title: Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features.
abstract: OBJECTIVE
  The purpose of this study is to determine which computed tomography (CT) findings and clinical data can help to diagnose gallbladder perforation in acute cholecystitis.
  
  
  METHODS
  The medical records and CT findings of patients with surgically proven acute cholecystitis within the last recent 5 years were retrospectively reviewed and compared between 2 groups with and without gallbladder perforation.
  
  
  RESULTS
  A total of 75 patients with acute cholecystitis were included in the study, and 16 patients were proven to have gallbladder perforation. Higher mortality rate was found in the perforation group (18.8% vs 1.7%; P = .029). Older age (>70 years; P = .004) and higher percentage of segmented neutrophil (>80%; P = .027) were significant clinical factors for predicting gallbladder perforation in acute cholecystitis. The significant CT signs related to gallbladder perforation included visualized gallbladder wall defect (P = .000), intramural gas (P = .043), intraluminal gas (P = .000), intraluminal membrane (P = .043), pericholecystic abscess or biloma formation (P = .009), intraperitoneal free air (P = .001), and presence of ascites in the absence of hypoalbuminemia or other intraabdominal malignancy (P = .017). In multivariate analysis, visualized gallbladder wall defect was the most significant predicting CT feature for diagnosing gallbladder perforation in acute cholecystitis.
  
  
  CONCLUSIONS
  Elderly patients with higher segmented neutrophil and CT signs of gallbladder wall defect associated with acute cholecystitis may have high possibility of gallbladder rupture.
authors.affiliation: Department of Emergency Medicine, Buddhist Tzu-Chi General Hospital, Hualien 970, Taiwan.
authors.forename: Ming-Jen
authors.initials: MJ
authors.lastname: Tsai
authors.forename: Jen-Dar
authors.initials: JD
authors.lastname: Chen
authors.forename: Chui-Mei
authors.initials: CM
authors.lastname: Tiu
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Chou
authors.forename: Sheng-Chuan
authors.initials: SC
authors.lastname: Hu
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging* / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*