Rebecca C Gologorsky, MD1, Justin R Tse, MD2, Aya Kamaya, MD2. 1University of California San Francisco-East Bay, 2Stanford University
Gangrenous cholecystitis is a severe complication of acute cholecystitis and is associated with high morbidity and mortality. There are few characteristic clinical indicators of gangrenous cholecystitis, making preoperative diagnosis difficult. Previously published algorithms involve extensive mathematics and therefore have limited application. We identify sonographic and clinical features of gangrenous cholecystitis and propose a scoring system to facilitate preoperative diagnosis.
We retrospectively reviewed all adult patients from 1/2014-5/2018 who underwent abdominal ultrasound within 48 of cholecystectomy for acute cholecystitis. A diagnosis of gangrenous cholecystitis (GC) versus uncomplicated acute cholecystitis (UAC) was confirmed by review of pathology reports. Pertinent clinical features, demographics, and laboratory values were recorded. Ultrasonographic imaging features were reviewed by a blinded abdominal radiologist. Two-tailed t-tests and Fisher’s exact tests were used to determine statistical significance for continuous and categorical variables, respectively. A multivariate analysis was performed using all statistically variables to create a model to predict a diagnosis of gangrenous cholecystitis.
One-hundred one patients met inclusion criteria. Forty-eight (48%) had GC and 53 (52%) had UAC. Points were assigned to each associated clinical or ultrasonographic feature as detailed in table 1. A total score of 0-2 points correlated with low probability (<25%), 3-4 points with intermediate probability (25-75%), and 5 or more points high probability (>75%) of GC. Of our patient cohort 45% (45/101) fell into the low probability, 29% (29/101) fell into the intermediate probability, and 27% (27/101) fell into the high probability category. There were no UAC patients who were categorized as high risk.
We propose a simple scoring system based on clinical and imaging features to facilitate preoperative diagnosis of GC. Prompt identification of GC may improve treatment planning and clinical outcomes. Evaluation of the impact of diagnosis timing versus surgical intervention and outcomes should be studied, as well as clinical factors that lead to late-stage diagnosis of cholecystitis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95795
Program Number: P262
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster