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Acute cholecystitis or simple biliary colic after an emergency presentation: why it matters
Author(s) -
Nguyen Chu Luan,
Dijk Aafke,
Smith Garett,
Leibman Steven,
Mittal Anubhav,
Albania Maria,
Reuver Philip,
Hugh Thomas J.
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15603
Subject(s) - medicine , medical diagnosis , acute cholecystitis , bile duct , emergency department , cholecystitis , cholecystectomy , retrospective cohort study , clinical diagnosis , presentation (obstetrics) , laparoscopic cholecystectomy , general surgery , surgery , gallbladder , radiology , pediatrics , psychiatry
Background Laparoscopic cholecystectomy (LC) is often performed during the index admission after emergency presentation for acute biliary pain. Many patients have acute cholecystitis (AC) that may increase operative difficulty and complications. Our primary aim was to assess the validity of Tokyo Guidelines (TG18) for diagnosing AC by comparison with the admitting team diagnosis, operative findings and histopathology. The secondary aim was to assess outcomes after same‐admission or delayed LC. Methods Retrospective analysis of patients who underwent LC after presenting to a tertiary hospital emergency department over a 12‐month period was conducted. Results A total of 139 patients underwent LC with no mortality or bile duct injury. A diagnosis of AC made by the admitting surgical team had sensitivity of 84% and specificity of 57%. The TG18 diagnosis had sensitivity of 84% and specificity of 53%. A diagnosis of AC by the admitting surgical team correlated well with TG18 criteria diagnosis. There was poor correlation between clinical and histopathological diagnoses. Nine percent of patients had complications and 4% required conversion to open procedure. Patients with a clinical diagnosis of AC had longer post‐operative length of stay and more complications compared with those who had non‐AC diagnosis. There was no difference in outcomes between same‐admission LC or delayed LC. Conclusion TG18 diagnosis of AC does not improve accuracy of diagnosis or predictability of a poor outcome over the admitting surgical team diagnosis. Same‐admission LC for patients with AC is associated with similar outcomes compared to those who undergo delayed LC.