title: Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy.
abstract: BACKGROUND
  Gangrenous cholecystitis occurs in up to 30% of patients admitted with acute cholecystitis. Factors predicting gangrenous disease in patients with acute cholecystitis remain poorly defined, making preoperative diagnosis difficult. Identification of these factors and early diagnosis of gangrenous cholecystitis will indicate more aggressive treatment, earlier operation, and a lower threshold for conversion of laparoscopic to open cholecystectomy.
  
  
  METHODS
  We reviewed our experience with acute cholecystitis during the 2-year period of 1995 to 1996. Admitting history, physical examination, operative report, laboratory and radiology data, and pathology report were analyzed for each patient. Acute cholecystitis and its gangrenous complication were diagnosed by both gross and microscopic examination.
  
  
  RESULTS
  One hundred fifty-four patients were admitted to the hospital with acute cholecystitis and underwent cholecystectomy; gallbladder gangrene was found in 27 (18%) of these patients. Four patients with gallbladder gangrene underwent open cholecystectomy and 23 patients underwent laparoscopic cholecystectomy, of which 15 (65%) were completed laparoscopically and 8 (35%) had open conversion as a result of severe inflammation. Risk factors for gallbladder gangrene included male gender, age older than 50 years, history of cardiovascular disease, and leukocytosis greater than 17,000 white blood cells/mL.
  
  
  CONCLUSIONS
  Older male patients (age older than 50 years) with history of cardiovascular disease, leukocytosis greater than 17,000 white blood cells/mL, and acute cholecystitis have increased risk of gallbladder gangrene and conversion of laparoscopic cholecystectomy to open cholecystectomy. Urgent laparoscopic cholecystectomy with low threshold for conversion to open cholecystectomy should be considered in these patients at high risk for gallbladder gangrene.
authors.affiliation: Department of Surgery, Northwestern Memorial Hospital, and Northwestern University Medical School, Chicago, Ill 60611, USA.
authors.forename: L T
authors.initials: LT
authors.lastname: Merriam
authors.forename: S A
authors.initials: SA
authors.lastname: Kanaan
authors.forename: L G
authors.initials: LG
authors.lastname: Dawes
authors.forename: P
authors.initials: P
authors.lastname: Angelos
authors.forename: J B
authors.initials: JB
authors.lastname: Prystowsky
authors.forename: R V
authors.initials: RV
authors.lastname: Rege
authors.forename: R J
authors.initials: RJ
authors.lastname: Joehl
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002764:Cholecystitis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005734:Gangrene / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007258:Informed Consent; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012307:Risk Factors