Gangrenous cholecystitis

Last revised by Yacoob Omar Carrim on 30 Jan 2023

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. Cystic duct obstruction results in increased gallbladder luminal pressure, which may lead to gallbladder wall ischemia progressing to necrosis. Gallbladder perforation occurs in about 10% of necrotic gallbladders.

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 3:

  • intraluminal membranes suggesting sloughing of the necrotic mucosa

  • 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

    • A negative sonographic Murphy Sign occurs in about a third of gangrenous cholecystitis. This may be 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

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Cases and figures

  • Case 1: ultrasound
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  • Case 1: CT
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  • Case 1: MRI
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5: DWI
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  • Case 6: with abscess formation
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  • Case 7
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  • Case 8
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  • Case 9
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