Gangrenous cholecystitis

Last revised by Liz Silverstone on 4 Nov 2024

Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients. 

Gangrenous cholecystitis occurs as a result of ischemia with necrosis of the gallbladder wall 4

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

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 1:

Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% 4

Cases and figures

  • Case 1: US, CT x 2, drain, MR, path
  • Case 1: CT
  • Case 1: MRI
  • Case 2
  • Case 3
  • Case 4
  • Case 5: DWI
  • Case 6: with abscess formation
  • Case 7
  • Case 8
  • Case 9
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