Gangrenous cholecystitis
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At the time the article was created Manchikanti Venkatesh had no recorded disclosures.
View Manchikanti Venkatesh's current disclosuresAt the time the article was last revised Liz Silverstone had no financial relationships to ineligible companies to disclose.
View Liz Silverstone's current disclosures- Membranous cholecystitis
Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients.
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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.
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
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- Gangrenous cholecystitis
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- 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
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