Complicated Cholecystitis

Charalel, Resmi A.; Jeffrey, R. Brooke; Shin, Lewis K.

doi:10.1097/ruq.0b013e31822a33e8

Cited by 48 publications

(23 citation statements)

References 36 publications

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“…Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care [5]. …”

Section: Discussionmentioning

confidence: 99%

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Saber

Hokkam

2014

Minimally Invasive Surgery

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Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient's satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient's satisfaction was 92.66 ± 6.8 in group A compared with 75.34 ± 12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.

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“…Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care [5]. …”

Section: Discussionmentioning

confidence: 99%

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Saber

Hokkam

2014

Minimally Invasive Surgery

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“…Thus far, the detection of severe cholecystitis has typically relied on imaging studies, such as abdominal ultrasound and computerized tomography (CT) scanning. However, these studies occasionally fail to detect severe cholecystitis [ 2 , 5 ]. In the present study, we demonstrated that a preoperative NLR of 3.0 has the potential to differentiate between simple and severe cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

“…Acute cholecystitis accounts for most of the hospital admissions related to gastrointestinal diseases [ 1 ]. In approximately 90% of patients, inflammation develops due to obstruction of the cystic duct by one or more gallstones [ 2 ]. Delayed management can lead to increased morbidity, due to progression to severe cholecystitis, such as gangrenous change, abscess formation, and gallbladder perforation.…”

Section: Introductionmentioning

confidence: 99%

The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study

Lee

Park

et al. 2014

BMC Surg

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BackgroundTo evaluate whether the neutrophil-to-lymphocyte ratio (NLR), as a prognostic indicator, in patients can differentiate between simple and severe cholecystitis.MethodsA database of 632 patients who underwent cholecystectomy due to cholecystitis during approximately a seven-year span in a single institution was evaluated. Severe cholecystitis was defined when the cholecystitis was complicated by secondary changes, including hemorrhage, gangrene, emphysema, and perforation. The NLR was calculated at admission as the absolute neutrophil count divided by the absolute lymphocyte count. We used receiver operating characteristic curve analysis to identify the optimal value for the NLR in relation to the severity of cholecystitis. Thereafter, the differences in clinical manifestations according to the NLR cut-off value were investigated.ResultsOur study population comprised 503 patients with simple cholecystitis (79.6%) and 129 patients with severe cholecystitis (20.4%). The NLR of 3.0 could predict severe cholecystitis with 70.5% sensitivity and 70.0% specificity. A higher NLR (≥3.0) was significantly associated with older age (p =0.001), male gender (p =0.001), admission via the emergency department (p <0.001), longer operation time (p <0.001), higher incidence of postoperative complications (p =0.056), and prolonged length of hospital stay (LOS) (p <0.001). Multivariate analysis found that patient age ≥50 years (odds ratio [OR]: 2.312, 95% confidence interval [CI]: 1.472–3.630, p <0.001), preoperative NLR ≥3.0 (OR: 1.876, 95% CI: 1.246–2.825, p =0.003), and admission via the emergency department (OR: 1.764, 95% CI: 1.170–2.660, p =0.007) were independent factors associated with prolonged LOS.ConclusionsNLR ≥3.0 was significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.

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“…Despite the above-mentioned advantages of conventional ultrasound, the sensitivity and accuracy are not satisfactory, especially when stones or some other gallbladder lesions fill the gallbladder lumen[ 3 , 4 ]. With no information of microvascularity, it is very hard to differentiate some benign diseases, such as benign gallbladder wall thickening or motionless sludge, from malignant ones using conventional ultrasound.…”

Section: Introductionmentioning

confidence: 99%

Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion

Zhang¹,

Bai²,

Gu³

et al. 2018

WJG

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AIMTo describe contrast-enhanced ultrasound (CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions.METHODSThis study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as (1) benign, (2) probably benign, (3) probably malignant or (4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared.RESULTSThere were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS (e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8% and 95.2%, respectively. These were significantly higher than conventional ultrasound (82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer.CONCLUSIONCEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.

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Complicated Cholecystitis

Cited by 48 publications

References 36 publications

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

The utility of the preoperative neutrophil-to-lymphocyte ratio in predicting severe cholecystitis: a retrospective cohort study

Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion

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