Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):228-233. 10.14701/ahbps.2019.23.3.228.

Predictive factors for gangrene complication in acute calculous cholecystitis

  • 1King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • 2Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia.
  • 3Department of Radiology, Al Ansar General Hospital, Medina, Saudi Arabia.
  • 4Department of Surgery, Faculty of Medicine, Taibah University, Medina, Saudi Arabia.


Gallbladder gangrene is a grave complication of acute calculous cholecystitis that is difficult to detect preoperatively. Ultrasound could show a gallbladder wall that is more thickened. In addition, other clinical measures were reported to be possible predictive factors. Therefore, we aim in this study to evaluate the gallbladder wall thickness measured by ultrasound and other clinical measures as predictive factors for gangrene complication in acute calculous cholecystitis.
A prospective cohort database analysis of the results of 674 patients diagnosed and treated for acute calculous cholecystitis between January 2010 and December 2014 was done. Patient's inclusion criteria were acute calculous cholecystitis in adults who were operated within three days of onset of symptoms.
117 (17.4%) patients had gangrene. Gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference (p≤0.01).
We conclude that gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis >15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference. By implementing these risk factors, patients urgency for surgery can be decided in the emergency department. Other risk factors such as high alanine aminotransferase, elevated aspartate aminotransferase, and high alkaline phosphatase could be of help in the decision for early operation.


Acute calculous cholecystitis; Complications; Risk factors; Gangrene of the gallbladder; Gallbladder wall thickness; Ultrasound

MeSH Terms

Alanine Transaminase
Alkaline Phosphatase
Aspartate Aminotransferases
Cohort Studies
Diabetes Mellitus
Emergency Service, Hospital
Prospective Studies
Risk Factors
Alanine Transaminase
Alkaline Phosphatase
Aspartate Aminotransferases


  • Fig. 1 Ultrasound of the abdomen showing a large gall stone measuring 25 mm impacted at the gallbladder neck with moderate dilatation of the gallbladder. The wall of the gallbladder is markedly thickened measuring 8.8 mm. The mucosa of the gallbladder is echogenic and hypervascular.


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