Fig. 1
Fig. 2
Fig. 3
Fig. 4
Complications of gallstones
| Complications |
|---|
| Acute cholecystitis* |
| Acute biliary pancreatitis* |
| Acute cholangitis* |
| Acute acalculous cholecystitis* |
| Biliary enteric fistula and gallstone ileus* |
| Choledocholithiasis |
| Cholestatic jaundice* |
| Cholesterolosis and gallbladder polyps |
| Chronic cholecystitis |
| Gallbladder carcinoma and porcelain gallbladder |
| Recurrent pyogenic cholangitis* |
Conditions predisposing to increased risk of acute cholecystitis
| Acute non-biliary diseases | Immunocompromised illness |
|---|---|
| Acute renal failure | Infections (hepatitis B virus, ascariasis in developing countries) |
| Age > 60 years | Major surgery |
| Biliary sludge | Female gender |
| Cardiovascular disease (history of ischemic stroke, cerebral hemorrhage) | Multiple trauma |
| Diabetes mellitus | Sepsis |
| Gallstones | Severe burns |
| Hormonal replacement therapy | Systemic vasculitis |
| Hypertriglyceridemia | Total parenteral nutrition, long term fasting |
Imaging techniques for acute cholecystitis
| Technique | Major findings | Notes |
|---|---|---|
| Abdominal ultrasonography | Enlarged gallbladder size | First choice |
| Gallbladder wall thickening (>4mm) Incarcerated gallstone(s) Intraluminal debris echoes Pericholecystic fluid collection or abscess Positive “sonographic” Murphy sign Sonolucent “double wall sign” | Moderate sensitivity (88%90%) and specificity (80%) [63, 122-124] | |
| Hepatobiliary scintigraphy (technetium iminodiacetic | Compound given intravenously and excreted by the liver Test is positive if the gallbladder is not visualized (i.e., cystic | Highest sensitivity and specificity (≈90-95%) [123] |
| acid or hydroxyiminodiacetic acid) | duct obstruction due to edema by acute cholecystitis) [63] | Not easily available |
| Computed Tomography (CT) | Gallbladder wall edema | High sensitivity 94% |
| Pericholecystic fluid Other complications [125] | Low specificity 59% [123, 126] | |
| Magnetic Resonance | Gallstones are likely passed in the common bile duct [127] | Moderate accuracy [123] |
| Cholangio-Pancreatography | Not easily available | |
| (MRCP) | Under evaluation |