The Effect of Leucocytosis, Gender Difference, and Ultrasound in the Diagnosis of Acute Cholecystitis in the Elderly Population

Abstract

Introduction. Acute cholecystitis is one of the most common reasons of acute abdominal pain for older patients to present to the emergency department (ED). Presentation may differ from that of the younger patient and is often complicated by coexistent disease due to elderliness. In this study, we aimed to evaluate the clinical presentation of acute cholecystitis, with special focus on comparision between elderly and young patients. Materials and Methods. This study included 318 patients who were admitted to the emergency department with right upper quadrant pain during a period of determined 8 months. After retrospective data collection, patients were groupped in accordance with their age, <65 and ≥65 years. Those who had ultrasonographic signs such as wall thickening and fluid collection were diagnosed as acute cholecystitis. Results. The young group (Group I) consisted of 225 patients, 132 females and 93 males. In Group I, 39 patients were diagnosed as acute cholecystitis of whom 27 were females and 15 were males. The elderly group (Group II) consisted of 93 patients 48 females and 45 males. In Group II, 36 patients were diagnosed as acute cholecystitis of whom 15 were females and 21 were males. Regarding the diagnosis of acute cholecystitis, the female to male ratio is 2.25 in Group I and 0.71 in Group II (p=0.016). The average white blood cells counts of patients with acute cholecystitis in Group I and in Group II were 9907x109/L(±4.437) and 17083x109/L(±7485), respectively (p<0,001). Conclusions. Acute cholecystitis is a common diagnosis in elderly patients with right upper quadrant pain. It is more frequent in female in the early ages, but the gender difference tends to change with age. Elderly patients demonstrate a higher level of white blood cells when compared to young patients in acute cholecystitis. Clinicians must maintain a degree of awareness in the evaluation of geriatric patients with right upper quadrant abdominal pain.

Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis

“…When we examine the relationship between the clinical grade and WBC count, the mean was measured 10550/mm in grade 1, 12900/mm in grade 2, and 11280/mm in grade 3. In addition to severe acute cholecystitis [11] and gangrenous cholecystitis [12], leukocyte counts were also found higher in the elderly than young patients [13]. Unlike stated in the literature, the mean WBC count of the patients included in our study was found lower.…”

Some Features of the Diagnosis of Acute Cholecystitis in the Elderly Age

“…Эта возрастная разница между женщинами и мужчинами была подтверждена во многих исследованиях [12]. Исследование GREPCO показало, что соотношение мужчин и женщин составляет 2,9 в возрасте от 30 до 39 лет, но соотношение уменьшается до 1,6 в возрасте от 40 до 49 лет и до 1,2 в возрасте от 50 до 59 лет [2]. Пациенты мужского пола с острым холециститом, как правило, были старше.…”

“…При наличии лейкоцитоза выше 14×10 9 /л необходимо уделять больше внимания желудочно-кишечным, мочевым и кожным инфекциям у пожилых пациентов с сепсисом. Некоторые исследования предполагают, что прогностическая способность подсчета лейкоцитов применима к пожилым людям, но есть необходимость в дальнейших исследованиях по этой теме [2].…”

“…Это может быть причиной того, что развитие мукоцеле, эмпиемы и перфорации было значительно чаще у пациентов с одиночными камнями желчного пузыря. Таким образом, пациент с одиночным камнем может нуждаться в большем внимании и хирургическом приоритете [2][3][4].…”

“…Из всех пациентов, поступающих в подразделения неотложной хирургии страны, приблизительно 40 % составляют лица старше 65 лет. За счет все более стареющего населения эта доля неуклонно увеличивается [1,2]. Возрастные физиологические изменения затрагивают почти каждую систему органов и влияют на проявление заболеваний.…”