Incidence and factor for acute acalculous cholecystitis during prolonged gastrointestinal disuse in external duodenal fistula

To investigate the incidence, risk factors, and outcomes of acute acalculous cholecystitis (AAC) following prolonged gastrointestinal disuse due to external duodenal fistula. This retrospective cohort study included adult patients with external duodenal fistula who experienced gastrointestinal tract disuse from January 2018 to January 2024. Patients were monitored until discharge or death. The primary outcome was the occurrence of AAC, while secondary outcomes included its treatment and prognosis. Of the enrolled 133 patients, 59 (44.4%) were diagnosed with AAC. The majority (79.7%) of AAC cases occurred during the reintroduction of enteral nutrition (EN). High SOFA score upon admission (Odds Ratio [OR] = 1.59, 95% Confidence Interval [CI]: 1.13-2.70, p = 0.005) and the vasopressor use upon admission (OR = 4.53, 95% CI: 1.09-19.22, p = 0.04) were associated with increased risk of AAC before EN reintroduction. For AAC occurring after EN reintroduction, the duration of intestinal disuse (OR = 1.06, 95% CI: 1.00-1.13, p = 0.04) was the sole risk factor. The incidence of AAC is notably high in patients undergoing prolonged gastrointestinal tract disuse, particularly after the reintroduction of Enteral Nutrition (EN) in patients with external duodenal fistula.