Presence of fever and leukocytosis in acute cholecystitis

To determine the frequency of fever and leukocytosis in patients presenting to the emergency department with acute cholecystitis (AC).

We carried out a retrospective review of charts from 1990 to 1993 at a university-affiliated hospital. Our subjects were ED patients with hepato-iminodiacetic acid (HIDA) scans interpreted as showing AC and who had undergone cholecystectomy during hospitalization. Final diagnosis was determined on the basis of the pathology report. Fever was defined as an oral temperature of 100 degrees F (37.7 degrees C) or greater or a rectal temperature of 100.4 degrees F (38.0 degrees C) or greater. Leukocytosis was defined as a WBC count of 11,000/mm3 or greater.

Of the 198 cases studied, the pathologic diagnosis of nongangrenous AC was made in 103 (52%), gangrenous AC was diagnosed in 51 (26%), and chronic cholecystitis was diagnosed in 44 (22%). In patients with nongangrenous AC, 71% were afebrile, 32% lacked leukocytosis, and 28% lacked fever and leukocytosis. In patients with gangrenous AC, 59% were afebrile, 27% lacked leukocytosis, and 16% lacked fever and leukocytosis.

We found that patients with AC diagnosed in the ED frequently lacked fever or leukocytosis. The clinician should not rely on the presence of these signs in making the diagnosis of acute cholecystitis.