Diagnostic Value of Computed Tomography and Ultrasound in Patients with Acute Cholecystitis

Abstract

Background: Gallstones are frequently linked to the inflammatory gallbladder illness known as acute cholecystitis (AC). In addition to occurring in surgical procedures, it can be the cause of up to 5% of ED visits. The majority of patients arrive with fever and pain in the right upper quadrant (RUQ). Furthermore, complex intra-abdominal infection is regarded as the second most common cause of AC, accounting for 18.5% of cases. Female sex, obesity, pregnancy, and being in one's forties are
risk factors for AC. Materials and Methods: The electronic medical records of the hospital were examined in order to obtain information about every patient who was diagnosed with AC. The information retrieved included the patient's height (cm), weight (kg), type of shift if they were admitted through the ED, fever, pain radiating to the shoulder or back, nausea, vomiting, and first clinical presentation, which included RUQ pain, epigastric pain, and unexplained abdominal pain. There were also other concurrent morbidities observed. The investigation encompassed the following laboratory values: total white blood cell count (WBC count), gamma-glutamyl transferase (GGT), aspartate transaminase (AST), alanine transaminase (ALT), total and direct bilirubin. Results: In the present retrospective study a total of 140 patients were enrolled based on inclusion and exclusion criteria. The mean age in years was 44.62±12.56 years, out of 140 patients 44 (31.42%) were males and 96 were females (68.5%). The clinical presentation showed that 62.8%, 37.14%, 22.85%, 15.71%, 34.28% and 52.85% patients presented with pain in RUQ, unspecified abdominal pain, epigastric pain, fever, nausea, and vomiting. Biochemical parameters and WBC counts were assessed, it is seen that 72.8%, 62.8%, 65.71%, 61.4%, 55.71% and 45.71% had elevated bilirubin, direct bilirubin, WBC counts, ALT, AST and GGT levels. Ultrasound examination was performed in 140 patients, the diagnostic accuracy showed 35.71% sensitivity, 76.19% specificity, 50% positive predictive value and 64% negative predictive value. Similarly CT abdomen assessment was done in 24 patients who have been identified with acute cholecystitis, which showed 82.3% sensitivity, 60%
specificity, 58.33% positive predictive value and 83.33% negative predictive value. Conclusion: The major objective of the current investigation was to ascertain the sensitivity and specificity of US and CT in respect to histopathological reports in order to predict AC. We discovered that although US is more specific in diagnosing AC, CT is more sensitive than US. Thus, we came to the conclusion that, in cases where imaging is required to establish the diagnosis of AC, US is the recommended primary modality for patients with typical indications of AC, whereas CT is the preferable option for patients with atypical clinical signs and symptoms or unclear US findings.