Early recognition and management of gangrenous cholecystitis: a single-center experience and a comprehensive review of risk factors and imaging findings
DOI:
https://doi.org/10.18203/2349-2902.isj20243977Keywords:
Gangrenous cholecystitis, Gallbladder necrosis, CholecystectomyAbstract
Background: Annually, approximately 200,000 acute cholecystitis (AC) cases are diagnosed in the U.S., with gangrenous cholecystitis (GC) occurring in 2-20% of AC cases. GC, characterized by ischemic necrosis of the gallbladder, is often associated with delayed diagnosis, leading to increased complications, longer hospital stays, and mortality rates ranging from 15-50%. This study presents a series of GC cases treated at our institution.
Methods: A retrospective review was conducted at a community hospital on patients from October 2012 to December 2022 with GC confirmed by pathology. Data collected included demographics, clinical parameters, lab values, imaging, operative findings, management, and outcomes, aiming to identify risk factors, treatment approaches, and associated outcomes.
Results: Out of 5,746 cholecystectomy patients, 67 (1.16%) had GC. The average age was 56, with a male predominance (64%). Incidence was highest among Hispanic (37%) and Asian (28%) populations. Common comorbidities included hypertension (48%), obesity (36%), and diabetes (33%). Clinical presentations included right upper quadrant pain (64%) and epigastric pain (46%). Computed tomography (CT) findings showed gallbladder distention (43%), fat stranding (22%), and perforation (3%). Surgical approaches were laparoscopic cholecystectomy (75%), converted-to-open cholecystectomy (19%), and open cholecystectomy (3%). Complications included bile leak (7%), wound infection (4%), hematoma (3%), and wound dehiscence (1%), with a 1.4% mortality rate.
Conclusions: GC is a severe AC complication linked to delayed presentation, with higher complication and mortality rates. Recognizing risk factors such as age, gender, and imaging/laboratory findings can facilitate early diagnosis and timely surgical intervention, improving patient outcomes.
Metrics
References
Wu B, Buddensick TJ, Ferdosi H, Narducci DM, Sautter A, Setiawan L, et al. Predicting gangrenous cholecystitis. HPB (Oxford). 2014;16(9):801-6. DOI: https://doi.org/10.1111/hpb.12226
Önder A, Kapan M, Ülger BV, Oğuz A, Türkoğlu A, Uslukaya Ö. Gangrenous cholecystitis: mortality and risk factors. Int Surg. 2015;100(2):254-60. DOI: https://doi.org/10.9738/INTSURG-D-13-00222.1
Nikfarjam M, Niumsawatt V, Sethu A, Fink MA, Muralidharan V, Starkey G, et al. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford). 2011;13(8):551-8. DOI: https://doi.org/10.1111/j.1477-2574.2011.00327.x
Yeh DD, Cropano C, Fagenholz P, King DR, Chang Y, Klein EN, et al. Deceiving ultrasounds, significant delay in surgical consult, and increased postoperative morbidity! J Trauma Acute Care Surg. 2015;79(5):812-6. DOI: https://doi.org/10.1097/TA.0000000000000832
Falor AE, Zobel M, Kaji A, Neville A, De Virgilio C. Admission variables predictive of gangrenous cholecystitis. Am Surg. 2012;78(10):1075-8. DOI: https://doi.org/10.1177/000313481207801014
Mok KW, Reddy R, Wood F, Turner P, Ward JB, Pursnani KG, et al. Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis? Int J Surg. 2014;12(7):649-53. DOI: https://doi.org/10.1016/j.ijsu.2014.05.040
Menéndez-Sánchez P, León-Salinas C, Amo-Salas M, Méndez-Cea B, García-Carranza A. Association of laboratory and radiologic parameters in the diagnosis of acute cholecystitis. Rev Gastroenterol Mex (Engl Ed). 2019;84(4):449-54. DOI: https://doi.org/10.1016/j.rgmxen.2019.02.007
Bakri K, Abu-Shaban K, Doddi S, Liu X, Begeman GA. Distinguishing Between Gangrenous Cholecystitis and Ascending Cholangitis: A Case Study. Cureus. 2022;14(8):e28322. DOI: https://doi.org/10.7759/cureus.28322
Asti E, Lovece A, Bonavina L. Gangrenous cholecystitis during hospitalization for SARS-CoV2 infection. Updates Surg. 2020;72(3):917-9. DOI: https://doi.org/10.1007/s13304-020-00814-6
Sureka B, Rastogi A, Mukund A, Thapar S, Bhadoria AS, Chattopadhyay TK. Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases. Indian J Radiol Imaging. 2018;28(1):49-54. DOI: https://doi.org/10.4103/ijri.IJRI_421_16
Amber IB, Leighton J, Li SY, Greene GS. The hot rim sign on hepatobiliary scintigraphy (HIDA) with CT correlation. BMJ Case Rep. 2012;2012:bcr0920114778. DOI: https://doi.org/10.1136/bcr.09.2011.4778
Yacoub WN, Petrosyan M, Sehgal I, Ma Y, Chandrasoma P, Mason RJ. Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score. Gastroenterol Res Pract. 2010;2010:901739. DOI: https://doi.org/10.1155/2010/901739
Bruni A, Garofalo E, Zuccalà V, Currò G, Torti C, Navarra G, et al. Histopathological findings in a COVID-19 patient affected by ischemic gangrenous cholecystitis. World J Emerg Surg. 2020;15(1):43. DOI: https://doi.org/10.1186/s13017-020-00320-5
Arroyo K, Bonadies J, Ciardiello K. Bile leak in open cholecystectomy: related to gangrenous cholecystitis? Conn Med. 2010;74(6):329-31.
Inoue H, Ochiai T, Kubo H, Yamamoto Y, Morimura R, Ikoma H, et al. Laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports. World J Clin Cases. 2021;9(14):3424-31. DOI: https://doi.org/10.12998/wjcc.v9.i14.3424
Hong X, He J, Li P, Chen J, Zou B, Li Z, et al. Evidence of SARS-CoV-2 infection in gallbladder and aggravating cholecystitis to septic shock: a case report. Ann Transl Med. 2021;9(21):1631. DOI: https://doi.org/10.21037/atm-21-4778
Downloads
Published
How to Cite
Issue
Section
