ACUTE CHOLECYSTITIS - DOES THE CLINICAL-DIAGNOSIS CORRELATE WITH THE PATHOLOGICAL DIAGNOSIS

Background: Most of the literature dealing with the surgical managemen t of acute cholecystitis bases patient selection on pathological diagn osis, either exclusively or using it as a major selection criteria or as a confirmation of diagnosis. The purpose of this study was to exami ne the correlation between preoperative clinical findings, intraoperat ive gross findings, and postoperative pathological findings. Methods: A retrospective review of 493 consecutive laparoscopic cholecystectomi es performed by a single surgeon (RJF) in a single institution was don e. Four different sets of criteria were used to define four groups of patients as having acute cholecystitis: (1) preoperative acute cholecy stitis based on defined criteria (PA); (2) intraoperative gross findin gs of acute or subacute cholecystitis based on surgeon assessment of i nflammation (IA); (3) initial pathological evaluation by a staff patho logist (IP); and (4) expert pathological (EP) review using strictly de fined histological criteria. Results: Of 41 patients, 40 (97.6%) were classified as having acute cholecystitis by IA, 21 (51.2%) by IP, and 17 (41.5%) by EP. Of the 75 patients classified as having acute cholec ystitis by IA, 40 (53.0%) were classified acute by PA, 34 (45.0%) by I P, and 17 (22.7%) by EP. Of the 72 IP patients, 34 (47.2%) were classi fied as acute by IA, 15 (20.8%) by EP, and 24 (33.3%) were PA. Of the 32 EP patients, 21 (65.6%) were classified as acute by IA, 14 (43.8%) by IP, and 18 (56.3%) were PA. Conclusion: The correlation between the pathological diagnosis and intraoperative findings is poor. Preoperat ive clinical findings of acute cholecystitis are highly reliable for p redicting intraoperative gross findings. However, intraoperative findi ngs of acute cholecystitis are commonly found in the absence of preope rative clinical signs. Recommendations for surgical therapy should be based on studies which use either operative findings or the preoperati ve clinical findings as the basis for patient selection.