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Turki A, Obaid AM, Bellaaj H, Ksantini M, AlTaee A. UIdataGB: Multi-Class ultrasound images dataset for gallbladder disease detection. Data Brief 2024; 54:110426. [PMID: 38708300 PMCID: PMC11068544 DOI: 10.1016/j.dib.2024.110426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Artificial Intelligence (AI) allows computers to self-develop decision-making algorithms through huge data analysis. In medical investigations, using computers to automatically diagnose diseases is a promising area of research that could change healthcare strategies worldwide. However, it can be challenging to reproduce or/and compare various approaches due to the often-limited datasets comprising medical images. Since there is no open access dataset for the Gallbladder (GB) organ, we introduce, in this study, a large dataset that includes 10,692 GB Ultrasound Images (UI) acquired at high resolution from 1,782 individuals. These UI include many disease types related to the GB, and they are organized around nine important anatomical landmarks. The data in this collection can be used to train machine learning (ML) and deep learning (DL) models for computer-aided detection of GB diseases. It can also help academics conduct comparative studies and test out novel techniques for analyzing UI to explore the medical domain of GB diseases. The objective is then to help move medical imaging forward so that patients get better treatment.
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Affiliation(s)
- Amina Turki
- CEMLab, National Engineering School of Sfax, University of Sfax, Tunisia
| | - Ahmed Mahdi Obaid
- National School of Electronics and Telecommunications of Sfax, University of Sfax, Tunisia
| | - Hatem Bellaaj
- ReDCAD, National Engineering School of Sfax, University of Sfax, Sfax 3029, Tunisia
| | - Mohamed Ksantini
- CEMLab, National Engineering School of Sfax, University of Sfax, Tunisia
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Medina VJ, Martial AM, Chatterjee T. Asymptomatic Gangrenous Acute Cholecystitis: A Life-Threatening Condition. Cureus 2023; 15:e36672. [PMID: 37123804 PMCID: PMC10132852 DOI: 10.7759/cureus.36672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 05/02/2023] Open
Abstract
Gangrenous gallbladder (GGB) is a life-threatening complication of acute cholecystitis, which happens due to gallbladder (GB) wall ischemia and necrosis. Delaying the diagnosis of GGB is life-threatening and may happen in asymptomatic patients. We present a case of an elderly male patient with a history of gastric carcinoid tumor, with partial gastric resection, who presented with generalized weakness and jaundice. His total bilirubin was elevated and an ultrasonography and computed tomography (CT) scan of the abdomen showed evidence of acute cholecystitis. An endoscopic retrograde cholangiopancreatography (ERCP) the day after admission showed no evidence of choledocholithiasis or cholangitis. It was during laparoscopic cholecystectomy three days later that the diagnosis of GGB was made as the GB was found to be necrotic with extensive adhesions. The patient also required intravenous antibiotics prior to discharge. This case illustrates risk factors for the development of gangrenous cholecystitis, physical findings in asymptomatic patients, and the importance of early diagnosis in order to reduce morbidity in this patient population.
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Affiliation(s)
- Victor J Medina
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Annia M Martial
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
| | - Tulika Chatterjee
- Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, USA
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Katsumata R, Manabe N, Urano T, Tanikawa T, Ishii K, Ayaki M, Fujita M, Suehiro M, Fujiwara H, Monobe Y, Kamada T, Yamatsuji T, Naomoto Y, Haruma K, Kawamoto H. Asymptomatic gangrenous cholecystitis diagnosed using contrast-enhanced ultrasonography in a patient with pancreatic cancer. Radiol Case Rep 2022; 17:2309-2314. [PMID: 35570858 PMCID: PMC9095665 DOI: 10.1016/j.radcr.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/02/2022] [Indexed: 10/25/2022] Open
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Fang R, Yerkovich S, Chandrasegaram M. Pre-operative predictive factors for gangrenous cholecystitis at an Australian quaternary cardiothoracic centre. ANZ J Surg 2021; 92:781-786. [PMID: 34904358 DOI: 10.1111/ans.17410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to determine associations between pre-operative factors and gangrenous cholecystitis. Gangrenous cholecystitis represents a severe spectrum of cholecystitis and is associated with an increased risk of complications. Early recognition and diagnosis of gangrenous cholecystitis can optimize prioritization for surgery and improve outcomes. METHODS A retrospective case-control study was undertaken. Patient demographics, medical comorbidities, pre-operative biochemical and ultrasound findings as well as post-operative outcomes were assessed. Four hundred and fourteen patients who underwent an emergency cholecystectomy between 2018 and 2020 were reviewed. RESULTS One hundred and nine (26%) patients who underwent emergency cholecystectomy during this 3-year period had gangrenous cholecystitis. These patients were older (median age 65 versus 45, P < 0.001) and more likely to be male (58.7% versus 32.5%, P < 0.001). Patients with coronary disease (OR 2.55, P < 0.001), hypertension (OR 2.25, P = 0.001), or arrhythmias (OR 3.64, P = 0.001) were two-to-three times more likely to have gangrenous cholecystitis. Patients with renal disease (OR 1.92, P = 0.004) or using antiplatelet medication (OR 2.27, P = 0.003) were twice as likely to have gangrenous cholecystitis. Patients who had gangrenous cholecystitis presented with a higher white cell count (median 13 x 109 /L versus 8 x 109 /L, P < 0.001) and a higher C-reactive protein (median 196 versus 18 mg/L, P < 0.001). Patients with gangrenous cholecystitis had poorer post-operative outcomes. CONCLUSION We verified predictive factors from existing literature and identified a number of novel pre-operative predictive factors for gangrenous cholecystitis which could help with development of a scoring system for clinical use.
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Affiliation(s)
- Robert Fang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie Yerkovich
- The Common Good Foundation, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manju Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Erlichman DB, Lipman JN, In H, Ye K, Lin J, Goldman I. Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis. Clin Imaging 2020; 73:53-56. [PMID: 33310404 DOI: 10.1016/j.clinimag.2020.11.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the association between the CT rim sign and gangrenous cholecystitis (GC) and increased surgical difficulty. METHOD Patients who had a contrast enhanced CT of the abdomen and pelvis, followed by non-elective cholecystectomy were analyzed. The scans were reviewed for the CT rim sign by radiologists blinded to the pathologic and clinical outcomes. Demographic and clinical characteristics were compared between patients with and without GC using t-tests or Wilcoxon ranked sum test for continuous variables, and Fishers' exact test for categorical variables, when appropriate. A logistic regression model was fitted with multiple risk factors. Odds ratios as well as 95% confidence intervals were then calculated for the risk factors. A secondary analysis predicting increased surgical difficulty, defined as an operative time of greater than 2 h or increased conversion rate to open surgery, was also examined. RESULTS A total of 100 patients were included; 20 of which had GC. On imaging, patients with GC were more likely to have a CT rim sign (65% vs 32.5%, OR = 3.80, 95% CI: 1.24-12.7, p = 0.011). The presence of the CT rim sign did not reach a statistically significant association with an operative time >2 h or conversion to open case (56.52% vs 33.77%, OR = 2.55, p = 0.056). CONCLUSION The CT rim sign can be utilized to raise the possibility of GC, however the presence of the CT rim sign does not demonstrate an association with increased surgical difficulty.
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Affiliation(s)
- David B Erlichman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Jeffrey N Lipman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Haejin In
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kenny Ye
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Juan Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Inessa Goldman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
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Argiriov Y, Dani M, Tsironis C, Koizia LJ. Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management. Front Surg 2020; 7:42. [PMID: 32793627 PMCID: PMC7385246 DOI: 10.3389/fsurg.2020.00042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.
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Affiliation(s)
- Yanna Argiriov
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Melanie Dani
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Christos Tsironis
- Department of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louis J Koizia
- Cutrale Perioperative and Ageing Research Group, Department of Bioengineering, Imperial College London, London, United Kingdom
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Falor AE, Zobel M, Kaji A, Neville A, De Virgilio C. Admission Variables Predictive of Gangrenous Cholecystitis. Am Surg 2020. [DOI: 10.1177/000313481207801014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of the present study was to identify admission clinical factors associated with gangrenous cholecystitis (GC) and factors associated with conversion to open cholecystectomy. We retrospectively evaluated 391 patients over a 17-month period who underwent urgent laparoscopic cholecystectomy for a diagnosis of acute cholecystitis. Eighty-nine patients with pathologically proven GC were compared with 302 patients without GC. On multivariable logistic regression, predictors of GC included male gender, white blood cell count greater than 14,000/mm3, heart rate greater than 90 beats per minute, and sodium 135 mg/dL or less. Conversion rate to open cholecystectomy was 7.9 per cent overall, 4 per cent for non-GC, and 19 per cent for GC (odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4; P < 0.00001). Conversion was predicted by increasing number of days to surgery, total bilirubin, and white blood cell count. Complication rate was higher in the GC group (10.1 vs 3.6% in the acute cholecystitis group, P = 0.01). The increased rate of conversion observed with surgery delay suggests that early laparoscopic cholecystectomy may be preferable in most patients.
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Affiliation(s)
- Ann E. Falor
- Departments of Surgery and Harbor-UCLA Medical Center, Torrance, California
| | - Michael Zobel
- Departments of Surgery and Harbor-UCLA Medical Center, Torrance, California
| | - Amy Kaji
- Departments of Emergency Medicine and the Harbor-UCLA Medical Center, Torrance, California
- Departments of Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Angela Neville
- Departments of Surgery and Harbor-UCLA Medical Center, Torrance, California
- Departments of Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Christian De Virgilio
- Departments of Surgery and Harbor-UCLA Medical Center, Torrance, California
- Departments of Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, Torrance, California
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Subtotal laparoscopic cholecystectomy for gangrenous gallbladder during recovery from COVID-19 pneumonia. Int J Surg Case Rep 2020; 72:335-338. [PMID: 32551214 PMCID: PMC7293458 DOI: 10.1016/j.ijscr.2020.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Gallbladder gangrene can present during hospital stay for COVID-19. Protective measures are mandatory to prevent transmission to hospital personnel. Subtotal laparoscopic cholecystectomy is feasible, safe, and effective.
Introduction Management of acute abdomen during COVID-19 pandemic may be challenging. Presentation of case A 42-year old man was hospitalized for Covid-19 pneumonia. Fever, respiratory symptoms and hypoxemia significantly improved over the next 2 weeks, but the patient developed abdominal pain, nausea, and low-grade fever. Computed tomography scan revealed absence of contrast enhancement of gallbladder wall and a micro-perforation of the fundus. At laparoscopy, gallbladder gangrene was confirmed and a subtotal cholecystectomy performed. Special precautions were adopted for patient transportation from the ward to a dedicated operating room, and two teams with adequate personal protective equipment took charge of the procedure. The patient was discharged home on postoperative day 7 under protective lockdown measures for 2 weeks. Discussion The pathogenesis of acute acalcolous gangrenous cholecystitis is multifactorial. It is unknown whether a prothrombotic state induced by COVID-19 contributes to wall ischemia and perforation. Percutaneous cholecystostomy should be avoided in patients with gallbladder gangrene. Contraindications to laparoscopy are not evidence-based since aerosolization is produced during both open and laparoscopic surgical procedures. However, personal protective equipment is key for prevention. Conclusion Early diagnosis and surgical therapy are critical in patients with gangrenous cholecystitis. Subtotal laparoscopic cholecystectomy for gangrenous gallbladder is safe and effective.
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Shirah BH, Shirah HA, Saleem MA, Chughtai MA, Elraghi MA, Shams ME. Predictive factors for gangrene complication in acute calculous cholecystitis. Ann Hepatobiliary Pancreat Surg 2019; 23:228-233. [PMID: 31501810 PMCID: PMC6728255 DOI: 10.14701/ahbps.2019.23.3.228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 01/18/2023] Open
Abstract
Backgrounds/Aims Gallbladder gangrene is a grave complication of acute calculous cholecystitis that is difficult to detect preoperatively. Ultrasound could show a gallbladder wall that is more thickened. In addition, other clinical measures were reported to be possible predictive factors. Therefore, we aim in this study to evaluate the gallbladder wall thickness measured by ultrasound and other clinical measures as predictive factors for gangrene complication in acute calculous cholecystitis. Methods A prospective cohort database analysis of the results of 674 patients diagnosed and treated for acute calculous cholecystitis between January 2010 and December 2014 was done. Patient's inclusion criteria were acute calculous cholecystitis in adults who were operated within three days of onset of symptoms. Results 117 (17.4%) patients had gangrene. Gallbladder sonographic wall thickness 5.1–6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference (p≤0.01). Conclusions We conclude that gallbladder sonographic wall thickness 5.1–6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference. By implementing these risk factors, patients urgency for surgery can be decided in the emergency department. Other risk factors such as high alanine aminotransferase, elevated aspartate aminotransferase, and high alkaline phosphatase could be of help in the decision for early operation.
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Affiliation(s)
- Bader Hamza Shirah
- King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hamza Asaad Shirah
- Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia
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Mehrzad M, Jehle CC, Roussel LO, Mehrzad R. Gangrenous cholecystitis: A silent but potential fatal disease in patients with diabetic neuropathy. A case report. World J Clin Cases 2018; 6:1007-1011. [PMID: 30568955 PMCID: PMC6288495 DOI: 10.12998/wjcc.v6.i15.1007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
Gangrenous cholecystitis (GC) is a severe and potentially deadly complication of acute cholecystitis. We present a 83-year-old gentleman with a past medical history of type 2 diabetes mellitus with significant associated neuropathy, presenting to a community hospital in a major metropolitan area with 10 days nausea and vomiting and a benign abdominal exam. While the patient was admitted for hyperglycemia, he was subsequently found to have severe GC requiring urgent surgical intervention.
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Affiliation(s)
- Melorin Mehrzad
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Brown University, Providence, RI 02903, United States
| | - Charles C Jehle
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Brown University, Providence, RI 02903, United States
| | - Lauren O Roussel
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Brown University, Providence, RI 02903, United States
| | - Raman Mehrzad
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Brown University, Providence, RI 02903, United States
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Safa R, Berbari I, Hage S, Dagher GA. Atypical presentation of gangrenous cholecystitis: A case series. Am J Emerg Med 2018; 36:2135.e1-2135.e5. [PMID: 30146394 DOI: 10.1016/j.ajem.2018.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis that has been associated with increased morbidity. Patient with GC can present with a wide variety of non-specific clinical, laboratory, and imaging characteristics, making the diagnosis challenging. This disease requires emergent treatment, which is why a quick and reliable diagnosis is essential for the wellbeing of the patient. The authors herein present a case of GC in a patient whose initial complaint was intractable hiccups, and provide a thorough review of the literature of cases of GC with atypical presentations.
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Affiliation(s)
- Rawan Safa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandrine Hage
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Sagrini E, Pecorelli A, Pettinari I, Cucchetti A, Stefanini F, Bolondi L, Piscaglia F. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis. Intern Emerg Med 2016; 11:19-30. [PMID: 26078199 DOI: 10.1007/s11739-015-1263-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/15/2015] [Indexed: 12/21/2022]
Abstract
Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.
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Affiliation(s)
- Elisabetta Sagrini
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy.
| | - Anna Pecorelli
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Irene Pettinari
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Alessandro Cucchetti
- Liver and Multiorgan Transplant Unit, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Federico Stefanini
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Luigi Bolondi
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Department of Medical and Surgical Sciences DIMEC, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
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Dhir T, Schiowitz R. Old man gallbladder syndrome: Gangrenous cholecystitis in the unsuspected patient population. Int J Surg Case Rep 2015; 11:46-49. [PMID: 25917175 PMCID: PMC4446664 DOI: 10.1016/j.ijscr.2015.03.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
Gangrenous cholecystitis has been seen more commonly in elderly subjects due to their asymptomatic nature, and many present to the emergency room later and had more complications due to delay in care. Risk factors for gangrenous cholecystitis include age and WBC, thickened gallbladder wall on ultrasound and lack of mucosal enhancement. On physical exam, lack of Murphy’s sign, secondary to denervation from gangrenous changes can also increase the index of suspicion. Presence of gangrenous cholecystitis can also increase patients’ postoperative complications, morbidity and mortality.
Introduction Acute cholecystitis is a common surgical condition, but not many are aware of the serious complication of gangrenous cholecystitis (GC). Presence of GC increases patients’ postoperative complications, morbidity and mortality. Predictive factors for GC include age >45, male gender, white blood cell count >13,000/mm3 and ultrasound findings of a negative Murphy’s sign. Case presentation (1) GW, 83 male with dull right upper quadrant pain and a negative Murphy’s sign with further imaging showing a thickened septated gallbladder suggestive of GC. Patient’s surgery was difficult and he received a cholecystostomy tube for drainage. (2) PH, 75 male with minimal right upper quadrant pain, equivocal ultrasound with a negative Murphy’s sign and computer tomography (CT) showing acute cholecystitis. Patient was taken to the operating room for cholecystectomy, with pathology consistent with gangrenous cholecystitis. Discussion Multiple laboratory findings and imaging patterns have been found to be highly predictive of GC. Along with age and WBC, thickened gallbladder wall and lack of mucosal enhancement have been predictive of GC. On physical examination, lack of Murphy’s sign secondary to denervation from gangrenous changes also increases the index of suspicion for GC. Conclusion GC is a serious complication of acute cholecystitis with increased morbidity and mortality. There should be a high index of suspicion for GC if the above unique physical and laboratory findings are present.
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Affiliation(s)
- Teena Dhir
- 14511 Pine Court, Riverside, CA 92503, USA.
| | - Robert Schiowitz
- Albert Einstein Medical Center, 5501 Old York Road Philadelphia, PA 19141, USA
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Önder A, Kapan M, Ülger BV, Oğuz A, Türkoğlu A, Uslukaya Ö. Gangrenous cholecystitis: mortality and risk factors. Int Surg 2015; 100:254-60. [PMID: 25692427 PMCID: PMC4337439 DOI: 10.9738/intsurg-d-13-00222.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.
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Affiliation(s)
- Akın Önder
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Murat Kapan
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Ahmet Türkoğlu
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Ömer Uslukaya
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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15
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan ACW, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:35-46. [PMID: 23340953 DOI: 10.1007/s00534-012-0568-9] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. Discussion by the Tokyo Guidelines Revision Committee concluded that acute cholecystitis should be suspected when Murphy's sign, local inflammatory findings in the gallbladder such as right upper quadrant abdominal pain and tenderness, and fever and systemic inflammatory reaction findings detected by blood tests are present but that definite diagnosis of acute cholecystitis can be made only on the basis of the imaging of ultrasonography, computed tomography or scintigraphy (HIDA scan). These proposed diagnostic criteria provided better specificity and accuracy rates than the TG07 diagnostic criteria. As for the severity assessment criteria in TG07, there is evidence that TG07 resulted in clarification of the concept of severe acute cholecystitis. Furthermore, there is evidence that severity assessment in TG07 has led to a reduction in the mean duration of hospital stay. As for the factors used to establish a moderate grade of acute cholecystitis, such as leukocytosis, ALP, old age, diabetes, being male, and delay in admission, no new strong evidence has been detected indicating that a change in the criteria used in TG07 is needed. Therefore, it was judged that the severity assessment criteria of TG07 could be applied in the updated Tokyo Guidelines (TG13) with minor changes. TG13 presents new standards for the diagnosis, severity grading and management of acute cholecystitis. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan.
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16
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Leukocytosis of unknown origin: gangrenous cholecystitis. Case Rep Med 2013; 2013:418014. [PMID: 23606852 PMCID: PMC3628491 DOI: 10.1155/2013/418014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 02/23/2013] [Accepted: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
There have been case reports where patients admitted with acute cholecystitis, who were managed conservatively, had subsequently developed GC (gangrenous cholecystitis). The current case is unique, since our patient denied any prior episodes of abdominal pain and the only tip off was leukocytosis. A high index of suspicion is essential for the early diagnosis and treatment of GC. GC has a mortality rate of up to 22% and a complication rate of 16-25%. Complications associated with GC include perforation, which has been reported to occur in as many as 10% of cases of acute cholecystitis. The radiological investigations may not be conclusive. Ultrasonography usually serves as the first-line imaging modality for the evaluation of patients with clinically suspected acute cholecystitis. However, CT can play an important role in the evaluation of these patients if sonography is inconclusive. There is a need for an early (if not urgent) surgical intervention in acute cholecystitis (whether laparoscopic or open surgery) in order to decrease the time elapsed from the start of symptoms to admission and treatment.
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17
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:578-85. [PMID: 22872303 PMCID: PMC3429769 DOI: 10.1007/s00534-012-0548-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13). Methods and materials We retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The “gold standard” for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis. Results Of 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III). Conclusion The proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
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18
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Nikfarjam M, Niumsawatt V, Sethu A, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 2011; 13:551-8. [PMID: 21762298 PMCID: PMC3163277 DOI: 10.1111/j.1477-2574.2011.00327.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies. METHODS Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC. RESULTS A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P= 0.001), diabetes (19% vs. 10%; P= 0.049), temperature of >38 °C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P= 0.002), detection of muscle rigidity on examination (27% vs. 12%; P= 0.01) and greater elevations in white cell count (WCC) (13.4 × 10⁹/l vs. 10.7 × 10⁹/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P= 0.001), bilirubin (19 µmol/l vs. 17 µmol/l; P= 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P= 0.016) and creatinine (82 µmol/l vs. 74 µmol/l; P= 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0-14 days vs. median = 1 day, range: 0-10 days; P= 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P= 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P= 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P= 0.017), but this was not an independent risk factor on multivariate analysis. CONCLUSIONS Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in complications when treated in a specialized unit.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Vic., Australia.
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19
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Chaudhry S, Hussain R, Rajasundaram R, Corless D. Gangrenous cholecystitis in an asymptomatic patient found during an elective laparoscopic cholecystectomy: a case report. J Med Case Rep 2011; 5:199. [PMID: 21600009 PMCID: PMC3127841 DOI: 10.1186/1752-1947-5-199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 05/21/2011] [Indexed: 12/14/2022] Open
Abstract
Introduction Gangrenous cholecystitis is a severe complication of acute cholecystitis. We present an unusual case of gangrenous cholecystitis which was totally asymptomatic, with normal pre-operative parameters, and was discovered incidentally during a laparoscopic cholecystectomy. We have not found any similar cases in the published literature. Case presentation A 79-year-old British Caucasian man presented initially with acute cholecystitis which responded to conservative management. After six weeks he was asymptomatic and had normal blood parameters. An elective laparoscopic cholecystectomy was performed and our patient was found to have a totally gangrenous gall bladder. Conclusion It is important to keep a high index of suspicion for the diagnosis of gangrenous cholecystitis in order to avoid potentially serious complications.
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Affiliation(s)
- Sunil Chaudhry
- Department of Histopathology, Royal Victoria Infirmary/NHS, Newcastle Upon Tyne, NE1 4LP, UK.
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Aydin C, Altaca G, Berber I, Tekin K, Kara M, Titiz I. Prognostic parameters for the prediction of acute gangrenous cholecystitis. ACTA ACUST UNITED AC 2006; 13:155-9. [PMID: 16547678 DOI: 10.1007/s00534-005-1042-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 08/18/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE The aim of this study was to identify preoperative prognostic parameters for gangrenous cholecystitis to differentiate this subgroup of patients with acute cholecystitis in order to provide immediate surgical therapy. METHODS The medical records of patients who had an emergency cholecystectomy with the diagnosis of acute cholecystitis between January 2002 and June 2005 were reviewed retrospectively. Univariate and multivariate analysis were performed on the data. RESULTS Out of 203 individuals with the clinical diagnosis of acute cholecystitis, 21 (10.3%) patients had a histological diagnosis of gangrenous cholecystitis. Multivariate analysis demonstrated an independent association of male sex, diabetes mellitus and white blood cell (WBC) count with the development of acute gangrenous cholecystitis. CONCLUSIONS The risk for gangrenous cholecystitis is increased in male patients who have diabetes and a greater WBC count than 14 900/mm(3). Urgent surgical intervention should be considered for these patients because of the high morbidity and mortality rate of the condition.
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Affiliation(s)
- Cagatay Aydin
- First General Surgery Department, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
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