Diagnosi in urgenza di colecistite acuta mediante ecografia. Puo' questa metodica essere considerata affidabile?

The purpose of this retrospective study was to analyse the data obtained from the use in emergency cases of ultrasonography as an instrumental means of accurately diagnosing acute cholecystitis, helping the surgeon to choose the right moment for cholecystectomy. The period covered by the study was from January 1987 to June 1991; during this time, 94 patients (52 males and 42 females of mean age 65.5 years, ranging from 32 to 90) with suspected clinical diagnosis of acute cholecystitis, underwent early cholecystectomy (within 72 hours of onset of symptoms) following clinical laboratory and ultrasound evaluation. The ultrasound findings considered for the study were: one or more stones in the gallbladder (A); Thickening of the wall (B); Distension of the gallbladder (C); One or more calculi in the bile duct (D); Dilation of the biliary tree (E); Gas in the gallbladder (F); Echogenic mass shadow about the gallbladder (C); Opacities which moved when the patients position was changed (H). In all cases histopathology confirmed the preoperative diagnosis, and in 19 of them presented a picture of serious cholecystitis (empyema in 4 cases, 4.2%; gangrene in 15 cases, 16%). The ultrasound findings most frequently seen together were B + C in 69 cases (73.5 %) and A + B + C in 63 cases (67%); if we consider only the serious cases of cholecystitis (19/94, 20%) the ultrasound finding B + C was seen in 84.2% of the patients. In 15% (14/94) of all cases leucocyte count was < 8000 w.c./mm3: in 11 (78.6%) of these 14 patients, the ultrasound showed A + B + C together. Eight of the 94 patients (8.5%) presented with leucocytosis > 20,000 G.B./mm3; in all cases (100%) the ultrasound showed A + B + C together and in 5 cases a fourth ultrasound finding was present. Ultrasonography, although dependent upon the observer and therefore giving variable results from one centre to another, is a simple method of emergency diagnosis, of relatively low cost, non-invasive, easily available and with good sensitivity (73.5%) increasing to 84.2% in serious cases. In conclusion, we confirm that the emergency diagnosis of acute cholecystitis still involves the overall evaluation of the various clinical and instrumental parameters, and that ultrasonography is the simplest and most reliable method of diagnosing acute cholecystitis.