Correlation of toxic signs, ultrasonographic findings and pathological changes in cholecystitis

Cholecystitis is a frequently encountered clinical problem. What parameters are reliable in helping predict its severity?

One hundred and forty-nine cholecystectomized cases of cholecystitis were analysed of which 99 (95 calculous) cases were pathologically diagnosed as chronic cholecystitis and 50 acute (43 calculous) cholecystitis. Medical records were reviewed to determine the frequency of toxic signs. Sonographic findings (performed within three days prior to operation), and final pathological changes with respect to the thickness and echotexture of the gallbladder wall were compared.

Of 99 chronic cholecystitis patients, 13 cases showed toxic signs. Sonography detected an abnormal wall in 64, but made a correct diagnosis in only 34 cases. A great discrepancy was found in wall thickness as measured by sonography and pathology. A discrepancy > or = 2mm was noted in 19 cases. Of 50 patients with acute cholecystitis (20 cases had complications, defined as severe acute cholecystitis), 31 cases (14 of the 20 severe acute cases) showed toxic signs. Sonographic findings demonstrated an abnormal wall in 46 cases (19 of the severe acute cases) and an accurate diagnosis in 28 cases (13 of the severe acute cases). A difference in the measurement of gallbladder wall thickness > or = 2mm was noted in 26 patients.

Clinical toxic signs and sonographic findings could not offer sufficient information to quickly identify lifethreatening gallbladder diseases.