Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis

Shuman, W P; Rogers, J V; Rudd, Thomas G.; Mack, L A; Plumley, T F; Larson, E. B.

doi:10.2214/ajr.142.3.531

Cited by 105 publications

(35 citation statements)

References 35 publications

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“…4,9 It would seem, therefore, that despite the increasing sophistication of biliary tract investigation, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical in the presence of typical symptoms and relies on the exclusion of other upper abdomen pathology. Nevertheless, a satisfactory outcome following cholecystectomy has been reported in 80% to 90% of patients with symptoms similar to those in cholelithiasis, 5,9,10 irrespective of the diagnostic methods used to select patients for surgery, and findings in the present series agree with such results.…”

Section: Discussionsupporting

confidence: 87%

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Chronic Acalculous Cholecystitis

1988

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Chronic acalculous cholecystitis is a controversial disorder, and surgeons are reluctant to perform cholecystectomy in the absence of clear evidence of biliary calculi. This report describes the clinical picture, investigations, and results of cholecystectomy in 20 patients diagnosed as having chronic acalculous cholecystitis. All the patients had right upper quadrant pain, highly suggestive of gallbladder origin. In six patients ultrasonography and cholecystography were completely normal, two patients showed evidence of "biliary sludge" in the gallbladder, and in the remaining 12 patients, the sole abnormality was ultrasonographic demonstration of a thickened gallbladder wall. At assessment 1 year after cholecystectomy, 17 patients were completely relieved of symptoms, two were improved, and only one patient failed to benefit. Despite the increasing sophistication of biliary tract investigative methods, the diagnosis of chronic acalculous cholecystitis remains predominantly clinical. In the presence of typical symptoms, and with exclusion of other upper abdominal pathology, cholecystectomy successfully relieves the majority of symptoms.

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Section: Discussionsupporting

confidence: 87%

“…5,7,[10][11][12] The female-to-male ratio is lower and the mean age is higher in acute acalculous cholecystitis than the more common chronic calculous form. 4 The diagnosis of chronic acalculous cholecystitis, although suspected clinically, can seldom be confirmed precisely by routine radiologic and laboratory studies.…”

Section: Discussionmentioning

confidence: 99%

Chronic Acalculous Cholecystitis

1988

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“…and US or/and CT examinations were carried out immediately. Although the comparatively low diagnostic accuracy of imaging examinations by US or CT has been reported by some investigators [18,19], in this study, these examinations, indicating enlargement and wall thickening of the gallbladder, or edema around it were extremely benficial for the diagnosis of both AAC and APC. as seen in other reports [6, 20.…”

Section: Discussioncontrasting

confidence: 62%

Ultrasound-Guided Percutaneous Transhepatic Cholecystic Puncture and Suction for Acute Acalculous or Postoperative Cholecystitis

Kinami¹,

Hagihara²,

Kita³

et al. 1992

Dig Surg

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As a nonsurgical treatment for acute acalculous or postoperative cholecystitis, ultrasound-guided percutaneous transhepatic cholecystic puncture and suction (PTCPS) has been performed in 24 patients with these diseases over the past 5 years. Cholecystic puncture and suction of the gallbladder contents were performed, followed by cholecystography. An antibiotic was infused into the gallbladder before removal of the puncturing needle. Eight patients received this treatment 2 or 3 times. Among the patients in whom a favorable effect was obtained, 19 were cured of acute cholecystitis by this treatment alone, and 1 recovered from this disease due to the addition of percutaneous cholecystostomy. Of 4 patients in whom there was no effect, 2 were treated with percutaneous cholecystostomy, and 2 underwent cholecystectomy. For all patients exhibiting a positive effect clinical symptoms disappeared, and laboratory data improved. These results suggest that PTCPS may be the procedure of first choice, for this treatment revealed the least invasiveness as a therapeutic means for acute acalculous or postoperative cholecystitis, in addition to its high rate of curing the diseases.

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“…Of these factors, bile stasis has been shown to be of particular importance and it can occur secondary to fasting, obstruction, surgery and ileus leading to bile thickening next to dehydration causing toxic effects to the gallbladder epithelium [10,18].…”

Section: Discussionmentioning

confidence: 99%

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

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Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis

Cited by 105 publications

References 35 publications

Chronic Acalculous Cholecystitis

Chronic Acalculous Cholecystitis

Ultrasound-Guided Percutaneous Transhepatic Cholecystic Puncture and Suction for Acute Acalculous or Postoperative Cholecystitis

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

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