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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