Treatment- cholecystitis

(Ann Surg 2013;258:385; NEJM 2015;373:357)

詳見Interventional Approaches to Gallbladder Disease. guidelines for the diagnosis and determination of severity of acute cholecystitis 詳見Acute cholecystitis: early versus delayed cholecystectomy, a multicenter

• NPO, IV fluids, nasogastric tube if intractable vomiting, analgesia as treatment ofcholecystitis

• Antibiotics (E. coli, Klebsiella and Enterobacter sp. are usual pathogens) ([2nd- or 3rd-generation cephalosporin or FQ] + MNZ) or piperacillin-tazobactam

• CCY (typically laparoscopic) w/in 24 h ↓ morbidity vs. waiting 7–45 d Figure:

• If unstable for surgery, EUS-guided transmural, ERCP-guided transcystic duct drainage, or percutaneous cholecystotomy (if w/o ascites or coagulopathy) are alternatives to CCY

• Intraoperative cholangiogram or ERCP to r/o choledocholithiasis in Pts w/ jaundice, cholangitis or stone in BD on U/S (see below)

Interventional Approaches to Gallbladder Disease | NEJM