Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise.

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment / Costanzo, Maria Ludovica; D’Andrea, Vito; Lauro, Augusto; Bellini, Maria Irene. - In: ANTIBIOTICS. - ISSN 2079-6382. - 12:3(2023). [10.3390/antibiotics12030482]

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

Costanzo, Maria Ludovica
Primo
;
D’Andrea, Vito
Secondo
;
Lauro, Augusto
Penultimo
;
Bellini, Maria Irene
Ultimo
2023

Abstract

Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise.
2023
acute cholecystitis; antibiotics; cholecystectomy; biliary lithiasis
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment / Costanzo, Maria Ludovica; D’Andrea, Vito; Lauro, Augusto; Bellini, Maria Irene. - In: ANTIBIOTICS. - ISSN 2079-6382. - 12:3(2023). [10.3390/antibiotics12030482]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1673469
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