title: Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients.
abstract: In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. Markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.
authors.affiliation: Allgemeines Krankenhaus Wien, University of Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Madl
authors.forename: G
authors.initials: G
authors.lastname: Grimm
authors.forename: R
authors.initials: R
authors.lastname: Mallek
authors.forename: B
authors.initials: B
authors.lastname: Schneeweiss
authors.forename: W
authors.initials: W
authors.lastname: Druml
authors.forename: A N
authors.initials: AN
authors.lastname: Laggner
authors.forename: K
authors.initials: K
authors.lastname: Lenz
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001201:Ascites / Q000150:complications*; D002763:Cholecystectomy; D002764:Cholecystitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016638:Critical Illness; D003937:Diagnosis, Differential; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012422:Rupture, Spontaneous; D014463:Ultrasonography / Q000592:standards
chemical_list: D000469:Alkaline Phosphatase