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Park YS, Yoon H, Kang SY, Jo IJ, Woo S, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG. Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis. Diagnostics (Basel) 2022; 12:diagnostics12030721. [PMID: 35328274 PMCID: PMC8946906 DOI: 10.3390/diagnostics12030721] [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: 03/01/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to evaluate the diagnostic value of gallbladder width measurement with computed tomography (CT) in patients with acute cholecystitis. This retrospective case−control study was conducted between March 2016 and March 2020 at a tertiary emergency department. Of 310 patients, 254 patients with acute cholecystitis confirmed by surgery were compared with 254 patients diagnosed with other diseases (controls). In the acute cholecystitis group, the number of older patients with underlying illnesses was much higher (64% of men). Upon CT, the median (interquartile range [IQR]) gallbladder width was significantly longer in patients with acute cholecystitis (2.26 [1.82−2.78] cm vs. 3.73 [3.32−4.16] cm, p < 0.001). The optimal cut-off value of gallbladder width for differentiating acute cholecystitis was 3.12 cm, showing a sensitivity of 88% and specificity of 86%. In a multivariable analysis using a logistic regression model for diagnosing acute cholecystitis with CT findings (gallbladder width, length, stone, wall thickening, and pericholecystic fluid), a gallbladder width of ≥3.12 cm was significantly meaningful, even when adjusting for other variables (odds ratio 37.9; p < 0.001). Therefore, an increase in gallbladder width (≥3.12 cm) measured with CT can be a simple and sensitive diagnostic sign of acute cholecystitis, supporting the underlying pathophysiology of bile outflow obstruction.
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Affiliation(s)
- Yong Suk Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
- Correspondence:
| | - Soo Yeon Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sookyoung Woo
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (Y.S.P.); (S.Y.K.); (I.J.J.); (G.L.); (J.E.P.); (T.K.); (S.U.L.); (S.Y.H.); (W.C.C.); (T.G.S.)
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Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis. World J Surg 2020; 44:4077-4085. [PMID: 32860139 DOI: 10.1007/s00268-020-05752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials. MATERIALS AND METHODS A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated. RESULTS Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion. CONCLUSION In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
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Demirkan A, Tanrıverdi AK, Çetinkaya A, Polat O, Günalp M. The Effect of Leucocytosis, Gender Difference, and Ultrasound in the Diagnosis of Acute Cholecystitis in the Elderly Population. Emerg Med Int 2019; 2019:6428340. [PMID: 31065386 PMCID: PMC6466953 DOI: 10.1155/2019/6428340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Acute cholecystitis is one of the most common reasons of acute abdominal pain for older patients to present to the emergency department (ED). Presentation may differ from that of the younger patient and is often complicated by coexistent disease due to elderliness. In this study, we aimed to evaluate the clinical presentation of acute cholecystitis, with special focus on comparision between elderly and young patients. MATERIALS AND METHODS This study included 318 patients who were admitted to the emergency department with right upper quadrant pain during a period of determined 8 months. After retrospective data collection, patients were groupped in accordance with their age, <65 and ≥65 years. Those who had ultrasonographic signs such as wall thickening and fluid collection were diagnosed as acute cholecystitis. RESULTS The young group (Group I) consisted of 225 patients, 132 females and 93 males. In Group I, 39 patients were diagnosed as acute cholecystitis of whom 27 were females and 15 were males. The elderly group (Group II) consisted of 93 patients 48 females and 45 males. In Group II, 36 patients were diagnosed as acute cholecystitis of whom 15 were females and 21 were males. Regarding the diagnosis of acute cholecystitis, the female to male ratio is 2.25 in Group I and 0.71 in Group II (p=0.016). The average white blood cells counts of patients with acute cholecystitis in Group I and in Group II were 9907x109/L(±4.437) and 17083x109/L(±7485), respectively (p<0,001). CONCLUSIONS Acute cholecystitis is a common diagnosis in elderly patients with right upper quadrant pain. It is more frequent in female in the early ages, but the gender difference tends to change with age. Elderly patients demonstrate a higher level of white blood cells when compared to young patients in acute cholecystitis. Clinicians must maintain a degree of awareness in the evaluation of geriatric patients with right upper quadrant abdominal pain.
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Affiliation(s)
- Arda Demirkan
- Ankara University, School of Medicine, General Surgery Department, Samanpazarı, Ankara, Turkey
| | - Ayça Koca Tanrıverdi
- Ankara University, School of Medicine, Emergency Department, Samanpazarı, Ankara, Turkey
| | - Arda Çetinkaya
- Ankara University, School of Medicine, General Surgery Department, Samanpazarı, Ankara, Turkey
| | - Onur Polat
- Ankara University, School of Medicine, Emergency Department, Samanpazarı, Ankara, Turkey
| | - Müge Günalp
- Ankara University, School of Medicine, Emergency Department, Samanpazarı, Ankara, Turkey
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Bourikian S, Anand RJ, Aboutanos M, Wolfe LG, Ferrada P. Risk factors for acute gangrenous cholecystitis in emergency general surgery patients. Am J Surg 2015; 210:730-3. [DOI: 10.1016/j.amjsurg.2015.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 11/25/2022]
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Mok K, Reddy R, Wood F, Turner P, Ward J, Pursnani K, Date R. Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis? Int J Surg 2014; 12:649-53. [DOI: 10.1016/j.ijsu.2014.05.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/03/2014] [Accepted: 05/07/2014] [Indexed: 11/16/2022]
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Dua A, Dua A, Desai SS, Kuy S, Sharma R, Jechow SE, McMaster J, Patel B, Kuy S. Gender based differences in management and outcomes of cholecystitis. Am J Surg 2013; 206:641-6. [DOI: 10.1016/j.amjsurg.2013.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 12/14/2022]
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