Gangrenous cholecystitis
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Gangrenous cholecystitis is a rare and severethe 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
Characteristic imagingIn addition to features includeof acute cholecystitis, the following may help diagnosis gangrenous cholecystitis 3:
- intraluminal membranes
-
overdistenionasymmetrical 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
adjacent hepatic enhancement
Treatment and prognosis
Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% 4.
-<p><strong>Gangrenous cholecystitis</strong> is a rare and severe complication of <a href="/articles/acute-cholecystitis">acute cholecystitis</a>.</p><h4>Radiographic features</h4><p>Characteristic imaging features include:</p><ul>- +<p><strong>Gangrenous cholecystitis</strong> is the most common complication of <a href="/articles/acute-cholecystitis">acute cholecystitis</a>, affecting ~15% (range 2-30%) of patients. </p><h4>Pathology</h4><p>Gangrenous cholecystitis occurs as a result of ischaemia with necrosis of the gallbladder wall <sup>4</sup>. </p><h5>Risk factors</h5><ul>
- +<li>male</li>
- +<li>increasing age</li>
- +<li>delayed surgery</li>
- +<li>cardiovascular disease</li>
- +<li>diabetes mellitus</li>
- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>In addition to features of acute cholecystitis, the following may help diagnosis gangrenous cholecystitis <sup>3</sup>:</p><ul>
-<li>overdistenion of the gallbladder</li>-<li>focal irregularity in gallbladder wall</li>-<li>absence of mural enhancement</li>- +<li>asymmetrical wall thickness</li>
- +<li>focal perfusion defects on Doppler (representing areas of necrosis)</li>
- +</ul><h5>CT</h5><p>In addition to features of acute cholecystitis, the following may help diagnosis gangrenous cholecystitis <sup>1</sup>:</p><ul>
- +<li>gallbladder wall or lumen gas</li>
- +<li>focal irregularity or defect in the gallbladder wall</li>
- +<li>intraluminal membranes</li>
- +<li>the absence of mural enhancement</li>
-<li>adjacent hepatic enhancement</li>-</ul>- +</ul><h4>Treatment and prognosis</h4><p>Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% <sup>4</sup>. </p>
References changed:
- 4. Önder A, Kapan M, Ülger BV, Oğuz A, Türkoğlu A, Uslukaya Ö. Gangrenous cholecystitis: mortality and risk factors. International surgery. 100 (2): 254-60. <a href="https://doi.org/10.9738/INTSURG-D-13-00222.1">doi:10.9738/INTSURG-D-13-00222.1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25692427">Pubmed</a> <span class="ref_v4"></span>
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