Gangrenous cholecystitis

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

Pathology

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

Risk factors

• male
• increasing age
• delayed surgery
• cardiovascular disease
• diabetes mellitus

Radiographic features

Ultrasound

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

• intraluminal membranes
• asymmetrical wall thickness
• focal perfusion defects on Doppler (representing areas of necrosis)

CT

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

• gallbladder wall or lumen gas
• focal irregularity or defect in the gallbladder wall
• intraluminal membranes
• the absence of mural enhancement
• pericholecystic abscess

Treatment and prognosis

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