Anna Gabriela Santana¹, Ana Paula Celes Morais¹ and Robson Uwagoya²*

¹Medicine Student of Centro Universitário das Américas (FAM), São Paulo/SP, Brazil
²Department of Trauma and Acute Care Surgery, Grupo de Pesquisa e Extensão em Cirurgia, Brazil

*Corresponding Author: Robson Uwagoya, Department of Trauma and Acute Care Surgery, Grupo de Pesquisa e Extensão em Cirurgia, Brazil.

Received: August 08, 2024; Published: September 01, 2024

Citation: Robson Uwagoya.,et al. “Hemorrhagic Cholecystitis: Acute Renal Injury in the Postoperative". Acta Scientific Gastrointestinal Disorders 7.10 (2024):01-02.

Hemorrhagic cholecystitis is an uncommon condition associated with a high risk of mortality. In cases of hemorrhagic cholecystitis, there is tissue necrosis in the wall of the gallbladder, leading to the development of a pseudoaneurysm in the cystic artery, followed by its rupture.

Acute renal failure (ARF) is a recognized complication of various biliary tract conditions, particularly evident during biliary tract surgeries in the presence of jaundice-related blockages. However, there is limited information on renal failure in cases of acute cholecystitis and its complications such as choledocholithiasis, infections, abscess, or perforation which can cause aerobilia and hemobilia, exacerbating hemorrhagic cholecystitis.

The postoperative period of biliary tract surgeries during jaundice-related blockage often presents temporary increases in creatinine levels and oliguria. The decrease in renal function and plasma flow in the postoperative period still has unknown etiologies, but hypovolemia, thrombocytopenia, bacteremia, pancreatitis, or hyperbilirubinemia may contribute to renal function impairment in patients under this condition.

Bacteremia is one of the causes cited for acute renal failure. In the study by Burden (1975), 14 patients with acute cholecystitis were analyzed, of whom six developed reversible acute renal failure. It is noteworthy that only one of the six patients was dehydrated. The study concluded that intravascular coagulation resulting from the infection was the cause of the acute renal failure.

Abdominal bacterial infections, particularly, substantially elevate the risk of acute renal failure when compared to infections originating in other anatomical sites. This heightened risk is attributed to the complex pathophysiological processes associated with abdominal infections.

Infections and sepsis are strongly correlated with both acute kidney injury and acute renal failure. The mechanisms underlying these conditions include the loss of fluid into the third space as a result of inflammatory responses. This fluid sequestration contributes to significant hemodynamic changes, including vasodilation and decreased effective circulating blood volume. These changes lead to hypoperfusion of the renal tubules, which in turn reduces the glomerular filtration rate. Prolonged hypoperfusion and subsequent ischemia result in cellular injury and necrosis within the renal parenchyma.

Consequently, these pathological processes collectively impair renal function and contribute to the development of acute renal failure.

Nowadays, laparoscopic cholecystectomies are commonly performed, typically involving the creation of a pneumoperitoneum with intra-abdominal pressures ranging between 12 and 15 mmHg. An increase in intra-abdominal pressure results in a reduction in venous return, which decreases renal perfusion and subsequently activates both the sympathetic nervous system and the renin-angiotensin-aldosterone system. The study by Allaria (2007) demonstrated that elevated intra-abdominal pressure during laparoscopic pneumoperitoneum is one of the factors associated with acute kidney injury. This study also observed congestion of the extra-glomerular capillaries, which supports this hypothesis.

Another factor that can be considered a predictor of acute kidney injury in the postoperative period of hemorrhagic cholecystitis is the anesthetic management during the surgical procedure. Although there is no specific evidence indicating that any particular anesthetic technique is more favorable for the progression of acute kidney injury, factors such as sustained hypotension, hypovolemic shock, and the volume of fluids administered during surgery may serve as predictors for renal impairment.

Hemorrhagic cholecystitis presents with severe conditions and high mortality rates, making prompt diagnosis and surgical intervention crucial. In addition to timely indication and effective surgical treatment, it is essential to provide comprehensive patient care during hospitalization in the ICU and on the wards with a multidisciplinary team to prevent complications such as acute kidney injury or to address them appropriately if they occur [1-8].

Bibliography

1. LÓPEZ Víctor. “Hemorrhagic Cholecystitis”. Radiology 2 (2018): 316-316.
2. Burden RP., et al. “Acute reversible renal failure in patients with acute cholecystitis and cholangitis”. Quarterly Journal of Medicine 173 (1975): 65-77.
3. Dönder Y and Karagöz Eren S. “Should the severity of acute cholecystitis (Tokyo 2018 guideline) affect the decision of early or delayed cholecystectomy?” Ulus Travma Acil Cerrahi Derg9 (2022): 1305-1311.
4. Liu , et al. “Rates, predictors, and mortality ofsepsis-associated acute kidney injury: a systematic review and meta-analysis”. BMC Nephrology 21.1 (2020).
5. Peerapornratana S., et al. “Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment”. Kidney International (2019).
6. Giger , et al. “Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery database”. Journal of the American College of Surgeons 203.5 (2006): 723-728.
7. Allaria , et al. “L'insufficianza renale acuta postchirurgia laparoscopica: evitabile complicanza? [Acute renal failure after videolaparoscopic surgery: an avoidable complication?]”. Giornale Italiano di Nefrologia 24.38 (2007): 72-75.
8. Boyer , et al. “Postoperative Acute Kidney Injury”. Clinical Journal of the American Society of Nephrologyl 17.10 (2022): 1535-1545.

Copyright: © 2024 Robson Uwagoya.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.