Complicated cholecystitis: the complementary roles of sonography and computed tomography.

Stanford University School of Medicine, Stanford University Medical Center, Stanford, CA, USA.
Ultrasound quarterly (Impact Factor: 1.4). 09/2011; 27(3):161-70. DOI: 10.1097/RUQ.0b013e31822a33e8
Source: PubMed

ABSTRACT Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.

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    ABSTRACT: To evaluate whether the neutrophil-to-lymphocyte ratio (NLR), as a prognostic indicator, in patients can differentiate between simple and severe cholecystitis. A database of 632 patients who underwent cholecystectomy due to cholecystitis during approximately a seven-year span in a single institution was evaluated. Severe cholecystitis was defined when the cholecystitis was complicated by secondary changes, including hemorrhage, gangrene, emphysema, and perforation. The NLR was calculated at admission as the absolute neutrophil count divided by the absolute lymphocyte count. We used receiver operating characteristic curve analysis to identify the optimal value for the NLR in relation to the severity of cholecystitis. Thereafter, the differences in clinical manifestations according to the NLR cut-off value were investigated. Our study population comprised 503 patients with simple cholecystitis (79.6%) and 129 patients with severe cholecystitis (20.4%). The NLR of 3.0 could predict severe cholecystitis with 70.5% sensitivity and 70.0% specificity. A higher NLR (>=3.0) was significantly associated with older age (p =0.001), male gender (p =0.001), admission via the emergency department (p <0.001), longer operation time (p <0.001), higher incidence of postoperative complications (p =0.056), and prolonged length of hospital stay (LOS) (p <0.001). Multivariate analysis found that patient age >=50 years (odds ratio [OR]: 2.312, 95% confidence interval [CI]: 1.472-3.630, p <0.001), preoperative NLR >=3.0 (OR: 1.876, 95% CI: 1.246-2.825, p =0.003), and admission via the emergency department (OR: 1.764, 95% CI: 1.170-2.660, p =0.007) were independent factors associated with prolonged LOS. NLR >=3.0 was significantly associated with severe cholecystitis and prolonged LOS in patients undergoing cholecystectomy. Therefore, preoperative NLR in patients undergoing cholecystits due to cholecystitis seemed to be a useful surrogate marker for severe cholecystitis.
    BMC Surgery 11/2014; 14(1):100. DOI:10.1186/1471-2482-14-100 · 1.24 Impact Factor
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    01/2014; 2014:162643. DOI:10.1155/2014/162643
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    ABSTRACT: During laparoscopic surgery for an acutely inflamed gallbladder, most surgeons routinely insert a drain. However, no consensus has been reached regarding the need for drainage in these cases, and the use of a drain remains controversial. This retrospective study divided 457 cases into two groups according to whether or not a drain was inserted and reviewed the surgical outcomes and perioperative morbidity. In this study, 231 patients had no drains and 226 had drains. Both groups were comparable in terms of pathology, demographics, and operative details. There was no statistical difference in operating time, visual analog scale for pain, or postoperative hospital stay. Morbidity occurred in 49 cases (10.7 %) and did not differ significantly between the two groups. No mortality occurred in this study. The routine use of a drain after laparoscopic cholecystectomy for an acutely inflamed gallbladder had no effect on the postoperative morbidity. Therefore, this retrospective study supports that it is feasible not to insert a drain routinely in laparoscopic cholecystectomy for patients who have an acutely inflamed gallbladder.
    Journal of Gastrointestinal Surgery 01/2014; 18(5). DOI:10.1007/s11605-014-2457-9 · 2.39 Impact Factor