Clinical diagnosis of cholecystitis in emergency department patients with cholelithiasis is indication for urgent cholecystectomy: A comparison of clinical, ultrasound, and pathologic diagnosis

• Published in: The American journal of surgery 2022-07, Vol.224 (1), p.80-84
• Main Authors: Martin, W. Taylor, Stewart, Kenneth, Sarwar, Zoona, Kennedy, Ryan, Quang, Celia, Albrecht, Roxie, Cross, Alisa
• Format: Article
• Language: English
• Subjects: Cholecystectomy; Cholecystitis; Cholelithiasis; Diagnosis; Emergencies; Emergency department; Emergency medical care; Emergency medical services; Evaluation; Gallbladder; Gallbladder diseases; Gallstones; Indication; Laboratories; Length of stay; Pain; Pathology; Patients; Sensitivity analysis; Surgeons; Ultrasonic imaging; Ultrasound; Variance analysis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.02.051

Biliary pathology is a common reason for emergency department visits with discharge and outpatient follow up if sonographic evaluation does not reveal evidence of cholecystitis. This retrospective review was conducted to assess the sensitivity of clinical versus sonographic evaluation for indication of urgent cholecystectomy. Retrospective chart review of 308 patients who presented to the emergency department (ED) with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. The history and physical exam, laboratory values, ultrasound (US), and final surgical pathology were compared for accuracy of clinical to pathologic diagnosis. 95.5% of our patients that presented to the ED secondary to RUQ pain with cholelithiasis had pathologic cholecystitis. Sensitivity of clinical diagnosis was superior to US findings as compared to pathologic diagnosis of cholecystitis at 96% vs 44% and 87% vs 18% for acute (AC) and chronic cholecystitis (CC) respectively. RUQ pain with known cholelithiasis lasting longer than 4 hours is sensitive for pathologic cholecystitis. This finding, even with the absence of sonographic evidence of cholecystitis, is indication for index encounter urgent cholecystectomy. •RUQ pain lasting longer than 4 h with known cholelithiasis is indicative of pathologic cholecystitis.•Cholecystectomy is recommended in patients presenting to the ED with cholelithiasis and RUQ pain lasting longer than 4 h.•Clinical exam is a better predictor of the pathologic diagnosis of cholecystitis.