Clinical Research
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 15, 2003; 9(12): 2821-2823
Published online Dec 15, 2003. doi: 10.3748/wjg.v9.i12.2821
Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis
Ay-Jiun Wang, Tsang-En Wang, Ching-Chung Lin, Shee-Chan Lin, Shou-Chuan Shih
Ay-Jiun Wang, Tsang-En Wang, Ching-Chung Lin, Shee-Chan Lin, Shou-Chuan Shih, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Ay-Jiun Wang, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital. 92, Sec. 2, Chung San North Road, Taipei, Taiwan, China. ajw@ms2.mmh.org.tw
Telephone: +86-2-25433535 Fax: +86-2-25574800
Received: August 26, 2003
Revised: September 26, 2003
Accepted: October 12, 2003
Published online: December 15, 2003
Abstract

AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).

METHODS: The medical records of patients hospitalized from January1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness > 3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or abscess.

RESULTS: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males predominated. Most patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52%, group A) and absent in 25 (group B). Six patients died with a mortality of 12%. Four of the 6 who died were in group A. Patients in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P = 0.04) and had a significantly higher white blood cell count (mean 15885.19 vs. 9948.40, P = 0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band forms. The most commonly cultured bacteria in both blood and bile were E. coli and Klebsiella pneumoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points.

CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC.

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