Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

Mirzaei Roozbahani, Mehrdad; Shahmoradi, Mohamad Kazem; Mehri, Jafar; Qolampoor, Arefe; Nasiri, Bahram; Pakmehr, Fatemeh

doi:10.33945/SAMI/IJABBR.2019.3.7

Document Type : Original Article

Authors

¹ Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran

² Assistant Professor, Department of General Surgery, Lorestan University of medical Sciences, Khorramabad, Iran

³ Resident of General Surgery, Department of General Surgery, Lorestan University of medical Sciences, Khorramabad, Iran

⁴ Medical Student, Student Research Committee, Lorestan University of medical Sciences, Khorramabad, Iran

10.33945/SAMI/IJABBR.2019.3.7

Abstract

Introduction: The aim of this study was to determine factors affecting the development of acute cholecystitis toward gangrenous cholecystitis in an Iranian society.
Materials and Methods: In this cross-sectional study, all patients who underwent cholecystectomy in the educational hospitals of Khorramabad from August 2013 to August 2016 were included in the study regardless of their age range. The data collected in each patient included demographic data, underlying illnesses, positive history and physical examination prior to surgery, early laboratory findings and preoperative imaging findings. Finally, patients were divided into two groups of acute Cholecystitis and Gangrenous Cholecystitis based on pathological findings after cholecystectomy. The data was finally analyzed using SPSS software.
Results: 51 patients were examined during the study. Histological studies indicated the presence of microscopic evidence of acute cholecystitis in all patients, of which 19 had histological evidence of Gangrenous Cholecystitis. In this study, nine variables that could be effective on the prognosis of acute cholecystitis and its progression toward the Gangrenous Cholecystitis were identified. These variables included age, WBC count, diabetes mellitus and coronary artery disease, fluid accumulation around gallbladder, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and lipase. Finally, multivariate analysis was performed using logistic regression. It was found that the age of ≥51 was effective in the development of diabetes mellitus.
Conclusion: In this study, it was observed that high age, diabetes mellitus and leukocytosis could lead to the development of acute cholecystitis toward Gangrenous Cholecystitis, a finding that requires more extensive studies with more sample size.

Keywords

Main Subjects

General Surgery

References

Aydin, C, Altaca, G, Berber, I, Tekin, K, Kara, M, Titiz, I. (2006). Prognostic parameters for the prediction of acute gangrenous cholecystitis. J. Hepatobiliary Pancreat Surg., 13(2):155-159.

Bedirli, A, Sakrak, O, Sozȕer, EM, Kerek, M, Gȕler, I. (2001). Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology, 48(41):1275–1278.

Fagan, SP, Awad, SS, Rahwan, K, Hira, K, Aoiki, N, Itani, KMF, Berger, DH. (2003). Prognostic factors for the development of gangrenous cholecystitis. Am. J. Surg., 186:481-485.

Festi, D, Sottili, S, Colecchia, A, Attili, A, Mazzella, G, Roda, E, Romano, F. (1999). Clinical manifestations of gallstone disease: Evidence from the multi-center Italian study on cholelithiasis (MICOL). Hepatology, 30(4):839-846.

Fry, DE, Cox, RA, Harbrecht, PJ. (1981). Gangrene of the gallbladder: a complication of acute cholecystitis. South Med. J., 74(6):666-668.

Ganapathi, AM, Speicher, PJ, Englum, BR, Perez, A, Tyler, DS, Zani, S. (2015). Gangrenous Cholecystitis: A Contemporary Review. J. Surg. Res., doi:10.1016/ j.jss.2015.02.058.

Gholipour, Ch, Abolghasemi Fakhree, MB, Alizadeh Shalchi, R, Abbasi, M. (2009). Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surgery, 9:13.

Girgin, S, Gedic, E, Taçyıldız, IH, Akgün, Y, Baç, B, Uysal, E. (2006). Factors Affecting Morbidity and Mortality in Gangrenous Cholecystitis. Acta chir. Belg., 106:545-549.

Gracie, WA, Ransohoff, DF. (1982). The natural history of silent gallstones: the innocent gallstone is not a myth. N. Engl. J. Med., 307:798.

Halldestam, I, Enell, EL, Kullman, E, Borch, K. (2004). Development of symptoms and complications in individuals with asymptomatic gallstones. Br. J. Surg., 91:734.

Hunt, DRH, Chu, CK. (2000). Gangrenous cholecystitis in the laparascopic era. Aust. N. Z. J. Surg, 70:428-430.

Jethwani, U, Singh, GJ, Mohil, R, Kandwal, V, Razdan, S, Chouhan, J, Saroha, R, Bansal, N. (2013). Prediction of difficulty and conversion in laparoscopic cholecystectomy. OA Minimally Invasive Surgery, 1(1):2.

Kimura, Y, Takada, T, Kawarada, Y, Nimura, Y, Hirata, K, Sekimoto, M, Yoshida, M, Mayumi, T, Wada, K, Miura, F, Yasuda, H, Yamashita, Y, Nagino, M, Hirota, M, Tanaka, A, Tsuyuguchi, T, Strasberg, SM, Gadacz, TR. (2007). Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J. Hepatobiliary Pancreat Surg., 14(1):15-26.

Lammert, F, Sauerbruch, T. (2005). Mechanisms of disease: the genetic epidemiology of gallbladder stones. Nat. Clin. Pract. Gastroenterol Hepatol, 2(9):423-433.

Merriam, LT, Kanan, SA, Dawes, LG, Angelos, P, Prystowsky, PJB, Renge, RV, Joehl, RJ. (1999). Gangrenous cholecystitis: analysis of risk factors and experience with laparascopic cholecystectomy. Surgery, 126:680-686.

Mok, KWJ, Reddy, R, Wood, F, Turner, P, Ward, JB, Pursnani, KG, Date, RD. (2014). Is C reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis. Int. J. Surg., 12:649-653.

Morfin, E, Ponka, JL, Brush, BE. (1968). Gangrenous cholecystitis. Arch. Surg., 96(4):567-473.

Morrow, DJ, Thompson, J, Wilson, SE. (1978). Acute cholecystitis in the elderly. Arch. Surg., 113:1149–1152.

Nguyen, L, Fagan, SP, Lee, TC, Aoki, N, Itani, KM, Berger, DH, Awad, SS. (2004). Use of a predictive equation for diagnosis of acute gangrenous cholecystitis. Am. J. Surg., 188:463–466.

Nikfarjam, M, Niumsawatt, V, Sethu, A, Fink, MA, Muralidharan, V, Starkey, G, Jones, RM, Christophi, Ch. (2011). Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford), 13:551–558.

Rosen, M, Brody, F, Ponsky, J. (2002). Predictive factors for conversion of laparoscopic cholecystectomy. Am. J. Surg., 184(3):2548.

Sangeeta, A, Sreenivasa, J. (2000). Gallstones from gallbladder to gut. Postgrad. Med., 108(3):143-153.

Shiva, A. (2017). Predictive Factors of the Success of Laparoscopic Cholecystectomy in Patients with Acute Cholecystitis Referring to Qazvin Hospital. General Surgery Thesis, Qazvin University of Medical Sciences and Health Services. 2017. [In Persian]

Stefanidis, D, Bingener, J, Richards, M, Schwesinger, W, Dorman, J, Sirinek, K. (2005). Gangrenous cholecystitis in the decade before and after the introduction of laparoscopic cholecystectomy. JSLS, 9(2):169-173.

Sultan, AM, El-Nakeebet, A, Elshehawy, T, Elhemmaly, M, Elhanafy, E, Atef, E. (2013). Risk Factors for conversion during laparoscopic cholecystectomy: retrospective analysis of ten years’ experience at a single tertiary referral center. Dig. Surg., 30:51-55.

Teefy, SA, Baron, RL, Radke, HM, Bigler, SA. (1991). Gangrenous cholecystitis: new observations on sonograph. J. Ultrasound Med., 10:603-606.

Völzke, H, Baumeister, SE, Alte, D, Hoffmann, W, Schwahn, C, Simon, P, John, U, Lerch, MM. (2005). Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion, 71(2):97-105.

Yacoub, WN, Petrosyan, M, Sehgal, I, Ma, Y, Chandrasoma, P, Mason RJ. (2010). Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score. Gastroenterol Res. Pract., 2010:901739.

International Journal of Advanced Biological and Biomedical Research

Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

References

References

Volume 7, Issue 3
September 2019
Pages 255-262

Risk Factors of Gangrenous Cholecystitis in Patients with Acute Cholecystitis: A Cross-Sectional Study

References

References

Volume 7, Issue 3September 2019Pages 255-262

Volume 7, Issue 3
September 2019
Pages 255-262