title: Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy.
abstract: OBJECTIVE
  To establish whether preoperative computed tomographic (CT) findings in patients with acute cholecystitis were associated with conversion from laparoscopic to open cholecystectomy in patients with calculous acute cholecystitis.
  
  
  METHODS
  The study protocol was approved by the local institutional review board, and written informed consent was provided by all patients at enrollment. From 2008 to 2010, all patients admitted to a university medical center with acute calculous cholecystitis and for whom a preoperative contrast material-enhanced CT study was available were prospectively included. Cholecystectomy was always initiated laparoscopically. To identify risk factors for conversion specifically related to acute cholecystitis, CT studies were analyzed according to predefined criteria by two radiologists who were blinded to the patient's conversion status. Associations between conversion and radiologic findings were assessed by using univariate and multivariate logistic models.
  
  
  RESULTS
  A total of 108 patients were analyzed (61 men, 47 women; median age, 58 years; age range, 17-88 years). Conversion occurred in 24 (22%) cases. On preoperative CT images, the absence of gallbladder wall enhancement was associated with the presence of gangrenous acute cholecystitis (sensitivity, 73%). The absence of gallbladder wall enhancement (58% and 40% for conversion and nonconversion, respectively; P = .02) and the presence of a gallstone in the gallbladder infundibulum (78% and 22% for conversion and nonconversion, respectively; P = .04) were associated with acute cholecystitis-related conversion in a multivariate analysis. Interobserver agreement for CT study interpretation was very good (median k value, 0.92; range, 0.76-1.00).
  
  
  CONCLUSIONS
  The absence of gallbladder wall enhancement (associated with the presence of gangrenous acute cholecystitis) and the presence of a gallstone in the gallbladder infundibulum are associated with conversion from laparoscopic to open cholecystectomy.
authors.affiliation: Department of Digestive Surgery, Amiens University Medical Center, Place Victor Pauchet, 80054 Amiens, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mouly
authors.forename: Brice
authors.initials: B
authors.lastname: Robert
authors.forename: Hassene
authors.initials: H
authors.lastname: Hajji
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media