Abstract
To evaluate the severity of acute cholecystitis, we have applied the ultrasonographic findings. In this paper, our 112 patients of acute cholecystitis were classified to three grades accoding to ultrasonographical findings as follows. Grade 1; sonographic Murphy sign, significant gallbladder distention and gallbladder wall thickening. Grade 2; sonolucent layer, gallbladder sludge, subhepatic and intramural pericholecystic abscess. Grade 3 intraabdominal pericholecystic abscess, intraperitoneal fluid collection, acute cholangitis and liver abscess. These sonographic grading had a relation with clinical severity and APACHE II score system. Sonographic grade 1 ranked clinical mild, grade 2 moderate and grade 3 severe. Most patiente of grade 1 had mild inflammatory change in/along gallbladder at operation. About half patients in grade 2 and all in grade 3had inflammatory gallbladder at operation. Laparoscopic cholecystectomy was attempted in seven patients. Five patients (71%) underwent successful laparoscopic cholecystectomy. Elective operation included laparoscopic cholecystectomy should be applied to the ptients in grade 1 or 2. Urgent or early operation should be indicated to the patients in grade 3.
