Acute cholecystitis in the late phase of severe acute pancreatitis: a neglected problem

This study aimed to evaluate the incidence and risk factors for acute cholecystitis (AC) in the late phase of severe acute pancreatitis (SAP). A review of patients with SAP from January 2008 to December 2009 was performed. Clinical characteristics were compared between patients with AC in the late phase and those without. Risk factors for AC were analyzed using a logistic regression analysis. Receiver operating characteristic curve was used to estimate the predictive value of the risk factors. A total of 269 cases were included. Twenty-seven episodes of AC in the late phase were identified. Patients with AC had higher computed tomography severity index and Acute Physiology and Chronic Health Evaluation (APACHE) II score, as well as higher rate of intraabdominal hypertension, infective pancreatic necrosis (IPN) of the pancreas head, fistula, abdominal bleeding, mechanical ventilation, and prolonged enteral nutrition (EN) via jejunal tube. Independent risk factors for AC, based on the results of logistic regression analysis, included higher APACHE II score, prolonged EN via jejunal tube, and IPN of the pancreas head. Approximately 10% of patients with SAP will develop AC in the late phase. Risk factors include higher APACHE II score, prolonged EN via jejunal tube, and IPN of the pancreas head.