ULTRASONIC-DETECTION OF ACUTE CHOLECYSTITIS WITH PERICHOLECYSTIC ABSCESSES

  • 1 January 1981
    • journal article
    • research article
    • Vol. 47  (5) , 211-214
Abstract
Perforation of the gallbladder is a life-threatening complication of acute cholecystitis that is often difficult to diagnose at an early stage. Standard radiographic and laboratory tests were not reliable in identifying patients with this complication. In contrast, biliary sonography correctly diagnosed pericholecystic abscesses preoperatively in 3 patients with acute cholecystitis. The ultrasonic appearance of acute cholecystitis with a pericholecystic abscess was similar in all 3 patients. There was an extraluminal fluid collection located contiguous to a thick-walled gallbladder in the fundic region. The fluid collection was constant in location and could be seen in at least 2 different views. Of these 3 patients, 2 had acalculous cholecystitis; the initial clinical diagnosis in one was pancreatitis and in the other alcoholic hepatitis. Biliary sonography, by demonstrating a thickened gallbladder wall in the absence of ascites, strongly suggested that these 2 patients had acute acalculous cholecystitis and not hepatitis or pancreatitis. The ultrasonic examination was a critical factor in the decision for prompt surgery instead of continued nonoperative management in these patients. Not only can biliary sonography aid in the diagnosis of acute cholecystitis (calculous and acalculous), but it evidently can also visualize a pericholecystic abscess when it is present.

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