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Biliary Disease in Immunocompromised Patients: a Single-Center Retrospective Analysis

  • Justin George
  • Marc Cohen
  • Stewart Whitney
  • Erin Fennern
  • Celia DivinoEmail author
Original Article
  • 17 Downloads

Abstract

Background

Acute cholecystitis is a life-threatening disease process in immunocompromised patients. The purpose of this study is to determine the incidence, clinical course, and management of calculous and acalculous acute cholecystitis in immunocompromised patients.

Methods

A single center’s database was queried for all patients with a diagnosis of acute cholecystitis from January 1, 2003 to September 30, 2016 with concomitant diagnosis of neutropenia, leukopenia, leukemia, or lymphoma. These cases subsequently underwent chart review. Data on demographics, diagnostic studies, and management were collected and analyzed.

Results

There were 4525 patients diagnosed with acute cholecystitis during the study window. One hundred twenty patients were identified to be immunocompromised at time of diagnosis. Seventy-nine patients (65.8%) had acute calculous cholecystitis while 41 patients (34.2%) had acalculous cholecystitis. There were no significant demographic differences between calculous and acalculous groups. There was similar use of percutaneous cholecystostomy tube (7.6%, 9.8%, p = 0.69), laparoscopic cholecystectomy (70.9%, 61.0%, p = 0.27), and open cholecystectomy (10.3%, 2.4%, p = 0.13) in both calculous and acalculous groups.

Discussion

While immunosuppression is commonly thought to be associated with acalculous cholecystitis, our data suggest the majority of acute cholecystitis in immunocompromised patients are calculous. Most patients in our studies were managed successfully with laparoscopic cholecystectomy with acceptably low complication rates.

Conclusion

Calculous cholecystitis is more common than acalculous cholecystitis in immunocompromised patients. Both are often managed successfully with laparoscopic cholecystectomy with very low rates of conversion to open cholecystectomy.

Keywords

Immunocompromised Biliary Cholecystitis Calculous Acalculous 

Notes

Authors’ Contributions

Dr. Justin George, Mr. Marc Cohen, Dr. Stewart Whitney, and Dr. Erin Fennern were involved in data acquisition, data analysis, and manuscript revision. Dr. Celia Divino was involved in supervising all aspects of the study including data acquisition, analysis, and critical revisions to the final manuscript. All authors discussed the results and contributed to the final manuscript.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Justin George
    • 1
  • Marc Cohen
    • 1
  • Stewart Whitney
    • 1
  • Erin Fennern
    • 1
  • Celia Divino
    • 1
    Email author
  1. 1.Mount Sinai Department of General SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

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