Role of Abdominal Contrast-Enhanced Computed Tomography in Diagnosing Gangrenous Gall Bladder Wall Perforation

Complicated acute cholecystitis, particularly gangrenous cholecystitis and gallbladder perforation, represents a radiologic and surgical emergency because delayed recognition may lead to sepsis, abscess formation, and worse operative outcomes. Although ultrasonography is the first-line imaging modality, its ability to detect mural necrosis and perforation remains limited. This study evaluated the role of contrast-enhanced computed tomography (CECT) in identifying advanced gallbladder inflammation in patients with surgically confirmed complicated disease.

This retrospective observational study was conducted over a two-year period after ethics approval. Adult patients with clinically suspected acute or complicated cholecystitis who underwent contrast-enhanced CT abdomen and subsequently had operative and histopathological confirmation were included. Twenty patients with complete clinical, radiological, operative, and pathological records constituted the final cohort.

The mean age was approximately 54 years, with 11/20 males (55.0%) and 9/20 females (45.0%). Right upper quadrant pain was the most common presenting feature, seen in 19/20 patients (95.0%), followed by abdominal tenderness in 16/20 (80.0%), leukocytosis in 16/20 (80.0%), fever in 14/20 (70.0%), nausea or vomiting in 13/20 (65.0%), and positive Murphy's sign in 12/20 (60.0%). On ultrasonography, gallstones were identified in 16/20 (80.0%), gallbladder wall thickening in 15/20 (75.0%), distension in 9/20 (45.0%), pericholecystic fluid in 6/20 (30.0%), and suspicion of perforation in 4/20 (20.0%). On CT, wall thickening was present in 17/20 (85.0%), irregular wall contour in 12/20 (60.0%), pericholecystic fluid in 10/20 (50.0%), absence of mural enhancement in 9/20 (45.0%), intraluminal membranes in 6/20 (30.0%), gas in the gallbladder wall or lumen in 3/20 (15.0%), and wall discontinuity in 8/20 (40.0%). Surgery confirmed gangrenous cholecystitis in 12/20 patients (60.0%) and gallbladder perforation in 8/20 (40.0%).

Contrast-enhanced CT served as a decisive problem-solving modality in complicated acute cholecystitis by identifying mural devascularization, gangrene, perforation, and extra-gallbladder complications more reliably than ultrasonography. Its major value lies in pattern-based recognition of advanced disease that may directly influence operative urgency and treatment planning.