Ultrasound, clinical and laboratory diagnostics of the true morphological forms of acute cholecystitis: the need to change the classification

Aim. To compare clinical, ultrasound and morphological data in the treatment of patients with acute cholecystitis based on the recent recommendations and personal experience in the treatment of acute cholecystitis.

Materials and methods. For 18 months 2019—2020 of 219 patients with acute cholecystitis, 118 (53.8%) underwent surgical treatment. There were 36.4% of men, 63.6% of women; age ranged from 23 to 82 years. Patients of employment age accounted for 61.8%. According to generally accepted recommendations, all patients were divided into groups according to the severity of the disease. The severity of the disease was G1 in 66 patients, G2 — in 52. A retrospective expert assessment of clinical, ultrasound and morphological data was carried out. The histopathological assessment of inflammatory and destructive changes was performed according to the national and international classification, taking into account the depth of the lesion of the gallbladder wall (A.1, A.2).

Results. In 118 operated patients G1 and G2, the coincidence of clinical, anamnestic and morphological data according to the classification of A.1 and A.2, excluding ultrasonography data, was observed in 58 (49.2%) patients: A.1 (necrosis of the gallbladder mucosa) was revealed in 34 patients, A.2 (necrosis of all walls) — in 24. The addition of ultrasonography results in the expert assessment of the “depth” of necrosis made it possible to confirm the data on mucosal necrosis (A.1) in 57 (86.4%) patients and destruction of a deeper muscle-serous layer (A.2) in 31 (59.6%). The modern diagnosis, taking into account clinical and laboratory data and ultrasonography results, should combination of the definition of the disease, the etiological factor (calculous, emphysematous and acalculous), the severity of the course (G1—G3) and the depth of histopathological changes (A.1—A.2).

Conclusion. The results of palpation, the duration of the disease, the level of leukocytosis and the nature of body temperature in acute cholecystitis make it possible to establish the severity of the course of the disease (G1—G3). Ultrasonography in acute cholecystitis can confirm the diagnosis with a high probability of determining the depth of destruction (inflammation) of the gallbladder wall (A.1, A.2). Histopathological examination of the gallbladder in acute cholecystitis should reflect the depth of destruction (inflammation) of the gallbladder wall A.1 or A.2. The terms “catarrhal”, “phlegmonous”, “gangrenous”, “perforated” are not fully determine the essence of the pathological process. To determine the treatment tactics, the diagnosis should include the severity of the disease (G1—G3) and the depth of destruction (inflammation) of the organ wall.

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