Predictors of acute gangrenous cholecystitis and its complications: a retrospective cohort study

Acute gangrenous cholecystitis is a serious complication of acute cholecystitis. Predictors of its development and of its complications are not well established. The aims of our study were to determine factors related to acute gangrenous cholecystitis and its complications.

This was a retrospective cohort study of adult patients who underwent surgery for acute cholecystitis between 2010 and 2022 at a tertiary referral center. Data was collected from patients' medical records. Pathology reports were reviewed to differentiate acute gangrenous cholecystitis from acute non-gangrenous cholecystitis. Acute gangrenous cholecystitis was defined by the presence of focal or diffuse necrosis of the gallbladder wall on histopathologic examination. Demographic, clinical, laboratory and radiographic indicators were compared between acute gangrenous and acute non-gangrenous cholecystitis groups. Multivariable analysis was performed to identify factors that are associated with acute gangrenous cholecystitis and its complications.

Among 356 patients with acute cholecystitis, 121 had acute gangrenous cholecystitis and 9 were diagnosed preoperatively. Acute gangrenous cholecystitis was associated with age, male sex, comorbidities, presence of rebound tenderness, higher white blood cells count and bilirubin, and greater thickness of the gallbladder wall and gallbladder diameter. Patients with acute gangrenous cholecystitis were more likely to have sepsis and longer hospital stay. On multivariate analysis, age, male gender, gallbladder diameter and presence of pericholecystic abscess were associated with acute gangrenous cholecystitis. Age and diabetes were associated with sepsis in acute cholecystitis. Time from presentation to surgery was similar between the acute gangrenous and the non-gangrenous cholecystitis groups.

Acute gangrenous cholecystitis is common, and preoperative diagnosis is often missed. Our data suggests that considering age, co-morbidities and radiological indicators may be important to inform decision making in patients with acute cholecystitis and might facilitate timely diagnosis and optimize the medical and surgical management of those with acute gangrenous cholecystitis.