Early recognition and management of gangrenous cholecystitis: a single-center experience and a comprehensive review of risk factors and imaging findings

Abstract

Background: Annually, approximately 200,000 acute cholecystitis (AC) cases are diagnosed in the U.S., with gangrenous cholecystitis (GC) occurring in 2-20% of AC cases. GC, characterized by ischemic necrosis of the gallbladder, is often associated with delayed diagnosis, leading to increased complications, longer hospital stays, and mortality rates ranging from 15-50%. This study presents a series of GC cases treated at our institution. Methods: A retrospective review was conducted at a community hospital on patients from October 2012 to December 2022 with GC confirmed by pathology. Data collected included demographics, clinical parameters, lab values, imaging, operative findings, management, and outcomes, aiming to identify risk factors, treatment approaches, and associated outcomes. Results: Out of 5,746 cholecystectomy patients, 67 (1.16%) had GC. The average age was 56, with a male predominance (64%). Incidence was highest among Hispanic (37%) and Asian (28%) populations. Common comorbidities included hypertension (48%), obesity (36%), and diabetes (33%). Clinical presentations included right upper quadrant pain (64%) and epigastric pain (46%). Computed tomography (CT) findings showed gallbladder distention (43%), fat stranding (22%), and perforation (3%). Surgical approaches were laparoscopic cholecystectomy (75%), converted-to-open cholecystectomy (19%), and open cholecystectomy (3%). Complications included bile leak (7%), wound infection (4%), hematoma (3%), and wound dehiscence (1%), with a 1.4% mortality rate. Conclusions: GC is a severe AC complication linked to delayed presentation, with higher complication and mortality rates. Recognizing risk factors such as age, gender, and imaging/laboratory findings can facilitate early diagnosis and timely surgical intervention, improving patient outcomes.