Sonography of gangrenous cholecystitis

Abstract

Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-lamination, gas within the gall bladder, absence of calculi, and large peri-cholecystic collections. Both sonogram with color flow imaging and contrast-enhanced Computed tomography are complementary investigations to establish this important diagnosis in critically ill patients.

Vascular disorders of the gallbladder and bile ducts: Imaging findings

“…With color flow Doppler ultrasound, there may be focal perfusion defects within the necrotic gallbladder wall. 29 On CT, pericholecystic fat stranding is demonstrated. More specific findings include gas in the wall or lumen, intraluminal membranes, an irregular wall, 18 and perfusion defects of the gallbladder wall.…”

“…18 The clinical diagnosis is challenging as the differentiation from acute cholecystitis is difficult preoperatively. 29 As the gallbladder becomes necrotic, clinical symptoms and signs may become more generalized. The abdominal pain may be diffuse in up to 50% of patients.…”

“…The abdominal pain may be diffuse in up to 50% of patients. There is increased risk of perforation with possible peritonitis, fistula, and abscess formation, 29 therefore early cholecystectomy should be performed. 18 On US, asymmetric gallbladder wall thickening and sloughed intraluminal membranes raise the possibility of gangrene.…”

“…More specific findings include gas in the wall or lumen, intraluminal membranes, an irregular wall, 18 and perfusion defects of the gallbladder wall. 29 Focal transmural defects in the gallbladder wall may be apparent in the setting of perforation. 30 Multisequence MRI demonstrate similar findings (Figure 5).…”

Rare Case of Celiac Trunk and Sma Throm Bosis Presenting as an Isolated Gangrenous Cholecystitis: A Surgical Surprise

“…This will identify those acutely ill patients with gall bladder focal perfusion defects, as well as those with the sonographic signs of cholecystitis. [7] However, CT can play an important role in evaluation of these patients if sonography is inconclusive. [8] There is a controversy regarding the best surgical approach to Gangrenous Cholecystitis with some authors, such as Eldar et al [9] recommending open cholecystectomy.…”