E2185. Gallbladder Disease Complications: When Things Go Awry
Authors
Anish Neupane;
Bridgeport Hospital
Anisa Chowdhary;
Bridgeport Hospital
Gaurav Cheraya;
Bridgeport Hospital
Ismail Yardimcioglu;
Bridgeport Hospital
Rachana Borkar;
Bridgeport Hospital
Namita Bhagat;
Bridgeport Hospital
Marc Ferrante;
Bridgeport Hospital
Background
Approximately 25 million Americans suffer from gall stones: 90-95% develop acute calculous cholecystitis and 5 - 10% develop acalculous disease. Of them, 40 % develop complications such as gallstone ileus, mirizzi syndrome, postoperative hematoma, bilioma, abscess, cystic duct remnant pathology; suppurative, emphysematous, gangrenous, xantho-granulomatous cholecystitis, and cholecystoenteric fistula.
Educational Goals / Teaching Points
Complicated gallbladder (GB) disease can often be a primary imaging manifestation. Uncomplicated acute cholecystitis usually resolves in 7 - 10 days. CT usually diagnostic of complicated GB disease. Cholecystoenteric fistula is a rare complication in which cholecystoduodenal fistula is most common followed by cholecystocolonic fistula. No general consensus exists on management of fistulous disease, from conservative to extensive resection. Xanthogranulomatous cholecystitis is usually a difficult preoperative diagnosis (0.7 - 10% incidence) with following features. Ultrasound (US): gallstones with focal/diffuse thickening and hypoechoic nodules (characteristic). CT: diffuse wall thickening, intramural hypoattenuating nodules, luminal surface enhancement, and intramural fat. MRI: fat within GB wall. FDG PET: positive uptake. Treatment: surgery due to risk of cancer and complications.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
GB variants: septations and Hartmann pouch (infundibulum) are associated with cholecystitis. Diagnosis: clinical: right upper quadrant pain, leukocytosis, Murphy’s sign supplemented by imaging. US: first imaging, sensitive, gallstones, wall thickening, sonographic Murphy’s sign (92% sensitivity). CT: first imaging in nonspecific symptoms, less sensitive, wall thickening, pericholecystic fluid, better for complicated cholecystitis. Cholescintigraphy: equivocal cases, rule out Acalculus cholecystitis treatment: uncomplicated cholecystitis: lap cholecystectomy; complicated cholecystitis: open surgery, cholecystostomy.
Conclusion
GB disease is not always simple acute cholecystitis. Identifying imaging findings to suggest various mentioned complications is of utmost importance in patient management and mortality.
