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DOI: 10.4103/ijri.IJRI_421_16
Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases
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Abstract
Purpose: To study the imaging findings in gangrenous acute cholecystitis. Materials and Methods: Retrospective analysis of imaging findings in 31 histopathologically confirmed cases of gangrenous cholecystitis was done. The following imaging findings were analyzed: wall thickness, gallbladder distension, intraluminal membranes, mural striation, edema, wall enhancement, gallstones, gas, pericholecystic fluid, stranding, hemorrhage, hyperaemia in adjacent liver, mucosal/wall irregularity, complications. Statistical Analysis: Appropriate statistical tests were used using SPSS.22.0 software. The two proportions were compared using Chi-square or Fisher exact test and two means were compared using student t test. Results: Mean gallbladder wall thickening was 6 ± 1.93 mm. Gallstones, mural edema, mural striation, pericholecystic fluid, intraluminal membranes, gas were seen in 30, 27, 18, 20, 14 and 3 cases respectively. The mean short-axis distension of gallbladder lumen was 4.24 ± 0.91 cm. Gallbladder wall enhancement was studied in only 10 cases. Complete absence of enhancement was seen in 1, focal decreased enhancement in 8 cases. Mucosal/wall irregularity was seen in 28 cases. 74.2% cases had ≥4 cm gallbladder distension. Intraluminal membranes were present in 14 cases with mean short-axis distension of 4.6 cm and absent in 17 (P = 0.041), in 11 cases with mural striation (P = 0.036). Mean wall thickening was 6.69mm in patients with intraluminal membranes and 5.46 mm with absence of membranes (P = .078). Conclusion: Presence of more than one of these findings - gallbladder distension (short axis diameter of ≥4 cm), intraluminal membranes, mural striation, absent or decreased enhancement of gallbladder wall suggest high probability of gangrenous change in acute cholecystitis.
Publication History
Article published online:
26 July 2021
© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Girgin S, Gedik E, Taçyildiz IH, Akgün Y, Baç B, Uysal E. Factors affecting morbidity and mortality in gangrenous cholecystitis. Acta Chir Belg 2006; 106: 545-9
- 2 Mentzer Jr RM, Golden GT, Chandler JG, Horsley 3rd JS. A comparative appraisal of emphysematous cholecystitis. Am J Surg 1975; 129: 10-5
- 3 Fry DE, Cox RA, Harbrecht PJ. Gangrene of the gallbladder: A complication of acute cholecystitis. South Med J 1981; 74: 666-8
- 4 Nikfarjam M, Niumsawatt V, Sethu A, Fink MA, Muralidharan V, Starkey G. et al. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 2011; 13: 551-8
- 5 Chang WC, Sun Y, Wu EH, Kim SY, Wang ZJ, Huang GS. et al. CT findings for detecting the presence of gangrenous ischemia in cholecystitis. AJR Am J Roentgenol 2016; 207: 302-9
- 6 Bennett GL, Rusinek H, Lisi V, Israel GM, Krinsky GA, Slywotzky CM. et al. CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol 2002; 178: 275-81
- 7 Revel L, Lubrano J, Badet N, Manzoni P, Degano SV, Delabrousse E. Preoperative diagnosis of gangrenous acute cholecystitis: Usefulness of CEUS. Abdom Imaging 2014; 39: 1175-81
- 8 Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002; 325: 639-43
- 9 Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993; 165: 399-404
- 10 Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M. et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 15-26
- 11 Yacoub WN, Petrosyan M, Sehgal I, Ma Y, Chandrasoma P, Mason RJ. Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: A simple score. Gastroenterol Res Pract 2010; 2010: 901739
- 12 Falor AE, Zobel M, Kaji A, Neville A, De Virgilio C. Admission variables predictive of gangrenous cholecystitis. Am Surg 2012; 78: 1075-8
- 13 Wu B, Buddensick TJ, Ferdosi H, Narducci DM, Sautter A, Setiawan L. et al. Predicting gangrenous cholecystitis. HPB (Oxford) 2014; 16: 801-6
- 14 Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F. et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016; 11: 25
- 15 Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology 2012; 264: 708-20
- 16 Wu CH, Chen CC, Wang CJ, Wong YC, Wang LJ, Huang CC. et al. Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings. Abdom Imaging 2011; 36: 174-8
- 17 Cheng SM, Ng SP, Shih SL. Hyperdense gallbladder wall sign: An overlooked sign of acute cholecystitis on unenhanced CT examination. Clin Imaging 2004; 28: 128-31
- 18 Soyer P, Hoeffel C, Dohan A, Gayat E, Eveno C, Malgras B. et al. Acute cholecystitis: Quantitative and qualitative evaluation with 64-section helical CT. Acta Radiol 2013; 54: 477-86
- 19 Revel L, Lubrano J, Badet N, Manzoni P, Degano SV, Delabrousse E. Preoperative diagnosis of gangrenous acute cholecystitis: Usefulness of CEUS. Abdom Imaging 2014; 39: 1175-81