Evaluation of the CT Scan as the First Examination for the Diagnosis and Therapeutic Strategy for Acute Cholecystitis

Abstract

Background The CT scan has supplanted the abdominal ultrasound for emergency examinations. A comparison of CT scan and ultrasound performance for the diagnosis and management of acute cholecystitis in acute care was proposed. The hypothesis is that the CT scan may be sufficient for the diagnosis of acute cholecystitis, which would allow faster progress to surgery. Methods The retrospective study of consecutive patients operated for acute cholecystitis or gallbladder distension with pre‐operative imaging within 48 h in one centre. Results Between 2015 and 2017, a total of 341 cholecystectomies were performed in our centre. The analysis involved 120 patients. Ultrasound had better sensitivity than the CT scan, respectively, 79.4% [70.5–86.6] and 52.3% [42.5–62.1], but less specificity, with 61.5% [31.6–86.1] and 92.3% [64.0–99.8], respectively. However, there was a significant difference in favour of the CT scan for the diagnosis of complicated cholecystitis (p 0.004). The positive likelihood ratio of complicated cholecystitis is better at CT scan (7.8) [2.7–23.1] than in ultrasound (1.0) [0.1–9.7]. CT scan and ultrasound are equivalent for the diagnosis of acute cholecystitis, but CT scan is more efficient for the diagnosis of complicated cases (Youden index J 0.3 vs 0.001). Conclusion It is possible to place the surgical indication of cholecystectomy on the only data of the CT scan. We propose a decision‐making algorithm that uses the CT scan to make the diagnosis and decide on emergency treatment for complicated cases or that allows us to propose a delayed surgery for simple cholecystitis.

Acute acalculous cholecystitis as a rare cause of gastric outlet obstruction

“…In addition, he lacked the usual risk factors for acalculous cholecystitis. In our patient's case, a diagnosis of acute cholecystitis was made via CT and supplemented by ultrasonography, however it is worthwhile noting that ultrasonography is a more sensitive imaging modality and changes of cholecystitis may not be apparent on CT. 5 Abdominal ultrasound should therefore be considered in patients with GOO where a cause is not demonstrable on CT or endoscopy.…”

Сучасні Візуалізаційні Технології У Діагностиці Первинних Інтраабдомінальних Ускладнень У Хворих

“…Встановлено позитивну інформацію стосовно ускладненого холециститу, показники якого кращі при КТ, ніж при УЗД (відношення правдоподібності (li�eli�ood ratio) 7,8 та 1,0 відповідно). КТ та УЗД еквівалентні для діагностики гострого холециститу, але КТ більш ефективне для діагностики складних та ускладнених випадків (індекс Юдена (Yo�den index) 0,3 та 0,001 відповідно) [23].…”

Measurement of cystic artery diameter by computed tomography in the diagnosis of acute cholecystitis

“…AC refers to inflammation of the gallbladder and can result from cystic duct obstruction (2), bacterial infection, and chemical stimulation (3). The most common cause is gallstones, accounting for 90-95% of all cases (4,5). Clinical, laboratory, and radiologic findings are used in the diagnosis of AC (6).…”