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Prediction of extensive necrotic change in acute gangrenous cholecystitis

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Abstract

Purpose

Gangrenous cholecystitis (GC) is a severe type of acute cholecystitis that implies higher mortality and morbidity rates than uncomplicated cholecystitis. The characteristics of GC are various for each case. However, preoperative predictors of GC with extensive necrotic change have not been investigated well.

Methods

A total of 239 patients who were pathologically diagnosed with GC underwent laparoscopic cholecystectomy at our hospital between January 2013 and December 2021. Of these, 135 patients were included in this study and were subdivided into the extensive necrosis group (patients with necrotic change extending to the neck of the gallbladder, n = 18) and the control group (patients with necrotic change limited to the fundus or body, not extending to the neck, n = 117) according to each operation video. Patient characteristics and perioperative factors predicting extensive necrotic change were investigated.

Results

Pericholecystic fat stranding (83.3 vs. 53.8%, p = 0.018) and absence of wall enhancement on preoperative CT images (50.0 vs. 24.7%, p = 0.026) were significantly associated with extensive necrosis. Seven of 18 patients in the extensive necrosis group showed necrotic changes beyond the infundibulum. The absence of wall enhancement on preoperative CT images (71.4 vs. 28.8%, p = 0.018) was significantly associated with necrotic changes beyond the infundibulum.

Conclusions

Pericholecystic fat stranding and absence of wall enhancement on preoperative enhanced CT are predictors of extensive necrotic change in patients with GC. In addition, the absence of wall enhancement also predicts the presence of necrotic changes beyond the infundibulum.

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Authors and Affiliations

  1. Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan

    Atsushi Kohga, Kenji Suzuki, Takuya Okumura, Akihiro Makino, Kimihiro Yamashita, Jun Isogaki, Akihiro Kawabe & Taizo Kimura

  2. Division of Radiology, Fujinomiya City General Hospital, Shizuoka, Japan

    Katsuaki Muramatsu

Authors
  1. Atsushi Kohga
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  2. Kenji Suzuki
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  5. Kimihiro Yamashita
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Contributions

A.K. wrote the manuscript and performed data analysis. All authors contributed to acquire data and revise the manuscript. All authors read and approved the final manuscript.

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Correspondence to Atsushi Kohga.

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This work was supported by departmental resources only, and the corresponding author is not a recipient of a research scholarship.

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Kohga, A., Suzuki, K., Okumura, T. et al. Prediction of extensive necrotic change in acute gangrenous cholecystitis. Emerg Radiol 29, 723–728 (2022). https://doi.org/10.1007/s10140-022-02055-z

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  • DOI: https://doi.org/10.1007/s10140-022-02055-z

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