Histologic Correlation with the Clinical-Radiologic Acute Cholecystitis Syndrome
Suntrea TG Hammer, Katherine E Maturen, Henry D Appelman. University of Michigan Health System, Ann Arbor, MI
Background: The syndrome of acute cholecystitis is clinically defined as the presence of right upper quadrant abdominal pain, fever, leukocytosis, and gallbladder abnormalities on radiologic exam. There is also histologic acute gallbladder inflammation seen as acute mucosal or mural necrosis with transmural inflammation (TI). Little is written about the association between the clinical acute cholecystitis syndrome and histologic acute inflammation. We examined histologic acute cholecystitis cases over one year and correlated them with clinical and radiological features to identify any association.
Design: We found 27 cholecystectomy cases resected in 2010 for primary biliary disease with TI and acute mucosal necrosis. The presence of mucosal neutrophils, transmural neutrophilic infiltrate, transmural and mucosal necrosis, hemorrhage, wall edema and thickness were evaluated. Controls were 27 non-inflamed gallbladders resected for gallstones. Clinical data included age, gender, ethnicity, temperature > 37C, leukocytosis > 10.0 K/mm3, right upper quadrant pain >24 hrs, and clinical response to resection. Radiologic studies were reviewed by a staff radiologist for gallstones/sludge, pericholecystic fluid, wall thickness, and sonographic Murphy sign.
Results: The study group was a mean 10 yrs older than controls (48 v 58 yrs), more often male (60% vs 40%), and more often had systemic symptoms like fever (19% v 4%) and leukocytosis (74% v 26%). Seventy-seven percent of the study group had either fever or leukocytosis, versus 4% of controls. Scintigraphic studies correlated with histology better in study patients [92% (n=12) v 20% (n=5)]. Sonographic findings correlated well with histology in both study and control groups (85% v 86%). Ultrasounds were available on 24 study patients and 21 controls. Study patients more often had thickened gallbladder walls, distention, pericholecystic fluid, loculated fluid collections, and impacted neck stones. The time from imaging to surgery was significantly longer in controls (70 days vs 1.3 days). The intraoperative impression correlated better in study group patients (89% v 67%). There was similar symptomatic response in both groups.
Conclusions: There is clear, but imperfect correlation between our definition of acute cholecystitis, radiologic, and clinical features of the acute cholecystitis syndrome. The patients are slightly male predominant with at least one systemic symptom, have characteristic radiographic findings, and have acute inflammation intraoperatively.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 106, Wednesday Morning