title: Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis.
abstract: BACKGROUND
  The effects of gangrenous cholecystitis (GC) and consequent surgical interventions on the clinical outcomes and prognosis of patients with severe acute pancreatitis are not clear. The present study was to characterize the clinical outcomes of patients with severe acute pancreatitis complicated with GC.
  
  
  METHODS
  We retrospectively analyzed 253 consecutive patients hospitalized for acute pancreatitis in intensive care unit. Among them, 68 were diagnosed as having severe acute pancreatitis; 10 out of the 68 patients had GC. We compared these 10 patients with GC and 58 patients without GC. The indices analyzed included sepsis/septic shock, pancreatic encephalopathy, acute respiratory distress syndrome, acute renal failure, multiple organ dysfunction syndrome, and death.
  
  
  RESULTS
  Specific CT images of GC in patients with severe acute pancreatitis included enlarged and high-tensioned gallbladder, wall thickening, lumenal emphysema, discontinuous and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P<0.01), pancreatic encephalopathy (50.0% vs 17.2%, P<0.05), acute respiratory distress syndrome (90.0% vs 41.4%, P<0.01), multiple organ dysfunction syndrome (70.0% vs 24.1%, P<0.01), acute renal failure (40.0% vs 27.6%, P<0.05), and death (40.0% vs 13.8%, P<0.05) were significantly higher in patients with GC than in those without GC.
  
  
  CONCLUSIONS
  CT scans can help to identify early GC in patients with severe acute pancreatitis; early diagnosis and intervention for patients with GC can reduce morbidity and mortality.
authors.affiliation: Emergency Intensive Care Unit, and Surgical Intensive Care Unit, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China.
authors.forename: Er-Zhen
authors.initials: EZ
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Xu
authors.forename: Jian
authors.initials: J
authors.lastname: Fei
authors.forename: En-Qiang
authors.initials: EQ
authors.lastname: Mao
authors.forename: Sheng-Dao
authors.initials: SD
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002764:Cholecystitis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome