Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

Chawla, Ashish; Bosco, Jerome Irai Ezhil; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish

doi:10.11622/smedj.2015120

Cited by 54 publications

(28 citation statements)

References 23 publications

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“…-specific signs including gallstones (single or multiple) and sonographic Murhpy sign (maximal tenderness from ultrasound probe pressure over the GB) -aspecific signs including wall thickening ≥ 3 mm, gallstone dimensions >3 mm, GB distension, presence of pericholecystic fluid (10,11).…”

Section: Ultrasound Featuresmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

et al. 2020

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Background: Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder (GB) pathologies. We evaluated clinical, ultrasonographic (US) data as well as histopathological findings in children affected with symptomatic cholecystic disease (SCD) who underwent LC, with the aim of defining surgical timing. Methods: We reviewed our cases who underwent elective LC (ELC) or urgent LC (ULC). Clinical, US, surgical and histological features were used to create different risk scores. Results: We considered 26 children (17 ELC/9 ULC). US signs were not different in the two groups (p > 0.05). Operating times were longer in ELC than in ULC (p = 0.01). Histopathological evaluation revealed fibrosis and atrophy in both ELC and ULC. The clinical risk score was higher in ELC compared to ULC (p < 0.001). An increased operative risk score was noted in patients with systemic inflammatory signs (OR1.98), lithotherapy (OR1.4.3) and wall thickening ≥3 mm (OR2.6). An increased histopathological risk score was detected in children with symptom duration >7 days (OR3.61), concomitant hematological disease (OR1.23) and lithotherapy (OR3.61). Conclusion: Criteria adopted in adults cannot be adopted to detect the severity of GB damage in children. A dedicated clinical and US score is mandatory to define the most appropriate surgical timing.

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Section: Ultrasound Featuresmentioning

confidence: 99%

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

et al. 2020

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“…The remainder can present with anything from biliary colic, cholecystitis, cholangitis, choledocholithiasis (i.e., common bile duct [CBD] stones) and gallstone pancreatitis (7-11), to rarer severe variants such as Mirizzi's syndrome, gangrenous, haemorrhagic, or emphysematous cholecystitis. The latter group tend to have non-specific clinical, serological and radiological findings which can make diagnosis difficult (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

et al. 2020

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Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

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“…Gangrenous cholecystitis is one of the complications of acute cholecystitis, which is associated with higher morbidity and mortality rates compared to non-gangrenous cholecystitis [8,9]. Previous studies have described various CT findings that can predict gangrenous cholecystitis, but no single finding is specific for diagnosing this entity [4,5,[10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis

et al. 2020

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Purpose: The objective of our study was to evaluate the combined hyperdense gallbladder wall-lumen sign on computed tomography (CT) in diagnosing gangrenous cholecystitis. Material and methods: We retrospectively reviewed the unenhanced CT scans of surgically proven cases of acute gangrenous (GCh) and non-gangrenous cholecystitis (nonGCh). Eleven cases of pathologically proven acute gangrenous cholecystitis and 12 consecutive cases of surgically proven acute non-gangrenous cholecystitis that underwent CT at our institute were included in the study so as to have 1 : 1 control. The Hounsfield unit (HU) value of the gallbladder wall and intraluminal bile was measured. Interobserver variability for individual CT findings was also assessed. Results: The gangrenous cholecystitis group had significantly higher HU values of wall and bile (median value of 33 HU vs. 21 HU and median value of 21 HU vs. 8.5 HU, respectively, p < 0.05). The area under the receiver operator characteristic curve for HU lumen was 0.80 (95% CI: 0.62-0.98, p = 0.014) with an ideal cutoff at 31.5 HU, where the sensitivity was 54.5% and specificity was 91.7%. HU lumen has an even better assessment for gangrenous cholecystitis with AUC of its ROC as 0.92 (95% CI: 0.80-1.00, p = 0.001) with an ideal cutoff at 12.5 HU, where the sensitivity was 81.8% and specificity was 91.7%. The combined wall-lumen cutoff is 35 HU with sensitivity of 100% and specificity of 75%. Conclusion: A cutoff CT density value of the gallbladder wall of more than 31.5 HU, intraluminal bile more than 12.5 HU, and combined wall-lumen HU of more than 35 can predict GCh.

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Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

Cited by 54 publications

References 23 publications

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

Combined hyperdense gallbladder wall-lumen sign: new computed tomography sign in acute gangrenous cholecystitis

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