Acute Cholecystitis: Do Sonographic Findings and WBC Count Predict Gangrenous Changes?

Abstract

Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.

Diagnosis of gallbladder perforation by ultrasound

“…7 Since almost all perforated GBs are gangrenous (90% in this study), sonographic signs of gangrenous cholecystitis, such as severe inflammation, coexist. As described here, perforated GBs were found to be distended (mean 4.6 cm) and with thickened walls (mean 6 mm), which are findings that have been described for gangrenous cholecystitis [10,11]. In addition, most GBs contained gallstones and all of them contained debris or sludge.…”

“…Patients presented with elevated WBC levels (mean 13.9 x 10 9 /L) and with a high percentage of neutrophils (mean 85.7%), a known feature of complicated cholecystitis [1,10]. 7 Since almost all perforated GBs are gangrenous (90% in this study), sonographic signs of gangrenous cholecystitis, such as severe inflammation, coexist.…”

“…The association between this finding and gangrenous cholecystitis is not clear. While once considered a sign suggestive of gangrenous cholecystitis [12], in a recent publication by Teefey et al [10], there was no association. Interestingly, in most cases of the current cohort, additional sonographic findings in the surrounding area (rather than in the GB itself) were demonstrated.…”

Evaluating Patients with Right Upper Quadrant Pain

“…148 However, in a more recent analysis by the same investigators, this finding was nonspecific for the presence of gangrenous cholecystitis and it can be found in nongangrenous cholecystitis and other conditions that cause gallbladder wall edema, such as hepatitis. 150 Intraluminal membranes are considered a more specific finding. Importantly, a sonographic Murphy sign may not be present in these patients because of associated denervation of the gallbladder wall.…”

Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression/T2 image fusion

“…Murphy's sign, which is a pain on taking a deep breath in the right upper quadrant when the examiner's finger is on the location of the gallbladder, is considered to be the most useful indicator for the diagnosis of local inflammation in patients with acute cholecystitis (7). Systemic inflammation is confirmed based on the findings of blood tests, with leukocytosis and elevated levels of C-reactive protein (CRP) indicating systemic inflammation (8). To confirm the diagnosis of cholecystitis, diagnostic imaging is useful; computed tomography (CT) scanning typically reveals thickened walls of the gallbladder, pericholecystic inflammation, and the presence of liver abscesses (9).…”