Overview
Acute gangrenous cholecystitis is a severe form of acute cholecystitis characterized by necrosis of the gallbladder wall, often due to prolonged ischemia and infection. It is a surgical emergency associated with a higher risk of complications and mortality compared to uncomplicated acute cholecystitis.Diagnosis
Diagnostic imaging is recommended for suspected acute cholecystitis 1.
Imaging modalities may include ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) 1.
Specific imaging findings suggestive of gangrenous cholecystitis include gallbladder wall thickening, intramural gas, and pericholecystic fluid 1.Management
Surgical intervention, typically laparoscopic cholecystectomy, is the mainstay of treatment for acute gangrenous cholecystitis 1.
Antibiotic therapy is indicated to cover common biliary pathogens 1.
Adjunctive medical management may include fluid resuscitation and pain control 1.Special Populations
Recommendations for diagnostic imaging and management apply to adults, children, and pregnant people 1.Key Recommendations
Diagnostic imaging should be used to evaluate suspected acute cholecystitis 1. (Evidence: Strong)
Antibiotic therapy should be administered to patients with suspected acute gangrenous cholecystitis to cover common biliary pathogens 1. (Evidence: Strong)
Surgical management, such as cholecystectomy, is recommended for acute gangrenous cholecystitis 1. (Evidence: Strong)References
1 Bonomo RA, Edwards MS, Abrahamian FM, Bessesen M, Chow AW, Dellinger EP et al.. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intraabdominal Infections: Diagnostic Imaging of Suspected Acute Cholecystitis and Acute Cholangitis in Adults, Children, and Pregnant People. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2024. link