in burn patients

Acute cholecystitis is a complication in critical illnesses, including burns. The purpose of this report is to review one institution's experience with this complication during a 21-year time period. A computerized burn registry was used for data collection and analysis in this retrospective review. Twenty patients developed cholecystitis from a total burn admission population of 10,762 in this 21-year period (0.18%). Mean patient age was 43.5 years, and their mean burn size was 37.4% with a mean full-thickness burn size of 23% TBSA. Mean patient length of stay was 77.4 days. Sixteen of these patients were intubated and mechanically ventilated for a mean of 56 days. Total parental nutrition was required in 12 patients. The use of total parental nutrition steadily decreased over the length of the study, and early enteral tube feed use has become the norm. All but two patients were in the Burn Intensive Care Unit at the time of diagnosis. Men outnumbered women by three to one. Nine patients with positive sonograms were successfully managed without surgical intervention. Two of these patients also had positive hydroxy iminodiacetic acid scans. Surgically managed patients were treated with both open and laparoscopic cholecystectomy as well as cholecystostomy tube placement. Mortality was 25%. Acute cholecystitis remains a serious although relatively rare complication in burn patients. Patients often have an unreliable physical examination, several possible causes of fever, and abnormal laboratory results. A high index of suspicion and sound clinical judgment is required to manage this rare-but-challenging problem.