Significance of Wall Thickness in Symptomatic Gallbladder Disease

Abstract

One hundred cases of patients who underwent urgent cholecystectomy after presenting with symptoms of acute or subacute gallbladder disease were retrospectively reviewed. Sixty patients had pathologically proved acute cholecystitis, and 40 had chronic cholecystitis alone. One patient had an incidental gallbladder carcinoma, and four had global gangrene of the gallbladder. Focal ischemia, transmural hemorrhage, or focal necrosis (indicating more severe disease) was present in 19 patients. Fifty-four percent of patients had thin-walled gallbladders. Among patients with more severe acute disease, 56% had thin walls. Conversely, 24% of thin-walled gallbladders and 22% of thick-walled gallbladders had evidence of focal necrosis or gangrene. We conclude that gallbladder wall thickness, although demonstrable on preoperative ultrasound examination in all patients, does not correlate directly with severity of disease or pathologic findings.

Gangrenous Cholecystitis in the Laparoscopic Era

“…The relationship between gall bladder wall thickness and degree of inflammation remains a controversial issue. 13 Even though there was a statistical increase in gall bladder wall thickness for AC and GC, there are significant overlaps between the three groups, as indicated by 10 patients in the GC group with wall thickness of 3 mm or less. Sariego et al found that 56% of patients with GC had thin‐walled gall bladders (< 3 mm) and 24% of patients with thin‐walled gall bladders had severe gall bladder disease.…”

“…Sariego et al found that 56% of patients with GC had thin‐walled gall bladders (< 3 mm) and 24% of patients with thin‐walled gall bladders had severe gall bladder disease. 13 They concluded that preoperative US correlates well with pathological measurement of gall bladder wall thickness, but gall bladder wall thickness did not correlate with severity of disease.…”

“…Sonographic evidence of gangrenous cholecystitis includes the presence of intramural echoes that do not layer or shadow, intramural gas, irregular wall thickness, intraluminal sloughed membranes and the absence of sonographic Murphy’s sign. 13,14 …”

The Yield of Fever, Inflammatory Markers and Ultrasound in the Diagnosis of Acute Cholecystitis: A Validation of the 2013 Tokyo Guidelines

“…When we applied the 5-mm cut-off as per TG 2013 no statistical significant difference was found (p = 0.418). In literature, hyperaemia is proposed to be the distinguishing feature in thickened gallbladder walls between acute inflammation and secondary thickening due to other causes, including chronic cholecystitis [16][17][18]; but this feature is not included in the TG 2013. The feature of probe tenderness (US Murphy's sign) has been recommended [7,[16][17][18]], but we found it to be absolutely unhelpful (p [ 0.999) as has been reported as well in the literature [13][14][15].…”

Prevalência e fatores associados à bacteremia nos portadores de colecistite aguda litiásica

“…O diagnóstico de colecistite aguda litiásica foi baseado nos dados obtidos da história clínica, do exame físico, de exames laboratoriais e ultrasonografia abdominal. O exame considerado padrão de referência para este diagnóstico foi o histopatológico, que mostrou a presença de infiltrado polimorfonuclear e/ou achados de necrose, edema e hemorragia de uma das camadas da parede da vesícula biliar 19,20 .…”