Use of morphine cholescintigraphy in the diagnosis of acute cholecystitis in critically ill patients

Abstract

Objective

To determine the efficacy of morphine enhanced radionuclide cholescintigraphy (MC) in the diagnosis of acute cholecystitis (AC) in critically ill patients.

Design

Retrospective chart review.

Setting

2 university hospitals

Patients and methods

Records of all ICU patients who underwent MC as part of an evaluation for AC over an 8 year period were reviewed (n=45). All patients initially had standard radionuclide cholescintigraphy (RC) performed which showed nonvisualization of the gallbladder (GB) and were then given morphine sulfate (0.05–0.1 mg/kg iV).

Results

The mean age was 54 years (range 18–84 years). Risk factors for AC included fasting in 41 patients (mean 12.4 days) and total parenteral nutrition in 32 patients. Signs of biliary sepsis included temperature >100°F in 38 patients, WBC>10 000/ml³ in 40 patients, abdominal pain in 29 patients, and abnormal liver fuction tests in 42 patients. 23 patients had GB ultrasonography, with 7 showing stones. MC was positive (non-visualization) in 16 patients and negative (GB visualized) in 29, including 4 with gallstones. All patients in whom the GB was visualized did so within 1h. There were 13 patients with positive MC who underwent operation; 12 had AC (9 acalculous, 3 calculous). Three patients were treated medically and recovered (false positive). All 29 patients with negative MC were true negatives. Overall, MC had an accuracy of 91%, sensitivity of 100%, specificity of 88%, positive predictive value of 75%, and negative predictive value of 100%.

Conclusion

MC is a useful test in the evaluation of critically ill patients for suspected AC, particularly in patients with known risk factors or documented gallstones.