坏疽性胆囊炎的文献学习及典型的CT表现.pdf

Clinical History: A 69-year-old male patient presented with a three-week history of right upper quadrant abdominal pain, pyrexia. Plain X-Ray of the abdomen shows gas-filled structure in the right upper quadrant, most likely air filled gall bladder; for clinical correlation and further investigation. Diagnosis: Gangrenous cholecystitis Discussion: Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis. It is the result of marked distension of the gallbladder causing increased tension in the gallbladder wall.Associated inflammation leads to ischemic necrosis of the wall, with or without associated cystic artery thrombosis. It is more common in men and in patients with co-existing cardiovascular disease and leukocytosis — white cell count (WCC) greater than 17 × 109/L. Other associated factors include diabetes, critical illness and a high C-reactive protein (CRP) level. Pre-operative diagnosis of this condition may prove difficult. Once suspected, patients with GC generally undergo emergency cholecystectomy in order to avoid life-threatening complications. GC is the last stage of gallbladder inflammation and, in spite of its grave prognosis, its diagnosis can be elusive, both clinically and on laboratory investigation. The incidence of GC ranges from 2 percent to 29.6 percent in all patients with acute cholecystitis, in various surgical series, and generally occurs in older patients. Many factors have been implicated in its formation. Fagan et al. demonstrated that nine variables were associated with GC, but Contini et al. showed that there is no single clinical or laboratory finding, apart from a high WCC, predictive of severe inflammation of the gallbladder. Contini et al. showed that the time of hospitalization delay plays a crucial role in the formation of GC. The time between the onset of symptoms and hospital admission was significantly longer in patients with GC. The patients history (timely or delayed admissi