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Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

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Abstract

Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

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Conflict of interest

Fabio Piscaglia has received speaker or advisory board fees or research support from Bracco, Esaote, Siemens, General Electric in the last three years. No other financial support was received from the industry from other authors.

Statement of human and animal rights

The study protocol was in keeping with the latest Helsinki declaration and was communicated to the Institutional Review Board of the hospital.

Informed consent

Informed consent was obtained whenever patients were still reachable, otherwise it was accepted to have it waived, given the retrospective approach of the study.

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Authors and Affiliations

  1. Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy

    Elisabetta Sagrini, Anna Pecorelli, Irene Pettinari, Federico Stefanini, Luigi Bolondi & Fabio Piscaglia

  2. Liver and Multiorgan Transplant Unit, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy

    Alessandro Cucchetti

Authors
  1. Elisabetta Sagrini
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  2. Anna Pecorelli
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  3. Irene Pettinari
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  4. Alessandro Cucchetti
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  5. Federico Stefanini
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  6. Luigi Bolondi
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  7. Fabio Piscaglia
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Correspondence to Elisabetta Sagrini.

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Sagrini, E., Pecorelli, A., Pettinari, I. et al. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis. Intern Emerg Med 11, 19–30 (2016). https://doi.org/10.1007/s11739-015-1263-z

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  • DOI: https://doi.org/10.1007/s11739-015-1263-z

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