Abstract
In acute cholecystitis, the presence of gangrene is associated with higher morbidity and mortality and necessitates open surgical intervention rather than laparoscopic cholecystectomy. As Murphy’s sign may be absent, gangrene may not be detected ultrasonographically. This retrospective study evaluated indications of acute gangrenous cholecystitis on computed tomography (CT) in 25 patients, who were proven as having acute cholecysitis surgically and pathologically within 3 days of pre-operative CT. The CT images were reviewed by two board-certified radiologists blind to the initial CT report. Acute gangrenous cholecystitis was significantly correlated with the CT signs of perfusion defect (PD) of the gallbladder wall (P = 0.02), pericholecystic stranding (PS) (P = 0.028), and no-gallstone condition (No-ST) (P = 0.026). The presence of PD was associated with acute gangrenous cholecystitis with a relatively high accuracy (80%), a sensitivity of 70.6%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 61.5%. The combination CT signs of PD or No-ST improved the accuracy for acute gangrenous cholecystitis to 92%, with a sensitivity, specificity, PPV, and NPV of 88.2%, 100%, 100%, and 80%, respectively. Other CT signs were highly specific for acute gangrenous cholecystitis but of low sensitivity, including mucosal hemorrhage, mucosal sloughing, wall irregularity, pericholecystic abscess, gas formation, and portal venous thrombosis. CT was found to accurately diagnose acute cholecystitis, with the presence of PD, PS, or No-ST significantly correlated with that of gangrenous change. Thus, CT is useful in the preoperative detection of acute gangrenous cholecystitis.
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References
Bennett GL, Rusinek H, Lisi V, et al. (2002) CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol 178(2):275–281
Hunt DR, Chu FC (2000) Gangrenous cholecystitis in the laparoscopic era. Aust N Z J Surg 70(6):428–430
Singh AK, Sagar P (2005) Gangrenous cholecystitis: prediction with CT imaging. Abdom Imaging 30(2):218–221. doi:10.1007/s00261-004-0217-0
Merriam LT, Kanaan SA, Dawes LG, et al. (1999) Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 126(4):680–685. doi:S0039606099002974
Simeone JF, Brink JA, Mueller PR, et al. (1989) The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign. AJR Am J Roentgenol 152(2):289–290
Fidler J, Paulson EK, Layfield L (1996) CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR Am J Roentgenol 166(5):1085–1088
El-Wahsh M (2006) A case of portal vein thrombosis associated with acute cholecystitis/pancreatitis or coincidence. Hepatobiliary Pancreat Dis Int 5(2):308–310
Napolitano L, Waku M, Costantini R, Mazahreh T, Innocenti P (2009) Portal vein gas due to gangrenous cholecystitis treated by a laparoscopic procedure: report of a case. Surg Today 39(10):909–912. doi:10.1007/s00595-008-3936-y
Cheng SM, Ng SP, Shih SL (2004) Hyperdense gallbladder wall sign: an overlooked sign of acute cholecystitis on unenhanced CT examination. Clin Imaging 28(2):128–131. doi:10.1016/S0899-7071(03)00196-7
Shapiro MJ, Luchtefeld WB, Kurzweil S, et al. (1994) Acute acalculous cholecystitis in the critically ill. Am Surg 60(5):335–339
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Wu, CH., Chen, CC., Wang, CJ. et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings. Abdom Imaging 36, 174–178 (2011). https://doi.org/10.1007/s00261-010-9612-x
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DOI: https://doi.org/10.1007/s00261-010-9612-x