Postoperative acute cholecystitis: a collective review of 494 cases in Japan.

The clinical course and management of 494 patients with postoperative acute cholecystitis, encountered at 122 hospitals in Japan during the last decade, were reviewed. The incidence of the disease from the total operations was 0.06 per cent, and 445 patients (90 per cent) were acalculous. The mean age of the patients was 60 years, and the ratio of male to female was 2.8:1. Total gastrectomy, subtotal gastrectomy, and esophagectomy were the most common operations precipitating postoperative acute cholecystitis. Vagotomy, dissection of the upper abdominal lymph nodes, and prolonged fasting were prevalent among the risk factors. Clinical diagnosis was confirmed in most patients by ultrasonography. Among the various treatments, cholecystectomy brought the lowest mortality rate; the overall mortality rate being 23 per cent. When this disease is suspected, ultrasonography should be performed repeatedly and percutaneous transhepatic gallbladder drainage or cholecystectomy are recommended as being the treatments of choice.