Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features

• Published in: The American journal of emergency medicine Vol. 27; no. 5; pp. 574 - 581
• Main Authors: TSAI, Ming-Jen, CHEN, Jen-Dar, TIU, Chui-Mei, CHOU, Yi-Hong, HU, Sheng-Chuan, CHANG, Cheng-Yen
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.06.2009; Elsevier Limited
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chi-Square Distribution; Cholecystitis, Acute - diagnostic imaging; Cholecystitis, Acute - surgery; Emergency medical care; Emergency Service, Hospital; Female; Gallbladder; Humans; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Medical disorders; Medical imaging; Medical sciences; Mortality; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Retrospective Studies; Risk Factors; Rupture, Spontaneous - diagnostic imaging; Tomography, X-Ray Computed - methods; Intensive care; Digestive system; Perforation; Digestive diseases; Gallbladder; Computerized axial tomography; Biliary tract disease; Cholecystitis; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.04.024

The purpose of this study is to determine which computed tomography (CT) findings and clinical data can help to diagnose gallbladder perforation in acute cholecystitis. The medical records and CT findings of patients with surgically proven acute cholecystitis within the last recent 5 years were retrospectively reviewed and compared between 2 groups with and without gallbladder perforation. A total of 75 patients with acute cholecystitis were included in the study, and 16 patients were proven to have gallbladder perforation. Higher mortality rate was found in the perforation group (18.8% vs 1.7%; P = .029). Older age (>70 years; P = .004) and higher percentage of segmented neutrophil (>80%; P = .027) were significant clinical factors for predicting gallbladder perforation in acute cholecystitis. The significant CT signs related to gallbladder perforation included visualized gallbladder wall defect (P = .000), intramural gas (P = .043), intraluminal gas (P = .000), intraluminal membrane (P = .043), pericholecystic abscess or biloma formation (P = .009), intraperitoneal free air (P = .001), and presence of ascites in the absence of hypoalbuminemia or other intraabdominal malignancy (P = .017). In multivariate analysis, visualized gallbladder wall defect was the most significant predicting CT feature for diagnosing gallbladder perforation in acute cholecystitis. Elderly patients with higher segmented neutrophil and CT signs of gallbladder wall defect associated with acute cholecystitis may have high possibility of gallbladder rupture.