| The changing face of emphysematous cholecystitis. | |
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MedLine Citation:
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PMID: 9404199 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Emphysematous cholecystitis is a variant of acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple acute cholecystitis. The apparently high mortality and morbidity associated with emphysematous cholecystitis has previously emphasized the importance of emergency cholecystectomy. We have reviewed eight cases of emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and conservative management was employed in five of the patients. The remaining three patients underwent cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of emphysematous cholecystitis. As a result of the regular use of US in suspected hepatobiliary disease, emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients. |
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Authors:
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K S Gill; A H Chapman; M J Weston |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The British journal of radiology Volume: 70 ISSN: 0007-1285 ISO Abbreviation: Br J Radiol Publication Date: 1997 Oct |
Date Detail:
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Created Date: 1997-12-29 Completed Date: 1997-12-29 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0373125 Medline TA: Br J Radiol Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 986-91 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology, St James's University Hospital, Leeds, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aged, 80 and over Cholecystectomy Cholecystitis / radiography, surgery, ultrasonography* Emphysema / radiography, surgery, ultrasonography* Female Humans Male Middle Aged Tomography, X-Ray Computed Treatment Outcome |
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