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Predictive factors for gangrene complication in acute calculous cholecystitis
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):228-33
Published online August 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.3.228
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Bader Hamza Shirah1, Hamza Asaad Shirah2, Muhammad Adnan Saleem2, Mohammad Azam Chughtai3, Mohamed Ali Elraghi3, and Mohamed Elsayed Shams4

1King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Departments of 2General Surgery and 3Radiology, Al Ansar General Hospital, 4Department of Surgery, Faculty of Medicine, Taibah University, Medina, Saudi Arabia
Received December 31, 2018; Revised February 20, 2019; Accepted February 21, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Gallbladder gangrene is a grave complication of acute calculous cholecystitis that is difficult to detect preoperatively. Ultrasound could show a gallbladder wall that is more thickened. In addition, other clinical measures were reported to be possible predictive factors. Therefore, we aim in this study to evaluate the gallbladder wall thickness measured by ultrasound and other clinical measures as predictive factors for gangrene complication in acute calculous cholecystitis.
Methods: A prospective cohort database analysis of the results of 674 patients diagnosed and treated for acute calculous cholecystitis between January 2010 and December 2014 was done. Patient’s inclusion criteria were acute calculous cholecystitis in adults who were operated within three days of onset of symptoms.
Results: 117 (17.4%) patients had gangrene. Gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference (≤0.01).
Conclusions: We conclude that gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference. By implementing these risk factors, patients urgency for surgery can be decided in the emergency department. Other risk factors such as high alanine aminotransferase, elevated aspartate aminotransferase, and high alkaline phosphatase could be of help in the decision for early operation.
Keywords : Acute calculous cholecystitis; Complications; Risk factors; Gangrene of the gallbladder; Gallbladder wall thickness; Ultrasound

 

August 2019, 23 (3)