Acute Cholecystitis: Do Sonographic Findings and WBC Count Predict Gangrenous Changes?
ABSTRACT The purpose of our study was to determine, first, if gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features; and, second, if WBC count or other sonographic findings are associated with gangrenous cholecystitis.
Sixty-eight patients who underwent cholecystectomies within 48 hours of sonography comprised the study group. Sonograms and reports were reviewed for wall thickness, striations, Murphy sign, pericholecystic fluid, wall irregularity, intraluminal membranes, and luminal short-axis diameter. Medical records were reviewed for WBC count and pathology reports for the diagnosis. Histologic specimens were reviewed for pathologic changes. Statistical analyses tested for associations between nongangrenous and gangrenous cholecystitis and sonographic findings and for associations between wall striations and histologic features.
Ten patients had gangrenous cholecystitis and 57, nongangrenous cholecystitis. One had cholesterolosis. Thirty patients had wall striations: 60% had gangrenous and 42% nongangrenous cholecystitis. There was no association with the pathology diagnosis (p = 0.32). There was no association between any histologic feature and wall striations (p ≥ 0.19). A Murphy sign was reported in 70% of patients with gangrenous cholecystitis and in 82% with nongangrenous cholecystitis; there was no association with the pathology diagnosis (p = 0.39). Wall thickness and WBC count were greater in patients with gangrenous cholecystitis than in those with nongangrenous cholecystitis (p ≤ 0.04).
Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.
Article: Gallbladder Wall ThickeningAmerican Journal of Roentgenology 01/2014; 202(1):W1-W12. DOI:10.2214/AJR.12.10386 · 2.74 Impact Factor
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ABSTRACT: Introduction: Cholecystectomy is one of the most common surgical procedures. Postoperative investigation of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical consequences. The aim of this study was to evaluate the association between cholesterolosis and the reports indicating some histopathological alterations in symptomatic cholecystitis. Methods: This paper is based on a retrospective study. Histopathological reports of 432 cholecystectomy specimens between January 2011 and June 2013 were reviewed. Three reports were excluded due to perioperative diagnosis of cancer. Reports of 429 cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting was questioned. Age, gender, histopathological wall thickness of gallbladder, reporting rates of acute inflammation, cholesterolosis, polypoid lesions, epithelial hyperplasia, gastric or intestinal metaplasia, dysplasia and incidental cancer were investigated and compared between patients with and without cholesterolosis. Reported rates of histopathological findings were comparable between patients under and over 60 years old and patients with and without reported cholesterolosis. Results: Reported histopathological findings were presented as acute inflammation in 46 (10.7%), cholesterolosis in 79 (18.4%), gallbladder polypoid lesions in 7 (1.6%), epithelial hyperplasia in 16 (3.7%), metaplasia of any type in 34 (7.9%) of 429 patients. Dysplasia was excluded whereas one incidental gallbladder carcinoma was reported. Epithelial hyperplasia and metaplasia were found to be related to age. Gallbladder wall thickness was decreased with cholesterolosis. However, only a correlation between cholesterolosis and gender or metaplasia was noted. Conclusion: Recent study suggests that cholesterolosis is somehow associated with metaplasia. Thus, surgeons should carefully interpret the histopathology reports based on unusual or exceptional findings corresponding to the cholecystectomy specimens. Any abnormal finding in the reports should be investigated in terms of the progress of the pathology and also its clinical consequences.International Journal of Surgery (London, England) 09/2014; DOI:10.1016/j.ijsu.2014.08.402 · 1.44 Impact Factor
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ABSTRACT: To investigate the feasibility and significance of the clinical application of ultrasound score in assessing the clinical severity of acute cholecystitis in the elderly. Pre-surgery ultrasonography was performed on 72 elderly patients with acute cholecystitis who were scheduled for cholecystectomy to determine the score based on ultrasonic imaging features to reflect clinical severity. Prior to operation, the cases were classified as mild, moderate, and severe according to clinical manifestation. The significance of ultrasonography for the prediction of the severity of acute cholecystitis and its pre-surgery guidance were evaluated based on intraoperative findings and postoperative pathology. In the aspect of clinical severity, of the 72 cases, 36 were mild, 21 were moderate, and 15 were severe. The cases that showed enlarged gallbladders, thickened gallbladder walls, double-layer images, gallbladder stones, incarcerated gall-stones, echoes in gallbladder fluid, peri-gallbladder effusions, or adherences were mostly moderate and severe cases. The difference in these cases with the mild cases exhibited statistical significance (P < 0.05). Of the 28 cases that scored ≤5, 26 (92.68 %) were mild cases. The 26 cases that scored between 6 and 9 mainly consisted of 15 moderate cases (57.7 %). The 18 cases that scored ≥10 mainly consisted of 13 severe cases (72.2 %). Significant differences were found in the cholecystostomy cases among the three groups (P < 0.05). Prior to cholecystectomy, ultrasound score could accurately determine the severity of acute cholecystitis in the elderly and may be used as a reference for surgical intervention timing and mode selection to guide clinical therapy.Aging - Clinical and Experimental Research 05/2014; 27(1). DOI:10.1007/s40520-014-0236-9 · 1.01 Impact Factor