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Clinically diagnosed cholecystitis: a case series.

Firas Bridges1, Jennifer Gibbs2, Joshua Melamed3

  • 1Division of General and Bariatric Surgery, Good Samaritan Hospital Medical Center, West Islip, NY, USA.

Journal of Surgical Case Reports
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Summary

Cholecystitis diagnosis relies on clinical signs, not solely imaging. Negative imaging results should not deter surgical intervention for patients with classic cholecystitis symptoms.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Diagnostic Accuracy

Background:

  • Cholecystitis diagnosis typically involves imaging, but accuracy varies, particularly for acalculous cholecystitis.
  • Current imaging modalities may fail to detect gallbladder inflammation in certain patient presentations.
  • This highlights a potential gap in diagnostic protocols for symptomatic patients.

Observation:

  • Four patients presented with classic cholecystitis symptoms but had negative results on multiple imaging studies.
  • Despite negative imaging, persistent symptoms led to surgical intervention (cholecystectomy).
  • All patients experienced symptom resolution post-surgery with sustained relief for 6-10 months.

Findings:

  • Cholecystitis should be primarily considered a clinical diagnosis.
  • Negative imaging findings should not override clinical judgment in suspected cholecystitis.
  • Surgical management, like cholecystectomy, can be effective even with inconclusive imaging.

Implications:

  • Clinicians should prioritize clinical presentation over potentially inaccurate imaging in diagnosing cholecystitis.
  • Consider cholecystectomy for patients with strong clinical evidence of cholecystitis, irrespective of imaging results.
  • This case series suggests a need to re-evaluate the role of imaging in the definitive diagnosis and management of cholecystitis.