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Chirurgia 2011 April;24(2):53-9

language: Italian

Predictive factors for diagnosis of gangrenous cholecystitis

Sias L., Secci L., Virdis F., Garau A., Pinna G., Pani C., Pomata M., Farina G. P.

Dipartimento Chirurgico, Materno-Infantile e di Scienze delle immagini, Azienda Ospedaliera-Universitaria
Ospedale San Giovanni di Dio, Cagliari, Italia


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Aim. The retrospective analysis of our experience has permitted to find out prognostic factors for early diagnosis of gangrenous cholecystitis.
Methods. From January 1999 to October 2010 at “Chirurgia Generale A - Ospedale San Giovanni di Dio in Cagliari”, 146 patients underwent cholecystectomy. Gangrenous cholecystectomy was diagnosed pathologically in 45 cases. We reviewed the medical charts of every patient, taking care of every useful predictive factor, especially the typycal aspects detected by ultrasonography.
Results. Thirty-one percent of patients had histological evidence of gangrenous cholecystitis. In 44 cases this disease was associated with the presence of stones and biliary sludge in the gallbladder lumen. In near the totality of patients leukocyte count was high, in 60% ≥15,000 Wbc/ml. A chi square analysis was also performed to compare the typycal ultrasonographic patterns, such as gallbladder dilation and wall thickening, between acute non gangrenous and gangrenous cholecystitis. A multistriated pattern, gallbladder wall thickening ≥7 mm and a cholecystic dilation ≥70 ml were found statistically significant and predictive for diagnosis of gangrenous cholecystitis.
Conclusion. In conclusion, we can state that prognostic factors for early diagnosis of gangrenous cholcystitis exist. Among various predictive parameters, the typical ultrasound findings, a strict monitoring of the ultrasonographic changes of gallbladder wall thickening, allow the detection of its evolution into grangrenous type and the choice of the most appropiate treatment of this disease.

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