CT Findings in Acute Gangrenous Cholecystitis

Bennett, Genevieve L.; Rusinek, Henry; Lisi, Virna; Israel, Gary M.; Krinsky, Glenn A.; Slywotzky, Chrystia M.; Megibow, Alec J.

doi:10.2214/ajr.178.2.1780275

Cited by 189 publications

(130 citation statements)

References 21 publications

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“…Presence of wall or lumen gas, irregular wall, lack of mural enhancement, intra-luminal membranes and pericholecystic fluid are findings suggestive of this condition. A superior degree of wall thickening and gallbladder distension may be the only result and is not specific [4]. Several studies have reported some differences concerning GC and NGAC, despite they are not consistent.…”

Section: Discussionmentioning

confidence: 92%

“…Gangrenous cholecystitis is considered a more severe form of acute cholecystitis. The incidence of gangrenous cholecystitis ranges from 2% to 29.6% in all patients with acute cholecystitis [4] and constitutes is a medical and surgical emergency.…”

Section: Discussionmentioning

confidence: 99%

“…Vascular compromise secondary to epithelial injury due to sustained obstruction of the cystic duct is also a critical mechanism. Additionally, due to epithelial injury, phospholipases are released and degrade adjacent cell membranes generating an important inflammatory reaction [4] [5]. Progression to gangrenous cholecystitis may take days to hours [6]- [8].…”

Section: Introductionmentioning

confidence: 99%

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Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman

Clérigo¹,

Rocha²,

Rodrigues³

et al. 2014

CRCM

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In elderly patients, numerous factors subsidize the diagnostic challenge and high incidence of complications in this specific population, taking gangrenous cholecystitis as a critical example. The aim of this work is to report an unusual case of gangrenous choleystitis in an elderly diabetic women and its atypical clinical presentation. A 79-year-old female patient came to our observation; her medical history showed nausea and vomiting of about 2 hours which rapidly ended with symptomatic therapy, without recurrence, and a 3-week history of intermittent fever associated with productive cough. No abdominal discomfort was declared. Physical examination of the abdomen was negative. Laboratory analysis revealed leukocytosis with the remaining criteria within the normal range. After 2 days, she started with a mildabdominal pain in the epigastric region that rapidly progressed to the right upper quadrant, right flank and right iliac fossa, without nausea, vomiting or fever. Abdominal computer tomography findings revealed thickness of the gall-bladder and important densification of the vascular bed. Acute cholecystitis was diagnosed. The patient was then submitted to a laparoscopic cholecystectomy under general anaesthesia with findings suggestive of gangrenous acute cholecystitis confirmed by histologic examination of the specimen. Delays in diagnosing acute cholecystitis in specific populations, such as elderly diabetics, result in a higher prevalence of morbidity and mortality due to potentially serious complications as gangrenous cholecystitis. Consequently, the diagnosis should be measured and investigated promptly in order to prevent poor outcomes.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman

Clérigo¹,

Rocha²,

Rodrigues³

et al. 2014

CRCM

View full text Add to dashboard Cite

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“…Gangrenous cholecystitis occurs in up to 30-35% of patientswith cholecystitis. 5 This occurs because the inflammation causes interruption of blood flow to the gallbladder which results in gangrenous changes. The mortality rate was reported to be up to 22% in these patients, and it is directly related to other severe complications, such as gallbladder perforation, abscess formation, peritonitis, etc.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, marked contrasts in the morbidity and mortality rates have been observed between patients with simple cholecystitis and severe cholecystitis. 3,6 Therefore, accurate detection and proper management of patients who are at risk of developing severe cholecystitis is very much essential in preventing associated complications.…”

mentioning

confidence: 99%

Neutrophil to lymphocyte ratio in diagnosing acute cholecystitis: a retrospective cohort study in a tertiary rural hospital

Hareen¹,

Bhaskaran²,

Jaswanthi³

2016

Int Surg J

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Background:Acute cholecystitis accounts for most of the hospital admissions related to gastrointestinal diseases. In approximately 90% of patients, inflammation develops due to obstruction of the cystic duct by one or more gall-tones. Delayed management can lead to increased morbidity, due to progression to severe cholecystitis, such as gangrenous change, abscess formation, and gallbladder perforation. The neutrophil to lymphocyte ratio is derived from the counts of circulating neutrophils and lymphocytes, both of which are major leukocyte subpopulations. The inflammation triggered release of arachidonic acid metabolites and platelet-activating factors results in neutrophilia, and cortisol induced stress results in relative lymphopenia, and thus, the neutrophil to lymphocyte ratio accurately represents the underlying inflammatory process. The objective of this study was to evaluate the utility of the neutrophil to lymphocyte ratio (NLR) as a prognostic indicator in patients with cholecystitis. And to identify a relevant NLR value that discriminates between simple and severe cholecystitis.Methods: A retrospective analysis of patient data compiled by assessment of operative findings documented and patient follow up recorded over the period encompassing three years (2015-2012) at RL Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India.Results:Our study population comprised of 250 patients with simple cholecystitis (69.63%) and 109 patients with severe cholecystitis (30.36%). The NLR of 3.0 could predict severe cholecystitis with 70.5% sensitivity and 70.0% specificity. A higher NLR (≥3.0) was significantly associated with older age (p = 0.001), male gender (p = 0.001), admission via the emergency department (p <0.001), longer operation time (p <0.001), higher incidence of postoperative complications (p = 0.056), and prolonged length of hospital stay (LOS) (p <0.001).Conclusions:NLR ≥3.0 was significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.

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