Predictive factors for the diagnosis of severe acute cholecystitis in an emergency setting

Abstract

Severe acute cholecystitis may be differentiated preoperatively from nonsevere acute cholecystitis based on clinical and US data, and predictive diagnostic values may be estimated according to the number of observed predictive factors. No differences were found when comparing phlegmonous and gangrenous cholecystitis.

Gangrenous cholecystitis: a contemporary review

“…All of the identified characteristics are surrogates in patients with less than optimal health, who commonly present with more extensive disease. Of note, our results suggest that diabetes is associated with GC, potentially secondary to the presence of pre-existing microvascular disease, although this association has been mixed in previous studies (4,9,12). Another possible explanation of the association of diabetes with GC may be that patients with DM have decreased sensation secondary to diabetic neuropathy and thus, present at later stages of cholecystitis, leading to an increased susceptibility to the development of GC.…”

Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis

“…Clearly, following this choice, the included patients may represent only a percentage of the total number of patients with theoretical complicated cholecystitis treated during the period of cases collections. However, we point out that the CEUS study was performed only for moderate-severe cases and not in all cases of mild cholecystitis, which are the most frequent cases in real life in a Unit of Internal Medicine since data from studies report gangrenous cholecystitis in about 30 % of patients who undergo urgent surgery for acute cholecystitis [14,15]. Since symptoms of gangrenous cholecystitis may be mild especially in older patients or with diabetes, it could be argued that many more cases with a CEUS pattern of complicated disease could have been collected if we would have performed a CEUS study in all the consecutive patients with acute cholecystitis referred to our hospital.…”

“…Gangrenous cholecystitis is the most serious stage of gallbladder inflammation, following vascular compromise and gallbladder wall ischemia, eventually resulting in gallbladder necrosis and perforation. Older male patients ([50 years old) with a history of cardiovascular diseases or a leukocytosis greater than 17,000 cells/ mm 3 [14] recently found four factors to be independent predictive factors of severe acute cholecystitis in an emergency setting: fever, distension of the gallbladder, wall edema, and preoperative adverse events.…”

Risk factors for acute gangrenous cholecystitis in emergency general surgery patients

“…5 Multiple meta-analyses performed on acute cholecystitis fail to highlight acute gangrenous cholecystitis as a different entity, and do not provide guidelines for the clinician to triage sicker patients toward a more rapid operative treatment. Moreover, some of these studies support delaying operative treatment.…”