Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography

McGillicuddy, Edward A.; Schuster, Kevin M.; Brown, Elliott; Maxfield, Mark W.; Davis, Kimberly A.; Longo, Walter E.

doi:10.1016/j.amjsurg.2011.06.012

Cited by 23 publications

(9 citation statements)

References 7 publications

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“…Vomiting has been reported in 38–48% of elderly patients in two studies [16, 18]. Abdominal tenderness or guarding was reported in 64.7% of patients over 65 years old in one study [17, 19], while signs of peritonitis have been reported in 5.3–14.5% of elderly patients [17, 19].…”

Section: Resultsmentioning

confidence: 99%

“…Another study reported a sensitivity of 0.48, specificity of 0.79, and a positive predictive value of 0.58 for Murphy’s sign in the diagnosis of acute cholecystitis in the elderly [20]. Fever has been reported in 36–74% of patients with ACC (8–10), but only 6.4% to 10% of patients with ACC had a temperature > 38 °C [18, 19]. Clinical features including pain, fever, abdominal defense, and vomiting have been compared in different age decades within elderly patients without finding any difference in old and very old patients [17, 18].…”

Section: Resultsmentioning

confidence: 99%

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2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

et al. 2019

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Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

et al. 2019

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“…ERCP may show a larger CBD diameter due to increased pressures caused by the contrast medium injection in the CBD ( 28 , 29 ). CT measurements may be slightly larger (by 1.7 mm) than the US measurements because CT measurements are performed outer wall-outer wall, while US measurements are performed inner wall-inner wall ( 30 , 31 ). Most of the techniques (such as US and CT) cannot image the cystic duct because it is too small, so special care must be taken not to include the cystic duct in the CBD measurement ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Bile duct diameter changes after laparoscopic cholecystectomy: a magnetic resonance cholangiopancreatography prospective study

Pavlović¹,

Trtica²,

Perić³

2020

Croat Med J

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“…The appropriate management of acute cholecystitis hinges on timely diagnosis. Without timely diagnosis and management, the risk for potential complications, including sepsis, peritonitis, cholecystoenteric fistulae, and death is substantially increased [2]. Thus the frequency of acute cholecystitis and the risk for serious morbidity and/or mortality mandate the need for efficient and functional diagnostic imaging tools.…”

Section: Introductionmentioning

confidence: 99%

Development of a Novel CT Tool to Identify Cholecystitis

Dissanaike¹

2013

J. Radiol. Diagn. Imag.

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Background: Cholecystitis is a frequent surgical problem presenting via the emergency department. While clinical signs and symptoms are suggestive of cholecystitis, imaging is usually used as a diagnostic adjunct. Ultrasound (US) has been the modality of choice for evaluating the gallbladder; however the use of computed tomography (CT) has been increasing, particularly in emergency departments (ER). Unfortunately, there is limited data elucidating which CT findings identify cholecystitis. This study sought to identify specific CT findings that were easily identified even by nonexperts to aid in developing a checklist instrument to accurately diagnose acute cholecystitis using CT. Methods: We utilized CT scans of patients admitted through the ER who underwent CT scan as well as US and surgical cholecystectomy during the same admission from June 2010-December 2011. Data recorded included details from imaging and pathology reports. Based on previous literature, we created a 23 point checklist of CT findings in acute cholecystitis. A surgeon, blinded to all patient data, used this checklist in yes/no fashion to interpret the CT scans for diagnosis of cholecystitis. Using the diagnosis of cholecystitis by pathology as gold standard, sensitivities for checklistassisted CT, standard read CT and US, and individual imaging findings on CT scans were calculated. Results: Ninety-two patients were included in the study. When evaluating both acute and chronic cholecystitis, the sensitivity for US was 32.9%; the standard CT was 27.0% and checklist-assisted CT was 60.7%. When evaluating only acute cholecystitis, sensitivities were 47.1% for US, 42.9% for standard CT and 76.2% for checklist-assisted CT. Most sensitive findings on the checklist included presence of gallbladder distention (46.1%) sub-serosal halo/wall edema (38.2%), gallstones (37.1%), sludge (37.1%) and irregular/absent wall (32.6%). Conclusion: The use of a checklist improved detection of acute and chronic cholecystitis, even when used by a nonexpert, suggesting that this is a useful tool in evaluation of the disease.

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Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography

Cited by 23 publications

References 7 publications

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

Bile duct diameter changes after laparoscopic cholecystectomy: a magnetic resonance cholangiopancreatography prospective study

Development of a Novel CT Tool to Identify Cholecystitis

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