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% .

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