Backgrounds/Aims Gallbladder gangrene is a grave complication of acute calculous cholecystitis that is difficult to detect preoperatively. Ultrasound could show a gallbladder wall that is more thickened. In addition, other clinical measures were reported to be possible predictive factors. Therefore, we aim in this study to evaluate the gallbladder wall thickness measured by ultrasound and other clinical measures as predictive factors for gangrene complication in acute calculous cholecystitis. Methods A prospective cohort database analysis of the results of 674 patients diagnosed and treated for acute calculous cholecystitis between January 2010 and December 2014 was done. Patient's inclusion criteria were acute calculous cholecystitis in adults who were operated within three days of onset of symptoms. Results 117 (17.4%) patients had gangrene. Gallbladder sonographic wall thickness 5.1–6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference (p≤0.01). Conclusions We conclude that gallbladder sonographic wall thickness 5.1–6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference. By implementing these risk factors, patients urgency for surgery can be decided in the emergency department. Other risk factors such as high alanine aminotransferase, elevated aspartate aminotransferase, and high alkaline phosphatase could be of help in the decision for early operation.

Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis.

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