gangrenous cholecystitis

Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients.

Pathology

Gangrenous cholecystitis occurs as a result of ischemia with necrosis of the gallbladder wall .

Risk factors

• male
• increasing age
• delayed surgery
• cardiovascular disease
• diabetes mellitus
• systemic inflammatory response syndrome

Radiographic features

Ultrasound

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis :

• intraluminal membranes
• asymmetrical wall thickness
  • with possible wall disruption and/or ulceration
• focal perfusion defects on Doppler (representing areas of necrosis)
• variable absence of the sonographic Murphy's sign 
  • attributed to ischemic denervation of the gallbladder

CT

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis :

• gallbladder wall or lumen gas
• focal irregularity or defect in the gallbladder wall
• intraluminal membranes
• absence of mural enhancement
• pericholecystic abscess

Treatment and prognosis

Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% .

Siehe auch:

• perforierte Cholezystitis
• emphysematöse Cholezystitis
• Cholezystitis
• Gallenblasenempyem

und weiter:

• Cholecystitis
• Gallenblasendrainage
• air in the gallbladder wall