GANGRENOUS CHOLECYSTITIS IN AN URBAN VA HOSPITAL

Gangrenous cholecystitis is an advanced form of acute cholecystitis as sociated with increased morbidity and mortality. We sought to determin e the incidence of gangrenous cholecystitis in an urban VA hospital pa tient population and identify any distinguishing characteristics that may aid in its preoperative diagnosis. We retrospectively reviewed all urgent admissions that underwent cholecystectomy (n = 65) over the pa st 7 years at the Allen Park VAMC. Using histologic criteria, 17 (26%) of these patients had gangrenous cholecystitis. As a group compared t o patients with nongangrenous cholecystitis, patients with gangrenous cholecystitis were statistically older (64 vs 54) and had an elevated WBC (15.4 vs 11.5) and increased serum glucose levels (203 vs 141). Pr eoperative imaging studies (ultrasound and cholescintigraphy) correctl y identified only 31% of the gangrenous cholecystitis patients. We con clude that in an urban VA hospital patient population, the diagnosis o f gangrenous cholecystitis cannot be accurately made or ruled out amon g urgent admissions with acute biliary disease. Considering the high i ncidence (26%) and difficulty confirming the diagnosis of gangrenous c holecystitis in this setting, we recommend early surgical intervention for this and similar patient populations. (C) 1994 Academic Press, In c.