Colecistitis enfisematosa: control quirúrgico del foco, anestesia y cuidado crítico
Palabras clave:
Colecistitis. Colecistitis aguda. Colecistectomía. Colecistostomía. Sepsis. Cuidados críticos. AnestesiaResumen
DOI: https://doi.org/10.46296/gt.v9i18.0406
Resumen
Introducción: La colecistitis enfisematosa fue una variante infrecuente y rápidamente progresiva de la colecistitis aguda, caracterizada por gas en la pared o la luz vesicular y asociada con necrosis, perforación, sepsis y mortalidad elevada. Objetivo: Mapear la evidencia disponible sobre el manejo multidisciplinario de la colecistitis enfisematosa en adultos, con énfasis en control quirúrgico del foco, evaluación anestésica y soporte en cuidado crítico. Metodología: Se diseñó una revisión de alcance con marco población, concepto y contexto, búsqueda bibliográfica estructurada y síntesis narrativa por dominios clínicos. Resultados: La evidencia estuvo compuesta principalmente por guías de colecistitis aguda, series retrospectivas, estudios de drenaje vesicular y reportes de caso. La tomografía computarizada fue el método más útil para confirmar gas intramural o perivesicular y detectar perforación, absceso o neumoperitoneo. La colecistectomía temprana fue el control de foco definitivo cuando la reserva fisiológica y el riesgo anestésico lo permitieron. En pacientes con choque, falla orgánica o contraindicación anestésica, la colecistostomía percutánea apareció como estrategia puente o de rescate. Discusión: La decisión terapéutica dependió de la interacción entre gravedad local, sepsis sistémica, comorbilidad, tolerancia anestésica y disponibilidad de cirugía o drenaje. Conclusiones: Se propuso un algoritmo integrado para priorizar diagnóstico por imagen, reanimación, antibióticos y control de foco temprano.
Palabras claves: Colecistitis. Colecistitis aguda. Colecistectomía. Colecistostomía. Sepsis. Cuidados críticos. Anestesia.
Abstract
Introduction: Emphysematous cholecystitis was an uncommon and rapidly progressive variant of acute cholecystitis, characterized by gas in the gallbladder wall or lumen and associated with necrosis, perforation, sepsis and high mortality. Objective: To map the available evidence on multidisciplinary management of emphysematous cholecystitis in adults, emphasizing surgical source control, anesthetic assessment and critical care support. Methods: A scoping review was designed using the population, concept and context framework, a structured bibliographic search and narrative synthesis by clinical domains. Results: The evidence consisted mainly of acute cholecystitis guidelines, retrospective series, gallbladder drainage studies and case reports. Computed tomography was the most useful method to confirm intramural or perivesicular gas and to detect perforation, abscess or pneumoperitoneum. Early cholecystectomy was the definitive source control strategy when physiologic reserve and anesthetic risk allowed it. In patients with shock, organ failure or anesthetic contraindication, percutaneous cholecystostomy emerged as a bridge or rescue strategy. Discussion: Therapeutic decisions depended on the interaction among local severity, systemic sepsis, comorbidity, anesthetic tolerance and availability of surgery or drainage. Conclusions: An integrated algorithm was proposed to prioritize imaging diagnosis, resuscitation, antibiotics and early source control.
Keywords: Cholecystitis. Cholecystitis, Acute. Cholecystectomy. Cholecystostomy. Sepsis. Critical Care. Anesthesia.
Información del manuscrito:
Fecha de recepción: 14 de julio de 2026.
Fecha de aceptación: 10 de septiembre de 2026.
Fecha de publicación: 28 de octubre de 2026.
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