Predicting gangrenous cholecystitis

Abstract

Using models can improve a diagnosis of GC pre-operatively. A prediction of GC pre-operatively may allow surgeons to be better prepared for a difficult operation.

Sonographic Diagnosis of Complicated Cholecystitis

“…In this study, only 10% of patients with complicated cholecystitis had a correct diagnosis by sonography before surgery. This low detection rate concurs with the 9% rate recently reported by Wu et al 13 However, early diagnosis may substantially influence management. Nowadays, laparoscopic cholecystectomy is considered the standard of care in cases of acute calculus cholecystitis 14 – 16 .…”

“…Findings of intraluminal or intramural gas imply emphysematous cholecystitis. Nevertheless, identification of these entities is challenging, and only a minority of patients with complicated cholecystitis have a correct diagnosis before surgery 11 – 13 . From a radiologic perspective, underdiagnoses may partly result from the fact that some specific sonographic signs, such as intraluminal membranes, do not appear in all cases 4 .…”

Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis

“…Meanwhile, the disease course progresses to gallbladder wall necrosis or gangrenous cholecystitis in approximately 2–30% of patients . The etiology of gangrenous cholecystitis is primarily thought to be vascular compromise secondary to sustained obstruction of the cystic duct .…”

C-reactive protein has a better discriminative power than white cell count in the diagnosis of acute cholecystitis

“…The diagnosis of AC based on right upper quadrant pain and tenderness, fever, Guidelines (TG07, TG13) and added to existing diagnostic criteria of AC ( Murphy's sign, right upper quadrant mass/pain/tenderness, fever, elevated white cell count , liver ultrasound , magnetic resonance imaging, computed tomography and Tc-HIDA scan) Creactive protein (CRP) (5,6). CRP is not used as a diagnostic bench mark for AC in the United States, Canada, Europe, India, Australia and New Zealand CRP (7)(8)(9)(10)(11). In this setting, reliance on an elevated WCC as a criterion of AC would misdiagnose this condition in neutropenic patients.…”