Sonography for Selecting Candidates for Laparoscopic Cholecystectomy
A Prospective Study
Hans-Peter Dinkel1,2,
Simon Kraus1,
Johannes Heimbucher3,
Roland Moll1,
Joachim Knüpffer1,
Heinz-Jochen Gassel3,
Stefan M. Freys3,
Karl-Hermann Fuchs3 and
Gerhard Schindler1
1
Department of Diagnostic Radiology. University of
Würzburg, Luitpoldkrankenhaus,
Josef-Schneiderstr. 2, D-97080 Würzburg,
Germany
2
Present address: Institut für Diagnostische
Radiologie, Inselspital, Universität Bern,
Freiburgstr. 20, CH-3010 Bern, Switzerland.
3
Department of Surgery, University of Würzburg,
D-97080 Würzburg, Germany.
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Fig. 1A. —53-year-old woman with history of chronic cholecystolithiasis and
acute upper abdominal pain. Transverse sonogram of gallbladder region reveals
thickened (4.8 mm) gallbladder wall (arrow).
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Fig. 1B. —53-year-old woman with history of chronic cholecystolithiasis and
acute upper abdominal pain. Longitudinal section reveals hydropic gallbladder
(length, 9.4 cm; diameter, 5.1 cm). Thickening is most pronounced and focal at
fundus (arrow), consistent with advanced inflammatory change.
Preparation of gallbladder bed was difficult during laparoscopy because of
pericholecystic adhesions of severe acute cholecystitis.
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Fig. 2A. —77-year-old woman with acute right upper abdominal pain and history
of cholelithiasis. Transverse sonogram of gallbladder reveals severe wall
thickening (11 mm) and cholecystolithiasis.
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Fig. 2B. —77-year-old woman with acute right upper abdominal pain and history
of cholelithiasis. Longitudinal section reveals two gallstones (diameter, 2
cm) in lumen of acutely inflamed gallbladder with wall thickening and
pericholecystic fluid (arrows) in gallbladder bed. Laparoscopy was
difficult because of rigid gallbladder wall.
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Fig. 3A. —38-year-old woman with acute right upper abdominal pain. Transverse
sonogram reveals pericholecystic fluid in liver bed and Morrison's pouch
(arrow) and gallbladder wall thickening (10 mm) in acute
cholecystitis. Pericholecystic fluid is strong indicator of conversion to
laparotomy.
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Fig. 3B. —38-year-old woman with acute right upper abdominal pain.
Longitudinal section shows striated gallbladder wall with pericholecystic
fluid (arrows).
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Fig. 4A. —50-year-old woman with gallbladder empyema. Intraluminal echoes with
sonic shadow (calipers) in gallbladder fundus and infundibulum
represent gallbladder stones. Transverse sonogram reveals gallbladder wall
that cannot be completely delineated from liver boundary. Poorly delineated
wall is characteristic of severe inflammation. Note pericholecystic fluid and
edema in triangular zone dorsal to gallbladder (arrow).
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Fig. 4B. —50-year-old woman with gallbladder empyema. Intraluminal echoes with
sonic shadow (calipers) in gallbladder fundus and infundibulum
represent gallbladder stones. Longitudinal right upper abdomen section reveals
thickened gallbladder wall with regions of increased thickness or nodularity
(curved arrow) towards fundus. Note thin fluid film (short
arrow) between liver surface and wall. Also note zone of increased
echogenicity (long arrow) in dependent part of gallbladder with fluid
level representing pus in empyema. Fluid is inhomogeneous, unlike sludge;
however, no evidence of gas inclusions exists.
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Copyright © 2000 by the American Roentgen Ray Society.
