Akut Kolesistit
Özet
Akut kolesistit, genellikle safra kesesi taşlarının sistik kanalı tıkaması sonucu gelişen, safra kesesinin ani iltihaplanması durumudur. En belirgin belirtisi, sağ üst kadranda ani başlayan, sırta ve omuza yayılabilen, saatlerce süren şiddetli ağrı olup buna ateş, bulantı, kusma ve lökositoz eşlik eder. Tanıda fizik muayenedeki Murphy bulgusu ve en güçlü pratik yöntem olan hepatobiliyer ultrasonografi kritik rol oynar. Vakaların %5-10'unu oluşturan taşsız (akalkülöz) kolesistit ise genellikle yoğun bakımdaki ağır hastalarda görülür ve mortalitesi daha yüksektir. Tokyo Kriterleri (TG18) temel alınarak hastalık hafif, orta ve şiddetli olarak derecelendirilir. Tedavinin temelini sıvı-elektrolit dengesinin sağlanması, uygun antimikrobiyal terapi ve altın standart olan kolesistektomi (özellikle laparoskopik) cerrahisi oluşturur. Cerrahiyi kaldıramayacak hastalarda perkütan kolesistostomi ile safra drenajı hayat kurtarıcı bir alternatiftir. Tedavide gecikme yaşanması durumunda gangrenöz kolesistit, perforasyon, amfizematöz kolesistit veya safra taşı ileusu gibi ölümcül komplikasyonlar gelişebilir.
Acute cholecystitis is an acute inflammation of the gallbladder, primarily caused by gallstones obstructing the cystic duct. The most prominent symptom is a sudden, severe pain in the right upper quadrant that can radiate to the back and shoulder, accompanied by fever, nausea, vomiting, and leukocytosis. Murphy's sign during physical examination and hepatobiliary ultrasonography, the most effective imaging method, are critical for diagnosis. Acalculous cholecystitis accounts for 5-10% of cases, typically developing in critically ill patients in intensive care units, and carries higher mortality. Disease severity is classified into mild, moderate, and severe based on the Tokyo Guidelines (TG18). The mainstay of treatment involves fluid-electrolyte management, appropriate antimicrobial therapy, and cholecystectomy, with laparoscopic surgery being the preferred method. For patients unfit for immediate surgery, gallbladder drainage via percutaneous cholecystostomy is a life-saving option. Delayed diagnosis and treatment can result in life-threatening complications, including gangrenous cholecystitis, perforation, emphysematous cholecystitis, or gallstone ileus.
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