Theophilus Pham, MBA1, Daron Jacob, BS1, Chanaka Kahathuduwa, PhD2, Adel Alhaj Saleh, MD, MRCS1, Amir H Aryaie, MD, FACS1. 1Texas Tech University Health Sciences Center, 2Texas Tech University
Introduction: Cholecystitis and symptomatic cholelithiasis are two diseases that can present with very similar general symptoms making it difficult to distinguish between them based solely on clinical findings. Abdominal ultrasounds (US), and hepatobiliary iminodiacetic acid (HIDA) scans, are used to confirm diagnosis.
Objective: to determine predictive factors that can help the clinician more precisely diagnose acute cholecystitis for patients who were diagnosed with symptomatic cholelithiasis based on ultrasound.
Method: A retrospective review of all patients diagnoses with symptomatic cholelithiasis for last five years based on US. Data collection included demographics, admission, presence of nausea, presence of pain, presence of postprandial pain, positive Murphy’s sign, serum alkaline phosphatase (ALP), serum bilirubin, total White blood cell count, and the presence of a left shift in neutrophils.
Results: 287 patients with preoperative diagnosis of symptomatic cholelithiasis were included in the study, 226 (78.7%) of them had intra-operative findings of either acute or chronic cholecystitis. Pathology confirmed inflammation of the gall bladder in 282 (98.3%) of the patients. Presence of macroscopic features of cholecystitis during surgery was best predicted by the combination of sex, bilirubin level and the presence of left shift of neutrophils. The odds of a male patient having macroscopic features of cholecystitis was 1.12 times greater than the odds of a female patient having features of cholecystitis during surgery (p = 0.03). Similarly, the odds of a surgeon encountering features of acute or chronic cholecystitis was 1.17 time higher for patients with left shifted neutrophils (p = 0.003). Each 1 mg increase in serum bilirubin decreased the odds of having macroscopic features of cholecystitis by approximately 4% (OR = 0.96, p = 0.037). (Table #1)
Conclusion: Our data showed that only male sex, the presence of left-shifted neutrophils, and bilirubin were statistically significant to predict the intraoperative finding of cholecystitis. Additional studies could be used to expand the data pool in order to create a comprehensive preoperative scoring system to further differentiate between symptomatic cholelithasis and acute cholecystitis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96047
Program Number: P245
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster