Editorial

Acute Acalculous Cholecystitis After Trauma: The Role of Microcirculatory Failure and Cellular Hypoxia

Authors: Robert B. Sanda, FRCSI

Abstract

Critical illness is expensive. Neural transmission, ion transport, vasoconstriction, glandular and hormonal secretions are highly endergonic processes that are amplified in the face of trauma, sepsis, or both. It is not surprising, therefore, that the enzymes that drive catabolic reactions (citric acid cycle, oxidative phosphorylation and beta-oxidation), unlike the enzymes of anabolism, are located exclusively in the mitochondrial matrix. Low cardiac output in the aftermath of trauma imposes compensatory responses to divert blood from the rest of the body to the vital organs. Endogenous epinephrine and vasopressin interact synergistically to produce intense splanchnic vasoconstriction and hypoxia. Therapeutic agents (dobutamine, halothane and opioids) have similar adverse effects on the mesenteric microcirculation.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Lindberg EF, Grinnan GL, Smith L. Acalculous cholecystitis in Viet Nam casualties. Ann Surg 1970;171:152–157.
 
2.Chierego M, Verdant C, De Backer D. Microcirculatory alterations in critically ill patients. Minerva Anestesiol 2006;72:199–205.
 
3.Ince C. The microcirculation is the motor of sepsis. Crit Care 2005;9(suppl 4):S13–S19.
 
4.Sanda RB. Abdominal compartment syndrome. Ann Saudi Med 2007;27:183–190.
 
5.Spronk PE, Zandstra DF, Ince C. Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care 2004;8:462–468.
 
6.Glenn F, Becker CG. Acute acalculous cholecystitis: an increasing entity. Ann Surg 1982;195:131–136.
 
7.Ahmed N. Acalculous cholecystitis complicating major trauma. South Med J 2008;101:1146–1149.