Significance of ultrasonography in selecting methods for the treatment of acute cholecystitis
Surgical removal of the gallbladder is indicated in nearly all cases of complicated acute cholecystitis. In the 1990s, laparoscopic cholecystectomy became the method of choice in the treatment of cholecystolithiasis. Due to a large inflammatory reaction in the course of acute inflammation, a lapa...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Sciendo
2013-09-01
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| Series: | Journal of Ultrasonography |
| Subjects: | |
| Online Access: | http://jultrason.pl/index.php/issues/volume-13-no-54/significance-of-ultrasonography-in-selecting-methods-for-the-treatment-of-acute-cholecystitis?aid=170 |
| Summary: | Surgical removal of the gallbladder is indicated in nearly all cases of complicated acute
cholecystitis. In the 1990s, laparoscopic cholecystectomy became the method of choice
in the treatment of cholecystolithiasis. Due to a large inflammatory reaction in the course
of acute inflammation, a laparoscopic procedure is conducted in technically difficult
conditions and entails the risk of complications. The aim of this paper was: 1) to analyze
ultrasound images in acute cholecystitis; 2) to specify the most common causes of conversion
from the laparoscopic method to open laparotomy; 3) to determine the degree
to which the necessity for such a conversion may be predicted with the help of ultrasound
examinations. Material and methods: In 1993–2011, in the Second Department
and Clinic of General, Gastroenterological and Oncological Surgery of the Medical University
in Lublin, 5,596 cholecystectomies were performed including 4,105 laparoscopic
procedures that constituted 73.4% of all cholecystectomies. Five hundred and forty-two
patients (13.2%) were qualified for laparoscopic procedure despite manifesting typical
symptoms of acute cholecystitis in ultrasound examination, which comprise: thickening
of the gallbladder wall of > 3 mm, inflammatory infiltration in the Calot’s triangle region,
gallbladder filled with stagnated or purulent contents and mural or intramural effusion.
Results: In the group of operated patients, the conversion was necessary in 130 patients,
i.e. in 24% of cases in comparison with 3.8% of patients with uncomplicated cholecystolithiasis
(without the signs of inflammation). The conversion most frequently occurred
when the assessment of the anatomical structures of the Calot’s triangle was rendered
more difficult due to local inflammatory process, mural effusion and thickening of the
gallbladder wall of >5 mm. The remaining changes occurred more rarely. Conclusions:
Based on imaging scans, the most common causes of conversion included inflammatory
infiltration in the Calot’s triangle region, mural effusion and wall thickening to > 5 mm.
The classical cholecystectomy in acute cholecystitis should be performed in patients with
three major local complications detected on ultrasound examination and in those, who
manifest acute clinical symptoms. |
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| ISSN: | 2084-8404 2451-070X |