Gangrenous Cholecystitis: Mortality and Risk Factors

Abstract

As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 6 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P , 0.001, P ¼ 0.001, P ¼ 0.044, P ¼ 0.005, P ¼ 0.049, P ¼ 0.009, P ¼ 0.022, P ¼ 0.011, and P ¼ 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

Treatment of acute cholecystitis after cardiovascular surgery

“…There were no differences between the CS group and the control groups in terms of operation time; however, in the CS group, blood loss tended to be greater and postoperative hospital days tended to be longer, than the control group. Furthermore, a tendency was observed that the rate of postoperative complications of the AC after CS group was higher than that of the control group, as in previous reports . On the other hand, in Grade III patients, postoperative hospital days were significantly longer and the period from CS to cholecystectomy tended to be shorter than those of Grade II.…”

“…The proportion of gangrenous cholecystitis in AC after CS was significantly higher than that of the control group. The incidence of postoperative complications and mortality has been reported to be high in cases of gangrenous cholecystitis . With regard to diagnosis of gangrenous cholecystitis, many AC cases after CS had a poor general condition, so it was often difficult to perform contrast‐enhanced CT. As a result, it was hard to obtain typical findings which were previously reported, such as irregularity of the gallbladder wall or decreased gallbladder wall enhancement on contrast‐enhanced CT .…”

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

“…Complications of AC include gangrenous cholecystitis (GC) and perforation, which are considered medical emergencies and carry a high morbidity and mortality rate 7. GC occurs subsequent to impaired gall bladder wall perfusion due to increased pressure within the gall bladder, often associated with obstruction of the cystic duct 8.…”

Laparoscopic Cholecystectomy of Gangrenous Cholecystitis Safety and Feasibility

“…A randomized controlled trial (RCT) to specify the risk factors on mortality in GC by Akın ¨Onder reported 24.3% of cases ofGC had CVD and 19.6% had DM [12]. In this study the co-morbidity presented in 57.5% in all cases mainly CVD (37.5%) and DM (30%).…”

“…While the postoperative hospital stay was variable as short as 2 days in the uncomplicated cases who represented the majority of our study and as long as 12 days in complicated cases with mean 3.0± 1.2 days. The hospital stay was ranging 1-28 (mean8.0 ± 5.7) days in study by Akın ¨Onder [12] and the hospital stay was 14.0±2.03 days in laparoscopic group versus 36.0±4.99 days in open group in study conducted by АBDUKHAKIM KHADJIBAEV [20].…”