Laboratory Studies• Patients have leukocytosis that is markedly high

sometimes• Liver transaminases are typically normal or

slightly elevated, reflecting the patient's febrile state

• Very abnormal liver test results (in particular, ALP, bilirubin, or GGTP) suggest a common duct obstruction or intrahepatic disease

• Urinalysis, chest radiograph, and electrocardiogram—obtained as part of the patient’s preoperative assessment

Imaging Studies

Abdominal Radiograph

• gallbladder lumen/wall/pericholecystic tissues contains gas

• upright view of the abdomen demonstrates air-fluid levels in the gallbladder

Imaging Studies

CT scan• Air in the

lumen of the gallbladder

• Thickened wall of the gallbladder

Management

• Medications are used to control infection and manage comorbidities – The 3 most common organisms involved are E coli,

Klebsiella species, and clostridial species

• Definitive treatment involves surgical intervention

• Preoperative percutaneous drainage may improve survival

Management

Surgical intervention1. Open

cholecystectomy• a major abdominal

surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision

Management

2. Laparoscopic cholecystectomy• requires several small incisions in the abdomen

to allow the insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity

• The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports

Management

Laparoscopic Cholecystectomy