How should biliary colic and acute cholecystitis be managed in elderly patients?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

The incidence of gallstone increases with age. Elderly patients are more likely to go from asymptomatic gallstones to serious complications of gallstones without gallbladder colic. Delays in diagnosis are common, as symptoms may be limited to change in mental status or decreased food intake. Physical examination and laboratory indexes may be normal. [44, 45]

A systematic review and meta-analysis of 8 studies comprising 592 geriatric patients (age ≥70 years) indicates that early cholecystectomy is feasible for acute cholecystitis in this population. [46] In 316 patients who underwent early laparoscopic cholecystectomy, there was a 23% conversion rate to the open procedure, 24% perioperative morbidity, and 3.5% mortality.


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