Ultrasonography in acute gallbladder perforation

Sonographic diagnosis of acute cholecystitis in patients with symptomatic gallstones

“…As widely adopted in the literature, we used the pathologic findings as the reference method for assessment of the diagnostic value. [14][15][16][17][18][19][20] Pathology is thought to be the most objectively effective method of assessing acute inflammation. Although interobserver differences have been reported, such uncertainty has been reported to be less important than the potential uncertainty of the diagnosis on the basis of the clinical course of acute cholecystitis.…”

“…The prevalence of acute cholecystitis is a key factor in the study population, and most of the published studies include patients with suspected acute cholecystitis. [14][15][16][17][18][19][20] The selection of a different study population with a different pretest probability of acute cholecystitis may influence the diagnostic results. The clinical applicability of the results to the general population is one of the most important features, which is why we chose to conduct this study among patients who had been admitted to the Department of Surgery for symptomatic gallstones; that is the population of patients in whom a differential diagnosis is of major concern because decisions on timing and treatment strategies are required.…”

“…The first involves Murphy's sign: although its diagnostic value as a single sign has not been clearly confirmed, Murphy's sign is still one of the most frequently used signs for the diagnosis of acute cholecystitis. [12][13][14][15][16][17]19,20 Two studies that specifically evaluated the diagnostic accuracy of Murphy's sign did not identify a fundamental role for it in the diagnosis of acute cholecystitis. 15,17 That result has been confirmed by our study; a weak correlation between the Murphy's sign on sonography and the diagnosis of acute cholecystitis was found in the univariate analysis, but the sign lacked any correlation in the multivariate analysis.…”

“…Different reference methods for the final diagnosis, different timing between the investigation and the reference method, different US criteria adopted for the diagnosis of acute cholecystitis, and different study populations may explain the varying diagnostic values reported in the literature. [12][13][14][15][16][17][18][19][20] Moreover, the diagnostic value of each single US sign or of different combinations of US signs have been rarely reported. 15,17 As a result, the best combination of US signs to use in diagnosing acute cholecystitis still remains to be investigated.…”

“…15,17 As a result, the best combination of US signs to use in diagnosing acute cholecystitis still remains to be investigated. Finally, most studies have focused the investigation on patients with clinically suspected cholecystitis, [14][15][16][17][18][19][20] although from a clinical point of view, making a differential diagnosis of acute cholecystitis is of major interest for patients admitted for symptomatic gallbladder stones, a larger group of patients for whom decisions about timing and targeted treatment are more questionable. 21 The aims of this study were therefore to assess which US signs correlate with the diagnosis of acute cholecystitis and to estimate the accuracy of US findings for the diagnosis of acute cholecystitis in a population of patients admitted to our Department of Surgery for symptomatic gallstone disease.…”