Acute chest syndrome shows a predilection for basal lung regions on the side of upper abdominal surgery

Abstract

Purpose: Upper abdominal surgery for cholecystectomy or splenectomy is the most frequently performed surgical procedure in patients with sickle cell disease (SCD). The acute chest syndrome (ACS) is the most common sickle-related postoperative complication. The objective of the study was to characterize the clinical and radiological presentation of ACS complicating cholecystectomy and splenectomy.

Methods: The medical records of all children with SCD undergoing cholecystectomy or splenectomy during the 15-year period from January 1988 through December 2002 were reviewed. Patients who experienced ACS within 14 days after surgery were identified. Data collected included demographics, perioperative management, clinical and radiological findings, and outcome.

Results: The overall incidence of postoperative ACS was 16%, occurring in nine of 51 patients having cholecystectomy and in seven of 48 patients having splenectomy. Mean time to onset of symptoms was 49 hr after surgery (range, 24-96 hr). Cough, fever, and an abnormal chest examination were documented for all patients at presentation. Radiologically, ACS involved the basal lobes in all cases and was multi-lobar in 25%. Patients were more likely to have new infiltrates involving the lung on the side of the surgery or bilateral infiltrates than isolated contralateral infiltrates at presentation (P < 0.0001). Isolated upper or middle lobe involvement did not occur. Fifty percent of cases demonstrated evidence of a pleural effusion.

Conclusion: ACS complicating cholecystectomy or splenectomy shows a predilection for basal lung regions and for the lung on the side of surgery. These results have implications for the pathogenesis and prevention of postoperative ACS.