Central Surgical AssociationGangrenous cholecystitis: Analysis of risk factors and experience with laparoscopic cholecystectomy☆
Section snippets
Methods
We reviewed medical records of all patients admitted to Northwestern Memorial Hospital with acute cholecystitis who underwent cholecystectomy during the same admission in the 2-year period of 1995 and 1996. Data used in our analysis included admitting history and physical examination, laboratory and radiologic data, operative log, and hospital course. The clinical diagnosis of acute cholecystitis was made preoperatively based on the presence of right upper quadrant or epigastric pain and
Results
During the study period, a total of 410 patients underwent cholecystectomy at Northwestern Memorial Hospital. Among this group, 154 patients were admitted with a clinical diagnosis of acute cholecystitis and subsequently had a cholecystectomy during the same hospital admission. Pathologists made the diagnosis of acute cholecystitis in gallbladder specimens from all of these patients. Of these, a total of 27 (18%) patients had gangrenous cholecystitis, identified by gross and microscopic
Discussion
Acute gangrenous cholecystitis is a severe complication of gallstone disease, and the morbidity and mortality of this disorder greatly exceed that of uncomplicated acute cholecystitis. Elderly and critically ill patients have particularly high risk for this problem and for its sequelae.1, 2, 3, 4 In this study, 70% of patients with gangrenous cholecystitis were older than 50 years of age, whereas in the patients with nongangrenous acute cholecystitis, only 35% of patients were older than 50
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Reprint requests: Raymond J. Joehl, MD, James R. Hines Professor of Surgery, Chief, Division of General Surgery, Northwestern University Medical School, 300 E Superior St, Tarry Building 11-703, Chicago, IL 60611.