Old man gallbladder syndrome: Gangrenous cholecystitis in the unsuspected patient population
Teena Dhir1, Robert Schiowitz2
114511 Pine Court, Riverside, CA 92503, USA.
Insights
Gangrenous cholecystitis (GC) is a severe complication of acute cholecystitis. Key predictors include age, elevated white blood cell count, thickened gallbladder wall, and a negative Murphy's sign, increasing suspicion for GC.
Area of Science:
- Surgical Pathology
- Gastroenterology
- Medical Imaging
Background:
- Acute cholecystitis is a common surgical condition.
- Gangrenous cholecystitis (GC) is a serious complication with increased morbidity and mortality.
- Predictive factors for GC include advanced age, male gender, elevated white blood cell count, and specific ultrasound findings.
Purpose of the Study:
- To highlight the critical nature of gangrenous cholecystitis (GC).
- To identify key predictive factors for GC in patients with acute cholecystitis.
- To emphasize the importance of a high index of suspicion for GC.
Main Methods:
- Case presentations of two patients with confirmed gangrenous cholecystitis.
- Review of laboratory findings and imaging patterns associated with GC.
- Analysis of physical examination findings, including the significance of a negative Murphy's sign.
Main Results:
- Predictive factors for GC include age >45, male gender, WBC >13,000/mm3, a negative Murphy's sign, thickened gallbladder wall, and lack of mucosal enhancement.
- Physical examination findings like a negative Murphy's sign can indicate denervation from gangrenous changes.
- Imaging and laboratory data are highly predictive of GC.
Conclusions:
- Gangrenous cholecystitis is a significant complication of acute cholecystitis.
- A high index of suspicion for GC is warranted when characteristic physical and laboratory findings are present.
- Early recognition and management of GC are crucial to improve patient outcomes.
Introduction:
Acute cholecystitis is a common surgical condition, but not many are aware of the serious complication of gangrenous cholecystitis (GC). Presence of GC increases patients' postoperative complications, morbidity and mortality. Predictive factors for GC include age >45, male gender, white blood cell count >13,000/mm3 and ultrasound findings of a negative Murphy's sign.
Case Presentation:
(1) GW, 83 male with dull right upper quadrant pain and a negative Murphy's sign with further imaging showing a thickened septated gallbladder suggestive of GC. Patient's surgery was difficult and he received a cholecystostomy tube for drainage. (2) PH, 75 male with minimal right upper quadrant pain, equivocal ultrasound with a negative Murphy's sign and computer tomography (CT) showing acute cholecystitis. Patient was taken to the operating room for cholecystectomy, with pathology consistent with gangrenous cholecystitis.
Discussion:
Multiple laboratory findings and imaging patterns have been found to be highly predictive of GC. Along with age and WBC, thickened gallbladder wall and lack of mucosal enhancement have been predictive of GC. On physical examination, lack of Murphy's sign secondary to denervation from gangrenous changes also increases the index of suspicion for GC.
Conclusion:
GC is a serious complication of acute cholecystitis with increased morbidity and mortality. There should be a high index of suspicion for GC if the above unique physical and laboratory findings are present.
Related Concept Videos
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:30Acute Pancreatitis II: Clinical Manifestations and Management