S1537 A Case of Gangrenous Cholecystitis Without Acute Cholecystitis

The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score) was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point), heart rate > 90 beats/min (1 point), male (2 points), Leucocytosis > 13,000/mm3(1.5 points), and ultrasound gallbladder wall thickness>4.5 mm (1 point). The prevalence of gangrenous cholecystitis was 13% in the low-probability (0–2 points), 33% in the intermediate-probability (2–4.5 points), and 87% in the high probability category (>4.5 points). A cutoff score of 2 identified 31 (69%) patients with no acute inflammation (PPV 90%). This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.

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Gangrenous Cholecystitis: A Grim Complication of Acute Cholecystitis

SAS Journal of Medicine ◽

10.36347/sasjm.2018.v04i08.002 ◽

2018 ◽

Vol 4 (8) ◽

pp. 116-118

Author(s):

Liaqat A. Khan ◽

Faisal I. Zaidan ◽

Ali H. Masmali ◽

Yahya M. Daghriri ◽

Laila E. Asiri ◽

...

Keyword(s):

Acute Cholecystitis ◽

Gangrenous Cholecystitis

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Leukocytosis of Unknown Origin: Gangrenous Cholecystitis

Case Reports in Medicine ◽

10.1155/2013/418014 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Amara Jyothi Nidimusili ◽

M. Chadi Alraies ◽

Naseem Eisa ◽

Abdul Hamid Alraiyes ◽

Khaldoon Shaheen

Keyword(s):

Acute Cholecystitis ◽

Surgical Intervention ◽

Imaging Modality ◽

Case Reports ◽

Unknown Origin ◽

First Line ◽

Current Case ◽

Gangrenous Cholecystitis ◽

Line Imaging ◽

High Index Of Suspicion

There have been case reports where patients admitted with acute cholecystitis, who were managed conservatively, had subsequently developed GC (gangrenous cholecystitis). The current case is unique, since our patient denied any prior episodes of abdominal pain and the only tip off was leukocytosis. A high index of suspicion is essential for the early diagnosis and treatment of GC. GC has a mortality rate of up to 22% and a complication rate of 16–25%. Complications associated with GC include perforation, which has been reported to occur in as many as 10% of cases of acute cholecystitis. The radiological investigations may not be conclusive. Ultrasonography usually serves as the first-line imaging modality for the evaluation of patients with clinically suspected acute cholecystitis. However, CT can play an important role in the evaluation of these patients if sonography is inconclusive. There is a need for an early (if not urgent) surgical intervention in acute cholecystitis (whether laparoscopic or open surgery) in order to decrease the time elapsed from the start of symptoms to admission and treatment.

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Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137095 ◽

2019 ◽

Vol 96 (1133) ◽

pp. 134-138 ◽

Cited By ~ 1

Author(s):

Liqaa Raffee ◽

Samer Kuleib ◽

Alaa Oteir ◽

Tariq Kewan ◽

Khaled Alawneh ◽

...

Keyword(s):

Acute Cholecystitis ◽

Cell Count ◽

White Cell Count ◽

Clinical Signs ◽

Liver Function Tests ◽

Total Leucocyte Count ◽

Histopathological Diagnosis ◽

Gangrenous Cholecystitis ◽

Increased Risk ◽

Complete Cell

BackgroundAcute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication.ObjectivesThe study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis.Materials and methodsThis was a retrospective study included patients with acute cholecystitis diagnosis, who presented to ‘blinded for peer review’ from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis.ResultsA total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utilityConclusionMale patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.

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Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

International Journal of Advanced Biological and Biomedical Research ◽

10.33945/sami/ijabbr.2019.3.7 ◽

2019 ◽

Vol 7 (3) ◽

pp. 267-274

Keyword(s):

Risk Factors ◽

Acute Cholecystitis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Gangrenous Cholecystitis

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Admission Variables Predictive of Gangrenous Cholecystitis

The American Surgeon ◽

10.1177/000313481207801014 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1075-1078 ◽

Cited By ~ 11

Author(s):

Ann E. Falor ◽

Michael Zobel ◽

Amy Kaji ◽

Angela Neville ◽

Christian De Virgilio

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Cell ◽

Acute Cholecystitis ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Open Cholecystectomy ◽

Blood Cell Count ◽

Factors Associated ◽

Gangrenous Cholecystitis

The objective of the present study was to identify admission clinical factors associated with gangrenous cholecystitis (GC) and factors associated with conversion to open cholecystectomy. We retrospectively evaluated 391 patients over a 17-month period who underwent urgent laparoscopic cholecystectomy for a diagnosis of acute cholecystitis. Eighty-nine patients with pathologically proven GC were compared with 302 patients without GC. On multivariable logistic regression, predictors of GC included male gender, white blood cell count greater than 14,000/mm3, heart rate greater than 90 beats per minute, and sodium 135 mg/dL or less. Conversion rate to open cholecystectomy was 7.9 per cent overall, 4 per cent for non-GC, and 19 per cent for GC (odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4; P < 0.00001). Conversion was predicted by increasing number of days to surgery, total bilirubin, and white blood cell count. Complication rate was higher in the GC group (10.1 vs 3.6% in the acute cholecystitis group, P = 0.01). The increased rate of conversion observed with surgery delay suggests that early laparoscopic cholecystectomy may be preferable in most patients.

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Medical Image of the Month: Perforated Gangrenous Cholecystitis

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc010-21 ◽

2021 ◽

Vol 22 (5) ◽

pp. 100-101

Author(s):

Lauren Blackley ◽

◽

Madhav Chopra ◽

Tammer El-Aini

Keyword(s):

Acute Cholecystitis ◽

Hospital Admissions ◽

Open Cholecystectomy ◽

Antibiotic Administration ◽

Intravenous Contrast ◽

Methamphetamine Use ◽

Rebound Tenderness ◽

Gangrenous Cholecystitis ◽

History Of ◽

Pericholecystic Abscess

No abstract available. Article truncated after 150 words. Clinical Scenario: A 47-year-old lady with a past medical history of hypertension, DVT on Xarelto, and methamphetamine use presented with a 3-day history of progressive right upper quadrant pain. Physical examination demonstrated marked right upper quadrant tenderness with palpation and significant rebound tenderness. A CT of the abdomen and pelvis without intravenous contrast demonstrated findings consistent with acute calculus cholecystitis with evidence of perforation and a pericholecystic abscess. The patient was taken emergently to the operating room where she underwent an open cholecystectomy which demonstrated perforated gangrenous cholecystitis with a large abscess in the gallbladder fossa. She was admitted to the ICU post-operatively due septic shock and did well with fluid resuscitation and antibiotic administration. Discussion: Acute cholecystitis is the most common acute complication of cholelithiasis and accounts for 3-9% of hospital admissions for acute abdominal pain. Eight to 95% of cases of acute cholecystitis are the result of a …

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Laparoscopic Cholecystectomy in Patients with Emphysematous and Gangrenous Cholecystitis: An Experience at Khwaja Yunus Ali Medical College & Hospital, Enayetpur, Sirajgonj.

KYAMC Journal ◽

10.3329/kyamcj.v5i2.32366 ◽

2017 ◽

Vol 5 (2) ◽

pp. 519-523

Author(s):

Mohd Farid Hossain ◽

Sailendra Nath Biswas ◽

Masudur Rahman ◽

Tanvir Ahmed ◽

Apu Karmaker

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Operating Time ◽

Severe Form ◽

College Hospital ◽

Open Procedure ◽

Early Laparoscopic Cholecystectomy ◽

Calot’S Triangle ◽

Gangrenous Cholecystitis ◽

Surgical Technical

Objective- To look for the feasibility and safety of laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Back ground- Emphysematous and gangrenous cholecystitis are severe form of acute cholecystitis. They are considered as contraindication of laparoscopic cholecystectomy due to peri operative life threatening complications, surgical technical difficulties, frequent conversion to open procedure. This study describe our experience in terms of feasibility and safety with laparoscopic cholecystectomy in patients with emphysematous and gangrenous cholecystitis.Materials and methods- From January 2012 to December 2014,total 37 patients with clinical diagnosis of severe acute cholecystitis under went laparoscopic cholecystectomy within 72 hours of admission. Operative findings and histopathological reports were used to identify patients of emphysematous and gangrenous cholecystitis.Results- 35(94.59%)among 37 patient's laparoscopic cholecystectomy were performed successfully.29 case were emphysematous and 8 cases were gangrenous cholecystitis. Two patient's laparoscopic procedure were converted to open procedure due to various operative difficulties, of which the most common was distorted calot's triangle. Maximum operating time was up to 130 minutes(one case),Post operative major complications occurred in 2 cases(5.40%).maximum patients were discharged by 48 to72 hours. There was no mortality.Conclusion- laparoscopic cholecystectomy is feasible and safe in emphysematous and gangrenous cholecystitis. However the experience of the surgeon and his patience during surgery play key role in over all out come. Based on our experience we recommend an early laparoscopic cholecystectomy for these group of patients, provided expertise & gadgets are available.KYAMC Journal Vol. 5, No.-2, Jan 2015, Page 519-523

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