Gangrenous cholecystitis

Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients. 

Gangrenous cholecystitis occurs as a result of ischemia with necrosis of the gallbladder wall 4

  • male
  • increasing age
  • delayed surgery
  • cardiovascular disease
  • diabetes mellitus
  • systemic inflammatory response syndrome 5

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 3:

  • intraluminal membranes
  • asymmetrical wall thickness
    • with possible wall disruption and/or ulceration
  • focal perfusion defects on Doppler (representing areas of necrosis)
  • variable absence of the sonographic Murphy's sign 7
    • attributed to ischemic denervation of the gallbladder 6

In addition to features of acute cholecystitis, the following may help diagnose gangrenous cholecystitis 1:

  • gallbladder wall or lumen gas
  • focal irregularity or defect in the gallbladder wall
  • intraluminal membranes
  • absence of mural enhancement
  • pericholecystic abscess

Mortality is increased compared to uncomplicated acute cholecystitis, estimated at between 15-50% 4

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Article information

rID: 25209
Synonyms or Alternate Spellings:
  • Membranous cholecystitis

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Cases and figures

  • Case 1: ultrasound
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  • Case 1: CT
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  • Case 1: MRI
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  • Case 2
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  • Intraluminal memb...
    Case 3
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  • Case 4
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  • Case 5: DWI
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