Acalculous Cholecystitis : Is There Any Sonographic Finding to Indicate Cholecystectomy?

Rhim, Hyun Chul; Lee, Hak Soo; Lee, Tae Hee; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo

Journal of Korean Society of Medical Ultrasound 1996;15(1): 19-25.

Hyun Chul Rhim, Hak Soo Lee, Tae Hee Lee, Yong Soo Kim, Byung Hee Koh, On Koo Cho

Department of Diagnostic Radiology, College of Medicine, Hanyang University

ABSTRACT

PURPOSE : To assess clinical courses in patient with acalculous cholecystitis and sonographic criteria toindicate surgical intervention. MATERIAL & METHODS : Authors retrospectively reviewed clinical records andsonograms of 35 patients (aged 26-80 years) who were diagnosed as acalculous cholecystitis. They were confirmedclinically (n = 21) and surgically (n = 14) as acalculous cholecystitis. The clinical courses were assessed inview of the interval of symptom improvement during non-surgical management and after surgical management.Sonographic follow-up in 10 patients of non-surgical group was performed. Comparative assessment of sonographicfindings in non-surgical group with those in surgical group was performed in view of gallbladder distension [axialdiameter, longitudinal diameter, and roundness index(axial diameter/longitudinal diameter)], gallbladder wallthickening, halo sign, bile sludge, pericholecystic fluid, and sonographic Murphy sign. RESULTS : Acalculouscholecystitis in surgical group showed a tendency to be operated if clinical symptom was not improved afterconservative treatment over seven days. Follow-up sonographic findings were also improved in seven of 10non-surgical patients. Although one case showed development of gallstone after 5-years follow-up, no one has beenoperated due to recurrence of cholecystitis in non-surgical group. We found no significant sonographic criteriaexcept for sonographic murphy sign (33% vs 66% , P<0.05) between non-surgical and surgical groups. Nostatistically significant differences in longitudinal diameter (6.9±1.6cm vs 7.7±1.9cm ; p>0.05), axial diameter(3.2±0.9cm vs 3.3±1.1cm ; p>0.05), roundness index (0.47±0.08 vs 0.42±0.9 ; p>0.05), wall thickening(4.0±1.9mm vs 4.6±2.5mm ; p>0.05), halo sign (95% vs 78% ; p>0.05), bile sludge (38% vs 21% ; p>0.05),pericholecystic fluid (5% vs 7% ;p>0.05) were found between non-surgical and surgical groups. CONCLUSION : Exceptfor sonographic Murphy sign, any sonographic criteria in acalculous cholecystitis doesn't seem to be helpful toindicate surgical intervention. Conservative management is recommended if there is no significant sign ofperitoneal irritation in acalculous cholecystitis.

Keywords: Gallbladder, inflammations, Gallbladder, inflammations, diagnosis, Gallbladder, Inflammations, US