Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis. It is the result of marked distension of the gallbladder causing increased tension in the gallbladder wall. Associated inflammation leads to ischemic necrosis of the wall, with or without associated cystic artery thrombosis.
It is more common in men and in patients with co-existing cardiovascular disease and leukocytosis. Other associated factors include diabetes, critical illness and a high C-reactive protein (CRP) level.
Pre-operative diagnosis of this condition may prove difficult. Once suspected, patients with GC generally undergo emergency cholecystectomy in order to avoid life-threatening complications.
A patient with Gangrenous Cholecystitis will be hospitalized, and they will probably not be allowed to consume any solid or liquid foods for some time. They will be given liquids intravenously while fasting. Pain medications and antibiotics may also be given.
Surgery is recommended for acute cholecystitis because there is a high rate of recurrence from inflammation related to gallstones. However, if there is a low risk of complications, surgery can be done as an outpatient procedure.
If there are complications, such as gangrene or perforation of the gallbladder, the patient will need immediate surgery to remove the gallbladder. If the patient has an infection, a tube may be inserted through the skin into the gallbladder to drain the infection.
Removal of the gallbladder, or cholecystectomy, can be performed by open abdominal excision or laparoscopically.
Laparoscopic cholecystectomy involves several small incisions in the skin. A camera is inserted into one incision to help the surgeon see inside the abdomen, and tools for removing the gallbladder and inserted through the other incisions.
The benefit of laparoscopy is that the incisions are small, so patients usually have less pain after the procedure and less scarring.
