Ultrasonographic findings in acute acalculous cholecystitis

Beckman, Irwin; Dash, Nilima; Sefczek, Robert J.; Lupetin, Anthony R.; Anderson, Jeffrey S.; Diamond, Daniel L.; Young, Joseph C.

doi:10.1007/bf01893137

Cited by 33 publications

(18 citation statements)

References 26 publications

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“…Duplicate entries, cases of calculous cholecystitis or other biliary pathology were excluded from the study. We included all patients who on either ultrasonography (US) or CT imaging were found to have AAC with gall bladder wall thickness greater than 3 mm, periocholecystic fluid, subserosal oedema, intramural gas or sloughed mucosal membrane [2,12,[16][17][18][19][20][21]. Patients were required to satisfy at least 2 of these major criteria in the absence of biliary calculi and have AAC verified by the reporting radiologist.…”

Section: Methodsmentioning

confidence: 99%

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. Methods: Patients were identified via hospital coding using the keywords “acalculous cholecystitis, cholecystostomy and gall bladder perforation.” Follow-up data was obtained by performing a retrospective review of the patients' hospital records. Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.

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Section: Methodsmentioning

confidence: 99%

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

et al. 2017

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“…However, the findings frequently are nonspecific, demonstrating thickening of the gallbladder wall and sludge. 7 The demonstration of a positive sonographic Murphy's sign may be a valuable finding in cholecystitis. 9 However, many patients with suspected AAC either are critically ill or have altered mental status.…”

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Follow-up sonography in suspected acalculous cholecystitis: preliminary clinical experience

Jeffrey

Sommer

1993

Journal of Ultrasound in Medicine

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Fourteen adult patients with clinically suspected AAC and inconclusive initial sonograms underwent follow‐up sonography within 24 hours. Eight patients had initial studies demonstrating a normal thickness of the gallbladder wall. Four of these patients demonstrated progressive thickening of the gallbladder wall on follow‐up scans and were diagnosed as having AAC. In three of these patients AAC was proved at surgery, and the remaining patient improved clinically after percutaneous cholecystostomy. Four other patients with normal gallbladder wall thickness on both the initial and follow‐up sonograms had benign clinical follow‐up results without evidence of AAC. The remaining six patients had a thickened gallbladder on the initial sonogram. In one of these patients, the gallbladder wall thickening resolved on follow‐up sonography. In the remaining five patients the gallbladder wall thickening did not change. Four of these patients had benign follow‐up results but one patient was found to have AAC at surgery. Follow‐up sonography may be helpful to confirm AAC if there is progressive edema of the gallbladder wall. A normal gallbladder wall on an initial study does not exclude early AAC. Thickening of the gallbladder wall on initial studies still remains a problem and other ancillary criteria must be used to establish the diagnosis of AAC.

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“…Bei einer Wandverdickung von ≥ 4 mm gilt dieses als sicheres Zeichen einer entzü ndlichen Reaktion [1,2,5,6]. Bei einer Wandverdickung von ≥ 4 mm gilt dieses als sicheres Zeichen einer entzü ndlichen Reaktion [1,2,5,6].…”

Section: Diskussionunclassified

“…Hier kommt der Sonographie, als leicht verfü gbares und flexibel einsetzbares Diagnosticum, ein hoher Stellenwert zu [2]. Hier kommt der Sonographie, als leicht verfü gbares und flexibel einsetzbares Diagnosticum, ein hoher Stellenwert zu [2].…”

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Die postoperative und posttraumatische akute Cholecystitis Stellenwert der sonographischen Diagnostik

Orth

Wiedeck

Kunz

1997

Chirurg

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An often unrecognized but potentially fatal complication, mostly seen in posttraumatic patients under intensive care, is reactive acute cholecystitis. On account of the high specificity of ultrasound diagnosis in the biliary system we decided to examine the ultrasound criteria for early detection of posttraumatic cholecystitis. Ultrasound of the abdomen was performed prospectively, seven times on different days, in each of 40 artificially respirated patients under intensive care conditions over a period of 12 months. The results show that artificial respiration, parenteral feeding and previous trauma can lead to tardive (28/40) wall-thickening or to a three-layered wall of the gallbladder (9/40). In 22.5% of patients (9/40) we found the sonographic signs of acute cholecystitis. In correlation with the clinical signs, cholecystectomy was indicated in only two patients. The preoperative ultrasonographic findings and clinical signs of 23 patients with the diagnosis of acute reactive cholecystitis were analysed retrospectively. We found good correlation between sonographic and clinical signs of acute cholecystitis in 21 of these 23 patients. Our study shows that the morphological correlate of a thickened three-layered gallbladder wall can occur in the context of systemic alterations, even if there is no underlying cholecystitis. The diagnosis of acute reactive cholecystitis and the indication for cholecystectomy should be based on the synopsis of pathologic and clinical findings.

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Ultrasonographic findings in acute acalculous cholecystitis

Cited by 33 publications

References 26 publications

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Acalculous Cholecystitis: Is an Elective Interval Cholecystectomy Necessary

Follow-up sonography in suspected acalculous cholecystitis: preliminary clinical experience

Die postoperative und posttraumatische akute Cholecystitis Stellenwert der sonographischen Diagnostik

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