Correlation Between Power Doppler and Intraoperative Findings of Chronic and Acute Cholecystitis
Correlation Between Power Doppler and Intraoperative Findings of Chronic and Acute Cholecystitis
In theory, increased vascularity of GB wall could be associated with intraoperative findings,
 such as, GB wall inflammation and accompanying adhesions. There are not enough reports in the
 literature describing the correlation between GB wall vascularity and operative findings
 according to adhesion scoring scale. In this prospective clinical study, we aimed to
 highlight the correlation between preoperative power Doppler sonography detected GB wall
 vascularity and intraoperative findings - postoperative outcomes of chronic and acute
 cholecystitis patients.
Gray-scale sonography is generally considered as a first-line diagnostic tool for patients
 with suspected gallbladder (GB) diseases. Once the gallstone is detected in a patient who is
 complaining abdominal pain in the right upper quadrant, the second concern is to differential
 diagnosis, biliary colic or acute cholecystitis. Certain diagnosis of acute cholecystitis is
 important, because of these two entity require different treatments. Gray-scale sonography
 has proven to be a valuable imaging technique in differential diagnosis for acute or chronic
 cholecystitis (1). In the presence of gallstones, sonographic findings such as GB wall
 thickening and the Murphy's sign has 90% sensitivity for the diagnosis of acute cholecystitis
 (2). On the other hand, abdominal pain and accompanying GB wall thickening can be seen in
 different clinical scenarios such as, pancreatitis, hepatitis, cirrhosis, and congestive
 heart failure. Thus, the specificity of these sonographic findings are not as high as their
 sensitivity. To eliminate this diagnostic concern, the need for correlation between
 diagnostic tool and disease physiopathology was realized. The GB wall is thickened and the
 vascularisation is increased in acute cholecystitis, but in the chronic cholecystitis the
 thickening of the GB wall is caused by fibrosis. This pathologic difference is to key point
 of distinguishing between acute and chronic cholecystitis. Determining the vascularisation of
 the GB wall with Doppler sonography was showed valuable diagnostic benefits, and the
 diagnostic superiority was obtained especially with power Doppler sonography (3).

 Today, laparoscopic cholecystectomy (LC) has become the gold standard treatment for benign
 biliary diseases. Although, the laparoscopic approach to acute cholecystitis have a lot of
 advantages, such as; less postoperative pain, shorter hospital stay and better cosmetic
 results, timing of the operation and intraoperative findings of GB wall inflammation and
 adhesions are critical for performing a safe cholecystectomy. The risk of bleeding and bile
 duct injury are significantly increases in the presence of severe inflammation and adhesions
 (4). These findings may lead surgeon to convert LC to an open cholecystectomy.

 In theory, increased vascularity of GB wall could be associated with intraoperative findings,
 such as, GB wall inflammation and accompanying adhesions. There are not enough reports in the
 literature describing the correlation between GB wall vascularity and operative findings
 according to adhesion scoring scale. In this prospective clinical study, we aimed to
 highlight the correlation between preoperative power Doppler sonography detected GB wall
 vascularity and intraoperative findings - postoperative outcomes of chronic and acute
 cholecystitis patients.
Inclusion Criteria:

 -  Symptomatic chronic cholelithiasis patients, who were accepted to laparoscopic
 cholecystectomy

 -  Acute cholelithiasis patients, who were accepted to laparoscopic cholecystectomy in
 first 72-96 hours (from the onset of symptoms), Acute cholecystitis diagnosis was made
 according to; acute right upper quadrant abdominal pain with positive Murphy's sign,
 fever, leukocytosis and sonographically; distended GB, presence of gallstones or
 sludge, GB wall thickness of 3-mm or more, sonographic Murphy's sign.

 Exclusion Criteria:

 -  Choledocholithiasis

 -  <18 years old