Ultrasonographic predictors of acute gangrenous cholecystitis in patients treated with laparoscopic cholecystectomy: a single center retrospective study.

Background: Acute gangrenous cholecystitis, a severe complication of cholecystitis, carries a high risk of morbidity and mortality. Despite its severity, preoperative diagnosis is challenging, often only confirmed during surgery. Therefore, we analyzed various factors that could predict acute gangrenous cholecystitis in patients undergoing cholecystectomy.

Methods: We retrospectively reviewed patients who underwent laparoscopic cholecystectomy at Bundang Jasaeng General Hospital from January 2018 to December 2021. Only patients who proceeded directly to surgery without radiologic interventions were included, and all underwent trans-abdominal ultrasonography before surgery.

Results: Our study investigated 305 patients diagnosed with acute cholecystitis, identifying 37 with acute gangrenous cholecystitis. Analysis showed that patients with gangrenous cholecystitis were significantly older, more likely to be male, and had a higher prevalence of diabetes mellitus compared to those with uncomplicated cholecystitis. Ultrasound findings revealed a higher incidence of sonographic Murphy's signs, thickened gallbladder walls, gallbladder wall defects, and pericholecystic fluid in gangrenous cases. Multivariate analyses showed that a thickened gallbladder wall and the presence of pericholecystic fluid were significantly associated with gangrenous cholecystitis.

Conclusion: Our study showed that ultrasound findings of a thickened gallbladder wall, along with pericholecystic fluid, could be predictors of gangrenous cholecystitis. Additionally, leukocytosis and high CRP values strongly indicate the likelihood of this condition. Therefore, urgent management is recommended due to the high morbidity and mortality associated with gangrenous cholecystitis.