Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features

Tsai, Ming-Jen; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Hu, Sheng-Chuan; Chang, Cheng-Yen

doi:10.1016/j.ajem.2008.04.024

« Previous Next »American Journal of Emergency Medicine
Volume 27, Issue 5 , Pages 574-581, June 2009

Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED?

Correlation with clinical data and computed tomography features

Ming-Jen Tsai, MD
- Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital, Hualien 970, Taiwan
Jen-Dar Chen, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei 112, Taiwan
- Corresponding author. Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan. Tel.: +886 928832812; fax: +886 2 2871 0848.
Chui-Mei Tiu, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei 112, Taiwan
Yi-Hong Chou, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei 112, Taiwan
Sheng-Chuan Hu, MD
- Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital, Hualien 970, Taiwan
Cheng-Yen Chang, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- National Yang-Ming University School of Medicine, Taipei 112, Taiwan

Received 11 September 2007; received in revised form 23 April 2008; accepted 24 April 2008.

Abstract

Purpose

The purpose of this study is to determine which computed tomography (CT) findings and clinical data can help to diagnose gallbladder perforation in acute cholecystitis.

Materials and Methods

The medical records and CT findings of patients with surgically proven acute cholecystitis within the last recent 5 years were retrospectively reviewed and compared between 2 groups with and without gallbladder perforation.

Results

A total of 75 patients with acute cholecystitis were included in the study, and 16 patients were proven to have gallbladder perforation. Higher mortality rate was found in the perforation group (18.8% vs 1.7%; P = .029). Older age (>70 years; P = .004) and higher percentage of segmented neutrophil (>80%; P = .027) were significant clinical factors for predicting gallbladder perforation in acute cholecystitis. The significant CT signs related to gallbladder perforation included visualized gallbladder wall defect (P = .000), intramural gas (P = .043), intraluminal gas (P = .000), intraluminal membrane (P = .043), pericholecystic abscess or biloma formation (P = .009), intraperitoneal free air (P = .001), and presence of ascites in the absence of hypoalbuminemia or other intraabdominal malignancy (P = .017). In multivariate analysis, visualized gallbladder wall defect was the most significant predicting CT feature for diagnosing gallbladder perforation in acute cholecystitis.

Conclusion

Elderly patients with higher segmented neutrophil and CT signs of gallbladder wall defect associated with acute cholecystitis may have high possibility of gallbladder rupture.