Diagnosis Of Acute Cholecystitis Research Articles

Association of biliary distention with a diagnosis of acute cholecystitis

BackgroundGallbladder distention has been described in radiology literature but its value on point-of-care ultrasound (PoCUS) performed by emergency physicians is unclear. We sought to determine the test characteristics of gallbladder distention on PoCUS for cholecystitis (acute or chronic), and secondarily whether distention was associated with an obstructing stone-in-neck (SIN), acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. MethodsThis was a dual-site retrospective cohort study of all Emergency Department (ED) patients that underwent diagnostic biliary PoCUS and were subsequently admitted from 11/1/2020 to 10/31/2022. Patients with pregnancy, liver failure, ascites, hepatobiliary cancer, prior cholecystectomy, or known cholecystitis were excluded. Gallbladder distention was defined as a width ≥4 cm or a length ≥10 cm. Saved ultrasound images were reviewed by three independent reviewers who obtained measurements during the review. Test characteristics, Cohen's kappa (κ), and strength of association between distention and our variables (acute cholecystitis on pathology report and SIN on PoCUS) were calculated using a Chi Square analysis, where intervention (cholecystectomy, percutaneous cholecystostomy, or intravenous antibiotics) was used as the reference standard for AC. A one-tail two sample t-test was calculated for mean operative times. ResultsOf 280 admitted patients who underwent ED biliary PoCUS, 53 were excluded, and 227 were analyzed. Of the 227 patients, 113 (49.8%) had cholecystitis according to our reference standard, and 68 (30.0%) had distention on PoCUS: 32 distended by both width and length, 16 distended by width alone, and 20 distended by length alone. Agreement between investigators was substantial for width (κ 0.630) and length (κ 0.676). Distention was 85.09% (95% CI 77.20–91.07%) specific and 45.1% (95% CI 35.8–54.8%) sensitive for cholecystitis. There was an association between distention and SIN; odds ratio (OR) 2.76 (95% CI 1.54–4.97). Distention of both length and width was associated with acute over chronic cholecystitis; OR 4.32 (95% CI 1.42–13.14). Among patients with acute cholecystitis, mean operative times were 114 min in patients with distention and 89 min in patients without distention (p = 0.03). ConclusionGallbladder distention on PoCUS was specific for cholecystitis (acute or chronic), and associated with SIN, acute cholecystitis on subsequent pathology report, and longer cholecystectomy operative times. Measurement of gallbladder dimensions as part of the assessment of cholecystitis may be advantageous.

Outcomes of patients with gallbladder cancer presenting with acute cholecystitis

The main purpose of this study is to explore the outcomes of patients found to have gallbladder cancer during investigation and diagnosis of acute cholecystitis. The incidence of primary gallbladder cancer co-existing in acute cholecystitis is not well defined in the literature, with anecdotal reports suggesting that they experience worse outcomes than patients with gallbladder cancer found incidentally.MethodsA retrospective review of all patients with gallbladder cancer managed at the Canberra Health Service between 1998 and May 2022 were identified and reviewed.ResultsA total of 65 patients were diagnosed with primary gallbladder cancer during the study period with a mean age of 70.4 years (SD 11.4, range 59–81.8 years) and a female preponderance (74% versus 26%) with a ratio of 2.8. Twenty (31%) patients presented with acute calculus cholecystitis and were found to have a primary gallbladder cancer. This group of patients were older and predominantly female, but the difference was not statistically significant. The overall 5-year survival in the cohort was 20% (stage 1 63%, stage 2 23%, stage 3 16%, and stage 4 0%). There was no statistically significant difference in survival between those who presented with acute cholecystitis vs other presentations.ConclusionsA third of the patients with gallbladder cancer presented with acute cholecystitis. There was no statistically significant difference in survival in those with bile spillage during cholecystectomy as well those presenting with acute cholecystitis.

Measurement of cystic artery diameter by computed tomography in the diagnosis of acute cholecystitis

Aim: The aim of this study is to measure the diameter of the cystic artery using computed tomography in patients undergoing emergency surgery for the diagnosis of acute cholecystitis, as well as to understand the role of cystic artery diameter in the diagnosis of acute cholecystitis, and to investigate its association with clinical data, laboratory data, and computed tomography findings.
 Methods: A total of 187 patients admitted to the general surgery clinic between 2019 and 2023, comprising 123 individuals as the patient group and 64 individuals as the control group, were reviewed in terms of their radiological images, demographic data, and laboratory parameters. The patients' surgical records, laboratory parameters, and computed tomography scans taken during the diagnosis were investigated.
 Results: The diameter of the cystic artery was measured, and a cut-off value of cystic artery diameter >1.9 mm was found to be sensitive and specific for the diagnosis of acute cholecystitis (AUC: 0.852, 94% sensitivity, 75% specificity, p <0.001, 95% confidence interval 0.792-0.899).
 Conclusion: A cystic artery diameter >1.9 mm was found to be highly specific for the diagnosis of acute cholecystitis. This study suggests that the measurement of cystic artery diameter can be used as an additional criterion in the evaluation of computed tomography for the diagnosis of acute cholecystitis.

Nasopharyngeal malignant melanoma masquerading in the gallbladder: the importance of histological assessment.

Metastatic melanoma of the gallbladder is a rare entity that is often diagnosed late, leading to a poor prognosis. The disease may present insidiously as acute cholecystitis or remain asymptomatic. Optimal management remains unclear but surgical resection is considered the mainstay of treatment for this condition. We report the case of a 47-year-old man who suffered a protracted course of generalised abdominal symptoms eventually culminating in a diagnosis of acute cholecystitis. Following an emergency laparoscopic cholecystectomy, the histology revealed a melanoma with an unknown primary. Subsequently this was traced to the nasopharynx. Because of the presence of concurrent liver metastasis, systemic immunotherapy with palliative intent was commenced following a multidisciplinary team discussion. This case highlights the importance of sending clinical specimens for histological analysis. We argue against selectively choosing which specimens to send for histology because radiological and/or intraoperative macroscopic inspection of resected tissue alone can result in a missed diagnosis.

A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis.

To evaluate the recently reported relative diagnostic accuracy of US, CT, MRI, and cholescintigraphy for diagnosing acute cholecystitis. 2 radiologists independently performed systematic electronic searches for articles published between 2000 and 2021 and applied inclusion/exclusion criteria. 2 different radiologists extracted data from the articles and scored each with a methodological quality tool. Pooled estimates of sensitivity and specificity were calculated with a bivariate linear mixed model. A second analysis made head-to-head comparisons (US vs. CT, US vs. cholescintigraphy). Factors were also analyzed for potential confounding effects on diagnostic accuracy. Of 6121 initial titles, 22 were included. The prevalence of cholecystitis varied widely across studies (9.4-98%). Pooled sensitivity and specificity estimates were 69% (confidence limit [CL] 62-76%) and 79% (CL 71-86%) for US, 91% (CL 86-94%) and 63% (CL 51-74%) for cholescintigraphy, 78% (CL 69-84%) and 81% (CL 71-88%) for CT, and 91% (CL 78-97%) and 93% (CL 70-99%) for MRI. Regarding head-to-head comparisons, the sensitivity of CT (87.6%, CL 70-96%) was significantly higher than US (66.8%, CL 43-84%), while specificities (81.7% with CL 54-95% for US, 91.9% with CL 67-99% for CT) were similar. The sensitivity of cholescintigraphy (87.4%, CL 76-94%) was significantly greater than US (61.6%, CL 44-77%), while the specificity of US (82%, CL 65-92%) was significantly higher than cholescintigraphy (68%, CL 47-84%). Recent data suggests that CT may have a higher sensitivity than US for diagnosing acute cholecystitis, with similar specificity. Cholescintigraphy remains a highly sensitive modality with lower specificity than previously reported. MRI remains under studied, but with promising results.

Diagnosis of Acute Cholecystitis Using T1 and T2 Mapping by Cardiac MRI.

Diagnosis of Acute Cholecystitis Using T1 and T2 Mapping by Cardiac MRI.

1019 Timing of Laparoscopic Cholecystectomy in Patients with Acute Cholecystitis at a District General Hospital

Abstract Aim Early laparoscopic cholecystectomy (LC) is recommended in the treatment of acute cholecystitis (AC) as a balance between reducing gallstone-related complications and surgery-related complications. NICE guidelines recommend LC within a week of diagnosis for adults with AC or to be delayed once acute episode has subsided at least 4 weeks after diagnosis. This audit aimed to assess our Trust's compliance to these recommendations. Method A retrospective analysis was conducted on all patients who received cholecystectomy following a diagnosis of acute cholecystitis between June 2021 - July 2021. After implementation, a re-audit was conducted from May 2022 - July 2022. Results A 100% compliance rate was achieved in the first cycle of the audit. Out of the 35 patient sample of newly diagnosed AC, only 16 patients underwent surgery in 2021. Out of these 16 patients, 81.3% had LC within a week and 18.7% had the procedure performed after 4 weeks. The re-audit, with a sample size of 52 patients, had an overall compliance of 96.8%. Out of the 31 patients who had surgery, 71% had surgery within a week of diagnosis and 25.8% had surgery after 4 weeks of diagnosis. Only 1 patient (3.2%) had surgery outside of the recommended timeframe as the surgery took place 9 days from diagnosis. Conclusions This audit demonstrated that our Trust has very good compliance with the guidelines where >95% of patients received their surgery within the recommended time frame. Our Trust demonstrated high rates of LC during acute admission, which aims to improve long waiting lists for elective LC.

A case of acute cholecystitis with abnormally high CA19-9

BackgroundCA19-9 is strongly expressed in malignant tumors of the digestive system and is widely used as a marker for gastrointestinal cancer. In this report, we describe a case of acute cholecystitis in which CA19-9 was markedly elevated.Case presentationA 53-year-old man was admitted to our hospital with a diagnosis of acute cholecystitis after being referred to our hospital with a chief complaint of fever and right hypochondrial pain. CA19-9 was abnormally high at 17,539.1 U/ml. Although the possibility of malignancy was considered, there was no obvious malignant lesion on imaging; the patient was diagnosed with cholecystitis, and laparoscopic cholecystectomy was performed the day after admission. The surgical specimen showed no malignant findings either grossly or in the final pathological examination. There were no complications in the patient’s postoperative course, and he was discharged from the hospital on the third postoperative day. CA19-9 level quickly returned to within normal range after surgery.ConclusionsIn acute cholecystitis, CA19-9 levels exceeding 10,000 U/ml are very rare. We report a case of acute cholecystitis without malignant findings despite a high CA19-9 level.

The role of frailty score in early surgical treatment of elderly cholecystitis patients

Objectives: The average life expectancy is increasing all over the world, and as a result, the number of elderly patients is increasing. Acute cholecystitis is one of the most common diseases requiring emergency surgical treatment in the elderly. In the literature, it has been reported that in the treatment of elderly patients with acute cholecystitis, physicians do not fully comply with the current literature recommendations due to some concerns and do not apply surgical treatment in the early period. The concept of frailty, which has come to the fore in geriatric assessment today, provides objective information about the general health status of the patient. In our study, the role of frailty assessment in the decision made regarding the early surgery in elderly patients with acute cholecystitis treated in our hospital was investigated. Methods: In our study, the clinical features, comorbidities, American Society of Anesthesiologists (ASA) scores, Canadian Study of Health and Aging (CSHA) frailty scale, treatment modalities and prognosis of patients over the age of 65 who were treated with the diagnosis of acute cholecystitis between January 2018 and January 2021 were evaluated retrospectively. Results: Of the 182 patients included in the study, 24 (13.2%) were found to be frail. It was observed that the mean age and multi-morbidity were higher in the frail group (p < 0.001). It was observed that the mean C-reactive protein and leukocyte values, which are inflammatory mediators, increased in both groups, both fragile and non-fragile, and complicated cholecystitis accompanied by cholangitis or pancreatitis was observed in a total of 64 (35.16%) patients. There were 57 (31.3%) patients using anticoagulant or antiaggregant agents. The patients were most frequently treated with medical treatment (n = 108; 59.3%), the other treatment methods were early surgery ( (n = 46; 25.3%), endoscopic retrograde cholangiopancreatography (n = 22; 12.1%) and percutaneous cholecystostomy (n = 11; 6.0%). Surgical treatment was more common in ASA I and II patients, and percutaneous cholecystostomy was more common in frail patients (p < 0.001). There were 20 (14.70%) patients who were re-admitted to the hospital and 6 (3.29%) patients ended up with mortality. No statistical relationship could be demonstrated between these conditions and frailty (p > 0.05). Conclusions: In the treatment of the elderly cholecystitis patients, early surgical treatment is the most favorable treatment method in order to reduce re-admission and prevent possible complications. However, we think that a detailed geriatric evaluation should be made in a multidisciplinary manner for the decision making regarding the of surgical treatment of elderly patients, and frailty evaluation should also be made in this context.

A Comparative Study between Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis in a Tertiary Care Center of Nepal

Background: Laparoscopic Cholecystectomy is considered as a gold standard treatment for symptomatic cholelithiasis. The timing of surgery for acute Cholecystitis is still controversial, weather to go early surgery or wait for six to eight weeks after conservative management. Therefore, the aim of this study is to compare the clinical outcomes of early versus delayed laparoscopic cholecystectomy for acute Cholecystitis.
 Materials and Methods: A prospective study was conducted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Total of 80 patients with the diagnosis of acute Cholecystitis were enrolled in the study. The patients were equally divided in two groups: 40 underwent early laparoscopic cholecystectomy within 72 hours of admission (Group A) and next 40 underwent delayed laparoscopic cholecystectomy after 6-8 weeks of conservative management (Group B).
 Results: Out of 80 patients of acute Cholecystitis, mean age of the patients in Group A was 43.40±13.45 years and that in Group B was 44.80±14.36 years. The mean operative time in Group A was 90.22±2.81 minutes whereas in Group B it was 80.97±4.47 minutes. Mean duration of Hospital stay in Group A was 2.02±0.15 days whereas in Group B it was 2.15±0.36 days. Two patients in Group A and one patient in Group B converted to open cholecystectomy. Three patients of Group A and one patient of Group B landed in outpatient department with superficial surgical site infection. Group B patients underwent second hospital admission compared to Group A patients.
 Conclusion: Early Laparoscopic cholecystectomy for acute cholecystitis is almost comparable with delayedLaparoscopic cholecystectomy. However, early laparoscopic cholecystectomy reduces the morbidity of patients as well as it is cost-effectiveness.

Acalculous variant of Mirizzi syndrome: Imaging and clinical characteristics

PurposeMirizzi Syndrome is a rare disease that causes biliary obstruction in the setting of an impacted stone in the gallbladder neck or Hartmann's Pouch which exerts mass effect on the common duct; however, we have noticed inflammatory biliary narrowing in the absence of an offending gallstone in the setting of acute cholecystitis. The purpose of this study is to report the clinical and MRCP findings in a series of 10 patients with this variant of Mirizzi Syndrome. Materials and methodsA search of our institution's PACS and electronic medical record identified 10 patients with a diagnosis of acute cholecystitis and narrowing of the common duct on imaging in the absence of an impacted gallstone. Imaging and clinical findings were confirmed by two board-certified abdominal radiologists. ResultsAll patients presented with abdominal pain and an average elevated total bilirubin of 3.0 mg/dL. Seven patients had MRCP findings of complete narrowing of the CBD. Nine patients had intrahepatic biliary ductal dilation. All nine patients with gadoliniumenhanced MRCP displayed biliary wall thickening with enhancement adjacent to the gallbladder. Nine patients underwent cholecystectomy, one patient underwent percutaneous cholecystostomy. Average bilirubin upon discharge was within normal limits at 0.9 mg/dL after intervention. Two patients had follow-up MRCP showing resolution of biliary narrowing. ConclusionA variant of Mirizzi Syndrome occurs in the absence of an offending gallstone in the gallbladder neck or cystic duct to explain the biliary narrowing. We postulate that acute cholecystitis can cause a local inflammatory narrowing resulting in biliary obstruction.

A novel biomarker in acute cholecystitis: YKL-40

BackgroundThe lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician efforts to diagnose and treat these patients. Therefore, the aim of this study was to measure plasma YKL-40 levels and investigate their diagnostic value in patients with acute cholecystitis (AC). MethodsThis study was carried out between February 2020 and September 2020 in the adult emergency department of a tertiary university hospital. Permission was obtained from the Ethics Committee of Scientific Research on 03/02/2020 with Decision No. 03/16. The study included 80 patients who were diagnosed with acute cholecystitis and 80 healthy volunteers without known chronic diseases. ResultsThe median YKL-40 protein level was 798.66 pq/mL in the patient group and 392.45 pq/mL in the control group. A statistically significant difference in YKL-40 protein levels was found between the two groups. YKL-40 protein levels were significantly higher in patients diagnosed with acute cholecystitis than in healthy individuals (p < 0.001). A positive correlation was found between YKL-40 protein levels and ALT, AST, LDH, and GGT levels (r = 0.272, p = 0.015; r = 0.397, p < 0.001; r = 0.386, p < 0.001; and r = 0.264, p = 0.018; respectively). ConclusionWhen evaluated together with physical examination, radiological imaging and other laboratory parameters, we think that plasma YKL-40 levels can be used effectively in the diagnosis of acute cholecystitis.

S3238 A Case of Concurrent Cholecystitis and Stauffer Syndrome

Introduction: Stauffer syndrome (SS) is a paraneoplastic syndrome seen in some malignancies, most commonly 4-15% of primary renal cell carcinomas, resulting in nephrogenic hepatic dysfunction. SS commonly results in elevated alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and prothrombin time (PT) as well as decreased albumin in the absence of liver metastasis. The etiology of SS is unknown, although three have been suggested: elevated interleukin-6, elevated colony stimulating factor or, least likely, autoimmune. We describe a case of a woman presenting with right upper quadrant (RUQ) pain who was found to have indirect predominant hyperbilirubinemia and acute cholecystitis and renal mass on ultrasound. Case Description/Methods: An 81-year-old female presented to an outside hospital for RUQ and epigastric pain that worsened after fatty meals. Imaging showed acute cholecystitis as well as a right renal mass. Physical exam at the time was remarkable only for diffuse tenderness to abdominal palpation, most notably in the RUQ. There was no scleral icterus or costovertebral angle tenderness on exam. Labs on presentation can be seen in Table 1. Given the elevated indirect bilirubin, gastroenterology was consulted and suggested Gilbert syndrome (GS) or SS given their concern for renal cell carcinoma (RCC). The next day the patient underwent a laparoscopic cholecystectomy notable for acute gangrenous cholecystitis with cholelithiasis, and had rapid normalization of bilirubin over 48 hours. The patient followed with outpatient urology for renal biopsy, which was positive for clear cell RCC. Follow up imaging revealed scattered pulmonary nodules up to 1.1cm, with concern for metastasis. Surgery was deemed inappropriate and the patient was conservatively managed, given her wishes to prioritize quality of life and not undergo chemotherapy. (Figure) Discussion: This case illustrates an interesting clinical picture where a patient with confirmed cholecystitis also has a new renal mass, with elevated indirect bilirubin and PT, consistent with SS. The diagnosis of SS is made clinically, with hopeful resolution of abnormal lab values upon RCC resection. In this case, surgery was not indicated, hemolysis was ruled out with stable hemoglobin and normal peripheral smear, and the diagnoses of acute cholecystitis and RCC causing SS was made. In addition to hemolysis, GS, and Criggler-Najjar when working up indirect hyperbilirubinemia, it is imperative to include SS on the differential diagnosis.Figure 1.: CT abdomen with right renal mass. Table 1. - Patient labs on presentation and 2 days post-cholecystectomy Lab Admission Post-Op Day 2 Normal WBC Count (103 cells/uL) 17 14 4.1-9.3 Platelet (103/uL) 246 248 130-350 Hemoglobin (g/dL) 10.6 9.8 11-14.7 Albumin (g/dL) 3.3 2.7 3.5-5.2 Total Bilirubin (mg/dL) 2.8 0.9 0.1-1.2 Indirect Bilirubin (mg/dL) 2.4 0-0.9 Alkaline Phosphatase (IU/L) 96 102 30-115 AST (IU/L) 23 20 5-45 ALT (IU/L) 12 16 5-60 Lipase (U/L) 12 11-82 Prothrombin Time (s) 14.3 9.4-12.9 INR 1.2 0.83-1.14 AST = aspartate transaminase, ALT = alanine transaminase.

Acute cholecystitis as the first manifestation of primary pure squamous cell carcinoma of the gallbladder; a case report

Background. SCC of the gallbladder is characterized by more rapid and invasive growth with infiltration of the adjacent organs and less spread to the lymph nodes compared to adenocarcinoma of the gallbladder. It is a rare neoplasm that accounts for 1.4–12.7 % of gallbladder tumors. SCC of the gallbladder has a poor prognosis. symptoms usually appear later when the disease has progressed and the malignancy has reached advanced stages. therefore, usually, the patients expire soon following the diagnosis. the etiology of the SCC of the gallbladder is complex and is mostly associated with gallstones. Case description. We report a case of a 56-year-old man that had been suffering from colicky abdominal pain in the right upper quadrant for about two weeks before his admission. He did not have nausea, vomiting, shortness of breath, fever, lack of appetite, or weight loss. after evaluation, a diagnosis of acute cholecystitis was established and antibiotic therapy was initiated. However, he did not respond to medical therapy and underwent surgery. A tumor mass was detected during surgery. therefore, cholecystectomy and extended right hepatectomy were performed. The pathological evaluation of the biopsy specimen revealed squamous cell carcinoma. consequently, he underwent radiotherapy and chemotherapy and was followed up for two years. He acquired complete tumor remission. Conclusion. The present case highlights the requirement of considering further investigation on the histogenesis of SCC of the gallbladder.

An Analysis of Outcomes and Management Strategies for Patients With Cholecystostomy Tubes.

Percutaneous cholecystostomy tube (PCT) drainage is an effective management strategy for acute cholecystitis in patients medically unfit for surgery. However, little is known about the fate of patients managed by PCT. We conducted this study to determine tube management outcomes for patients with acute cholecystitis managed by PCT. The electronic record was queried to identify patients with acute cholecystitis managed by PCT from 2012-2020. Patients were divided into three groups for analysis: 1) ultimately managed by cholecystectomy, 2) eventual confirmation of distal flow of bile from the gallbladder and tube removal, and 3) tubes left in place without further management. A total of 179 patients with acute cholecystitis treated by PCT were included. Sixty-six patients never fully recovered from the medical insult associated with their diagnosis of acute cholecystitis and had their tubes left in situ. Sixty-four of these 66 patients (97%) died during follow-up. The remaining 113 patients recovered from their illness and presented to clinic for evaluation for tube removal and/or cholecystectomy. When distal biliary flow was confirmed, tube removal was favored (n = 70). When cystic duct outflow occlusion persisted, cholecystectomy was planned for patients who became acceptable surgical candidates (n = 43). For patients managed by cholecystectomy, 8 were approached open and 35 laparoscopically, with 12 of 35 (34.3%) converted to open and 23 (65.7%) completed laparoscopically. Our study favors PCT removal for patients who recover from their acute illness when distal bile flow from the gallbladder is confirmed. We reserve cholecystectomy for patients who recover from their illness and demonstrate persistent cystic duct outflow obstruction.

Timing is everything: outcomes of 30,259 delayed cholecystectomies in New York State.

The timing of cholecystectomy in relation to outcomes has been debated. To our knowledge, there are no large population-based studies looking at outcomes and complications of delayed cholecystectomy [DC] (> 72h after presentation). This study utilizes a statewide database to determine whether there are differences in patient outcomes for DC performed at 3-4days, 5-6days, and ≥ 7days after presentation. The New York SPARCS database was used to identify adult patients presenting with a diagnosis of acute cholecystitis from 2005 to 2017. Patients aged < 18, those with missing identifier or procedure-date information, those who underwent early cholecystectomy < 72h or upon readmission, were excluded. Patients undergoing DC at 3-4days, 5-6days, and ≥ 7days were compared in terms of overall complications, hospital length of stay (LOS), 30-day readmissions/emergency department (ED) visits, and 30-day mortality. 30,259patients were identified. DCs were performed within 3-4days (n = 19,845, 65.6%), 5-6days (n = 6432, 21.3%), and ≥ 7days (n = 3982, 13.2%). There was a stepwise deterioration in outcomes with increased delay to surgery (Fig.1). When comparing 3-4 and ≥ 7days, overall complications (OR = 0.418, 95% CI: 0.387-0.452), 30-day readmissions (OR = 0.609, 95% CI: 0.549-0.674), 30-day ED visits (OR = 0.697, 95% CI: 0.637-0.763), 30-day mortality (OR = 0.601, 95% CI: 0.400-0.904), and LOS (OR = 0.729, 95% CI: 0.710-0.748) were lower in the 3-4day cohort. DC within 3-4days is associated with fewer complications, readmissions and ED visits, and reduced LOS compared to DC at 5-6 or ≥ 7days after presentation. In addition, 30-day mortality was also significantly different comparing 3-4 with ≥ 7-day cohorts. These data are important for guiding patients in the consent process and may point to choosing an earlier interval cholecystectomy for high-risk patients.

Can immature granulocytes be used as a predictive new marker in the diagnosis of acute cholecystitis?

Aim: Acute cholecystitis (AC) is one of the most common acute surgical diseases in the emergency department (ED). The aim of this study was to investigate the efficacy of inflammatory parameters as immature granulocyte count (IGC) and immature granulocyte percentage (IG%) in the diagnosis of AC. Material and methods: This retrospective and observational study consisted of patients, diagnosed with AC, who were admitted to a tertiary ED with abdominal pain between March 2019 and April 2021. The effectiveness of IGC and IG% in the diagnosis of AC was examined by comparing the results with the control group (CG). Results: A total of 493 patients were included in the study. 270 patients were in the AC group, 223 patients were in the CG. IG% and IGC were found to be significantly higher in the AC group than in the CG (0.5 (0.32) vs. 0.4 (0.2); 0.06 (0.08) vs. 0.03 (0.03); p<0.001, p<0.001 respectively). It has been shown that IGC, at a cut-off value of 0.03, predicts the diagnosis of AC with 72.1% sensitivity and 55.5% specificity. On the other hand, IG%, at a cut-off value of 0.45, predicts the diagnosis of AC with 53.2% sensitivity and 72.7% specificity (AUC [0.717 (0.672-0.762); 0.692 (0.645-0.738)], respectively p<0.001, p<0.001). Conclusions: In conclusion, IGC and IG% can be used as a useful inflammatory parameter in the diagnosis of AC in patients admitted to the emergency department.

Cholelithiasis-diagnostic approach: are clinical presentations in children different?

Cholecystitis has been considered an uncommon entity in children, but it’s incidence is reportedly increasing which may be attributed to widespread use of diagnostic imaging (ultrasonography). A healthy 11-year-old female Indian child presented to the emergency department with a chief complaint of abdominal pain. The pain was at the epigastric region and accompanied with vomiting. As per the complete examination and findings, a diagnosis of constipation colic was made. A month later, the patient presented with the same chief complaint, but general physical examination revealed tenderness at the right hypochondrium, and Murphy’s sign was positive. Upon performing an abdominal ultrasound, multiple small gallstones were noted in an otherwise normal gallbladder. No biliary obstruction was seen. A diagnosis of acute cholecystitis was made. Patient was then admitted and treated with a course of antibiotics. The incidence of cholelithiasis in children has not been sufficiently studied. The incidence of cholecystitis in India was found to be 0.3% with the incidence in age group 0-10 being less than 0.1%. In contrast to adult cholecystitis, it has been found that there is female predominance of cholecystitis in children. In children, 20% to 50% gallstones are radiopaque. Unknown causes are still prevalent in stone formation. Hence, the purpose of this paper was to increase awareness about the diagnosis of cholelithiasis in children. The probability of cholecystitis in children should not be ignored. Cholelithiasis should always be considered as a differential diagnosis when children present with complaints of abdominal pain.

The gallbladder: what's new in 2022?

This review focuses mainly on the imaging diagnosis, treatment, and complications of acute cholecystitis which is the most common benign disease of the gallbladder. The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented. The recent articles for using US, CT, MR, and HIDA in the evaluation of patients with suspected acute cholecystitis are reviewed in detail. The clinical management and postoperative complications are described. Because gallbladder polyps and adenomyomatosis can mimic gallbladder malignancies and acute cholecystitis, their imaging findings and management are presented. Finally, due the recent literature reporting better results with CT than US in the diagnosis of acute cholecystitis, a suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in an addendum.

Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis.

This study aimed to evaluate the diagnostic value of gallbladder width measurement with computed tomography (CT) in patients with acute cholecystitis. This retrospective case–control study was conducted between March 2016 and March 2020 at a tertiary emergency department. Of 310 patients, 254 patients with acute cholecystitis confirmed by surgery were compared with 254 patients diagnosed with other diseases (controls). In the acute cholecystitis group, the number of older patients with underlying illnesses was much higher (64% of men). Upon CT, the median (interquartile range [IQR]) gallbladder width was significantly longer in patients with acute cholecystitis (2.26 [1.82–2.78] cm vs. 3.73 [3.32–4.16] cm, p < 0.001). The optimal cut-off value of gallbladder width for differentiating acute cholecystitis was 3.12 cm, showing a sensitivity of 88% and specificity of 86%. In a multivariable analysis using a logistic regression model for diagnosing acute cholecystitis with CT findings (gallbladder width, length, stone, wall thickening, and pericholecystic fluid), a gallbladder width of ≥3.12 cm was significantly meaningful, even when adjusting for other variables (odds ratio 37.9; p < 0.001). Therefore, an increase in gallbladder width (≥3.12 cm) measured with CT can be a simple and sensitive diagnostic sign of acute cholecystitis, supporting the underlying pathophysiology of bile outflow obstruction.