Acute cholecystitis - Predictors of severity

Our purpose was to determine factors influencing the severity of acute cholecystitis, and to assess their prognostic significance. During the period 1995-2003, we operated urgently on 149 patients with the disease. The following parameters were prospectively recorded; Age, sex, presence of diabetes mellitus, blood white cell count, serum amylase and alkaline phosphatase levels at diagnosis, as well as radiological findings of peri-cholecystic fluid collection and presence of gas in the gallbladder wall. Operative records and histology findings were also included in the examined data. Histological diagnosis of gangrenous cholecystitis was established in 40 (26.8%) patients, with gallbladder perforation present in seven (17.5%) of them at laparotomy, and hepatic abscess development in one. Peri-cholecystic collection was present in 44(29.5%) patients. Analysis of our findings suggests that diabetes, a white cell count more than 15000/ml at diagnosis, and presence of peri-cholecystic fluid collection, could be useful prognostics of gangrenous cholecystitis.