Ulus Travma Acil Cerrahi Derg. 2025; 31(2): 161-166 | DOI: 10.14744/tjtes.2025.62703

Management of acute calculous cholecystitis in the emergency department: Evaluating the role of laboratory and radiological findings in a retrospective study

Omer Faruk Turan¹, Emine Sarcan¹, Seyda Gedikaslan¹, Aybuke Soylu¹, Fatih Mehmet Aksoy¹, Abdullah Dodurga¹, Gul Sila Mutlu¹, Yusuf Yavuz², Jacek Smereka^3
1Department of Emergency Medicine, Etlik City Hospital, Ankara, Türkiye
²Department of General Surgery, Konya City Hospital, Konya, Türkiye
³Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland

BACKGROUND: Acute calculous cholecystitis (ACC) is a significant cause of acute abdominal pain, accounting for 90-95% of
gallbladder inflammations caused by gallstones. Its clinical presentation ranges from nonspecific abdominal pain to septic conditions
associated with an acute abdomen. Timely and accurate diagnosis is critical in patient management, as delayed diagnosis or inadequate
treatment can result in increased morbidity and life-threatening complications such as perforation or biliary peritonitis. This study aims
to identify factors influencing the severity of ACC by analyzing the relationship between laboratory findings, radiological imaging, and
pathology results in cases managed in the emergency department.
METHODS: This retrospective study was conducted at the emergency department of Etlik City Hospital, a tertiary care center.
Patients diagnosed with acute cholecystitis were included in the study, while those under 18 years of age and those with choledocholithiasis
were excluded. Patients’ radiological findings, laboratory parameters, and pathological results were analyzed.
RESULTS: A total of 230 patients were included in the study. Patients with pericholecystic fluid exhibited significantly thicker gallbladder
walls (p=0.002). A significant association was found between elevated white blood cell (WBC) counts and gallbladder wall thickness
(p=0.035). However, no significant relationship was observed between liver function test results and gallbladder wall thickness.
CONCLUSION: This study evaluated the diagnostic and management parameters utilized by clinicians in cases of acute calculous
cholecystitis. The association between increased gallbladder wall thickness and pericholecystic fluid was highlighted as a key factor in
diagnosis and follow-up. Although laboratory and imaging modalities provide supportive roles in diagnosis, their necessity may vary
depending on the individual case. The study emphasizes the importance of a holistic approach that integrates clinical, laboratory, and
radiological findings to optimize patient outcomes in the emergency department, avoid unnecessary interventions, and prevent delays
in surgical treatment.

Keywords: Acute calculous cholecystitis, pericholecystic fluid, gallbladder wall thickness, emergency diagnosis, ultrasonography.

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Acil serviste akut taþlý kolesistit yönetimi: Laboratuvar ve radyolojik bulgularýn rolü: Retrospektif bir çalýþma

Omer Faruk Turan¹, Emine Sarcan¹, Seyda Gedikaslan¹, Aybuke Soylu¹, Fatih Mehmet Aksoy¹, Abdullah Dodurga¹, Gul Sila Mutlu¹, Yusuf Yavuz², Jacek Smereka^3
1Etlik Þehir Hastanesi, Acil Týp Uzmaný, Ankara, Türkiye
²Etlik Þehir Hastanesi, Acil Týp Asistaný, Konya, Türkiye
³Wroclaw Medikal Üniversitesi, Acil Týp Anabilim Dalý, Wroclaw, Poland

AMAÇ: Akut taþlý kolesistit (ATK), akut karýn aðrýsýnýn önemli bir nedenidir ve %90-95 oranýnda safra taþýna baðlý, safra kesesi iltihabý olarak karþýmýza
çýkar. Klinik seyri nonspesifik karýn aðrýsýndan baþlayýp akut karnýn eþlik ettiði septik tabloya kadar ilerleyebilmektedir. Bu nedenle zamanýnda ve
doðru taný, hasta yönetiminde kritik rol oynamaktadýr. Gecikmiþ taný veya ciddiyeti anlaþýlamamýþ yetersiz tedavi morbiditenin artmasýna yol açmakta,
perforasyon veya biliyer peritonit gibi ölümcül durumlara neden olabilmektedir. Bu çalýþma acil serviste tedavi edilen vakalarda laboratuvar bulgularý,
radyolojik görüntüleme ve patoloji sonuçlarý arasýndaki iliþkiyi analiz ederek AKK'nin ciddiyetini etkileyen faktörleri belirlemek istemiþtir.
GEREÇ VE YÖNTEM: 3. basamak bir klinik olan Etlik Þehir Hastanesi acil serviste akut kolesistit tanýsý konulan hastalar kabul edildi. Hastalarýn
radyolojik bulgularý, laboratuar ve patoloji sonuçlarý incelendi. 18 yaþ altý hastalar ve koledokolitiazis olan hastalar dýþlandý.
BULGULAR: Çalýþma 230 hasta ile tamamlandý. Perikolesistik sývýsý olanlarýn, safra kesesi duvar kalýnlýðý daha yüksek saptandý (p=0.002). WBC
yüksekliðinin safra kesesi duvar kalýnlýðý ile anlamlý iliþkisi saptandý (p=0.035). Karaciðer fonksiyon testlerinin safra kesesi duvar kalýnlýðý ile anlamlý
iliþkisi saptanmadý.
SONUÇ: Akut taþlý kolesistit hastalarýnýn taný ve tedavi süreçlerinde klinisyenlerin dayanak olarak kullandýðý parametreleri inceledik. Safra kesesi
duvar kalýnlýðý yüksekliðinin perikolesistitk sývý ile birlikteliðinin taný ve takipteki önemini vurguladýk. Laboratuvar ve görüntüleme yöntemleri tanýda
destekleyici rol oynasa da, gereklilikleri vakalar arasýnda farklýlýk gösterebilir. Bu çalýþma, ATK yönetiminde radyolojik ve laboratuvar bulgularýnýn
bütünleþtirici rolünü vurgulayarak önceki araþtýrmalarýn üzerine inþa edilmiþtir.

Anahtar Kelimeler: Akut taþlý kolesistit, perikolesistik sývý, safra kesesi duvar kalýnlýðý, acil taný, ultrasonografi.

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