Gangrenous cholecystitis
Last revised by Andrew Murphy on 7 Feb 2023
Citation, DOI, disclosures and article data
Citation:
Venkatesh M, Murphy A, Omar Carrim Y, et al. Gangrenous cholecystitis. Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-25209
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rID:
25209
Article created:
12 Oct 2013,
Manchikanti Venkatesh
Disclosures:
At the time the article was created Manchikanti Venkatesh had no recorded disclosures.
View Manchikanti Venkatesh's current disclosures
Last revised:
7 Feb 2023,
Andrew Murphy ◉
Disclosures:
At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.
View Andrew Murphy's current disclosures
Revisions:
24 times, by
20 contributors -
see full revision history and disclosures
Systems:
Tags:
Synonyms:
- Membranous cholecystitis
Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients.
On this page:
Epidemiology
Risk factors
- male
- increasing age
- delayed surgery
- cardiovascular disease
- diabetes mellitus
- systemic inflammatory response syndrome 5
Pathology
Gangrenous cholecystitis occurs as a result of ischemia with necrosis of the gallbladder wall 4.
Radiographic features
Ultrasound
In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 3:
- intraluminal membranes
- asymmetrical wall thickness
- with possible wall disruption and/or ulceration
- focal perfusion defects on Doppler (representing areas of necrosis)
- variable absence of the sonographic Murphy sign 7
- attributed to ischemic denervation of the gallbladder 6
CT
In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 1:
- gallbladder wall or lumen gas (emphysematous cholecystitis)
- focal irregularity or defect in the gallbladder wall
- intraluminal membranes
- absence of mural enhancement
- pericholecystic abscess
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Treatment and prognosis
Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% 4.
Quiz questions
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References
- 1. Bennett GL, Rusinek H, Lisi V et-al. CT findings in acute gangrenous cholecystitis. AJR Am J Roentgenol. 2002;178 (2): 275-81. doi:10.2214/ajr.178.2.1780275 - Pubmed citation
- 2. Jeffrey RB, Laing FC, Wong W et-al. Gangrenous cholecystitis: diagnosis by ultrasound. Radiology. 1983;148 (1): 219-21. Radiology (abstract) - Pubmed citation
- 3. Corr P. Sonography of gangrenous cholecystitis. J Emerg Trauma Shock. 2012;5 (1): 82-3. doi:10.4103/0974-2700.93112 - Free text at pubmed - Pubmed citation
- 4. Önder A, Kapan M, Ülger BV, Oğuz A, Türkoğlu A, Uslukaya Ö. Gangrenous cholecystitis: mortality and risk factors. International surgery. 100 (2): 254-60. doi:10.9738/INTSURG-D-13-00222.1 - Pubmed
- 5. Bourikian S, Anand RJ, Aboutanos M, Wolfe LG, Ferrada P. Risk factors for acute gangrenous cholecystitis in emergency general surgery patients. (2015) American journal of surgery. 210 (4): 730-3. doi:10.1016/j.amjsurg.2015.05.003 - Pubmed
- 6. Oppenheimer DC, Rubens DJ. Sonography of Acute Cholecystitis and Its Mimics. (2019) Radiologic clinics of North America. 57 (3): 535-548. doi:10.1016/j.rcl.2019.01.002 - Pubmed
- 7. Simeone JF, Brink JA, Mueller PR, Compton C, Hahn PF, Saini S, Silverman SG, Tung G, Ferrucci JT. The sonographic diagnosis of acute gangrenous cholecystitis: importance of the Murphy sign. (1989) AJR. American journal of roentgenology. 152 (2): 289-90. doi:10.2214/ajr.152.2.289 - Pubmed
Incoming Links
Cases:
- Gangrenous cholecystitis
- Complicated emphysematous cholecystitis
- Acute cholecystitis
- Perforated cholecystitis
- Gangrenous cholecystitis
- Subacute pericholecystic abscess
- Bouveret syndrome
- Severe gangrenous cholecystitis
- Gangrenous cholecystitis
- Gangrenous cholecystitis
- Gangrenous cholecystitis
- Gangrenous cholecystitis
- Gangrenous cholecystitis
- Gangrenous cholecystitis
- Cholecystitis with focal perforation and hepatic abscess
- Emphysematous cholecystitis
- Gangrenous cholecystitis
Multiple choice questions:
Related articles: Pathology: Hepato-Pancreato-Biliary
- liver
- depositional disorders
- infection and inflammation
- liver abscess
- hepatic hydatid infection
- cirrhosis
- hepatitis
- cholecystitis
- cholangitis
- malignancy
- liver and intrahepatic bile duct tumors
- benign epithelial tumors
- hepatocellular hyperplasia
- hepatocellular adenoma
- hepatic/biliary cysts
- benign nonepithelial tumors
- primary malignant epithelial tumors
- hepatocellular carcinoma
- hepatocellular carcinoma variants
-
cholangiocarcinoma
- intra-hepatic
- mass-forming type
- periductal infiltrating type - Klatskin tumors
- intraductal growing type
- extra-hepatic/large duct type
- intra-hepatic
- biliary cystadenocarcinoma
- combined hepatocellular and cholangiocarcinoma
- hepatoblastoma
- undifferentiated carcinoma
- primary malignant nonepithelial tumors
- hematopoietic and lymphoid tumors
- primary hepatic lymphoma
- hepatic myeloid sarcoma (hepatic chloroma)
- secondary tumors
- miscellaneous
- adrenal rest tumors
- hepatic carcinosarcoma
- hepatic fibroma
- hepatic hemangioma
- hepatic Kaposi sarcoma
- hepatic lipoma
- hepatic mesenchymal hamartoma
- hepatic myxoma
- hepatic rhabdoid tumor
- hepatic solitary fibrous tumor
- hepatic teratoma
- hepatic yolk sac tumor
- inflammatory myofibroblastic tumor (inflammatory pseudotumor)
- nodular regenerative hyperplasia
- pancreatic rest tumors
- primary hepatic carcinoid
- benign epithelial tumors
- liver and intrahepatic bile duct tumors
- metabolic
- trauma
-
vascular and perfusion disorders
- portal vein related
- hepatic artery related
- hepatic veins related
- inferior vena cava related
- other
- third inflow
- liver thrombotic angiitis
- infra diaphragmatic total anomalous pulmonary venous return (TAPVR)
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)
- pancreas
-
pancreatic neoplasms
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- non-epithelial pancreatic neoplasms
- others
- simple pancreatic cyst
-
pancreatitis (mnemonic for the causes)
- acute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- tropical pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- hypertriglyceridemia-induced pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- pancreaticopleural fistula
- segmental pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- pancreatic transplant
-
pancreatic neoplasms
- gallbladder and biliary
- congenital malformations and anatomical variants
- gallstones
- gallbladder inflammation
- bile ducts inflammation
- gallbladder wall abnormalities
- other gallbladder abnormalities
- bile duct dilatation (differential)
- bile duct wall thickening (differential)
- bile ducts neoplasms
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