Operative Timing for Acute Cholecystitis -Comparison of Clinical and Histopathological Findings-

Nobuhiko Ueda, Nobuki Takahashi, Hideo Yamasaki, Kazunori Hirano

Department of Surgery, Kaga Central Hospital

The present study examined the operative timing for acute cholecystitis and compared clinical findings with histopathological findings of the resected gallbladder in 26 cases of acute cholecystitis. They were divided into three phases by histopathological findings: congestion and edema phase (A phase), necrosis and abscess phase (B phase), and absorption phase (C phase). Cases in B or C phase were subdivided into B1 and C1 phase in which inflammation reached the muscular layer, and were subdivided into B2 or C2 phase in which inflammation reached the subserosal layer. Patients in B phase, especially in B2 phase, frequently had associated complications before or after the operation. So for patients in B2 phase it is necessary to perform an emergency operation. For patients in A or B1 phase an early operation is necessary to prevent later complications. Severe inflammatory changes, such as muscular defense, fever over 38°C, leukocytosis over 15,000/mm³, or on imaging findings, pericholecystic panniculitis, ascites, right pleural effusion, or subphrenic abscess, in addition to pericholecystic fluid accumulation, are important clinical findings from which B2 phase is conjectured.

Key words
acute cholecystitis, necrotic cholecystitis, operative timing for acute cholecystitis, pericholecystitis

Reprint requests
Nobuhiko Ueda Department of Surgery, Kaga Central Hospital
65 Hakkendou, Daishouji, Kaga, 922 JAPAN

Accepted
May 13, 1992

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