301 ACUTE ACALCULOUS CHOLECYSTITIS AND CARDIOVASCULAR DISEASE, WHICH CAME FIRST?

Abstract Background The existence of a close association between disease the biliary tract and heart's is known from mists time. Acute acalculous cholecystitis (AAC) can be defined as an acute necro-inflammatory gallbladder in absence cholelithiasis. AAC challenging diagnosis. atypical clinical onset associated to paucity similarity symptoms laboratory data mimicking cardiovascular (CVD) often results under misdiagnosed cases. Moreover, has commonly fulminant course compared calculous it with gangrene, perforation empyema well considerable morbidity mortality(up 50%). Early diagnosis crucial prompt treatment order avoid complications increase survivability. Even today, although scientific evidence shown CVD, due lack RCT, there still lot confusion regarding relationship consequently management CVD. In addition, emergency physicians are not always familiar transient ECG changes AAC. Aim aim this review was provide epidemiology, pathophysiology, presentation complex Methods we searched for publications addressing Acalculous disease, consulting Medline Scopus databases. Any retrospective or prospective study design systematic focusing on aforementioned topic accepted. This conducted accordance PRISMA AMSTAR Guidelines. Our search rendered 1422 hits (995 427 Scopus). After removing duplicates, were 114 studies. progressive screening, 268 full texts assessed eligibility 135 studies included qualitative synthesis. Results According literature, 11 cases reported after cardiopulmonary bypass surgery. Besides, patients recovering open-heart surgery extracorporeal circulation, prolonged time depressed cardiac output identified 22 Similarly, 6 7 following aortic reconstruction. Small vessel occlusion predominant phenomenon AAC, concluding that common cause visceral hypoperfusion. Histological analysis resulted leukocyte margination blood vessels, suggesting involvement ischaemia reperfusion mediated injury. These types histopathological alterations typical myocardium bile infiltration into bladder mucosa demonstrated by many authors, validates abnormal epithelial permeability Data suggest manifestation systemic critical illness. most noted T waves significant leads, slurring notching QRS elevation depression S-T segment, hypothesizing vagally reflex mechanism, distention duct, reduced coronary flow. Finally resolution cholecystectomy antibiotic within few days. Conclusion should suspected each general leading hypoperfusion such diseases major heart IMA could related Ultrasonography plays key role early also follow up Cholecystostomy represent two prevailing options