Elsevier

International Journal of Surgery

Volume 35, November 2016, Pages 196-200
International Journal of Surgery

Original research
Clinical implications of hepatobiliary scintigraphy and ultrasound in the diagnosis of acute cholecystitis

https://doi.org/10.1016/j.ijsu.2016.09.084Get rights and content
Under an Elsevier user license
open archive

Highlights

  • For acute cholecystitis, US had a sensitivity and specificity of 26% and 80%. HIDA scan had a sensitivity and specificity of 87% and 79%.

  • Glucose >140 mg/dL, age >50, and WBC count >10 (×109 /L) were independent clinical features associated with histologically confirmed acute cholecystitis.

  • Delayed HIDA scan protocol resulted in increased time to surgery, length of stay, and increased costs.

Abstract

Background

We assess the performance of ultrasound (US) and hepatobiliary scintigraphy (HIDA) as confirmatory studies in acute cholecystitis (AC) and demonstrate our current imaging protocol's impact on outcomes.

Study design

Between January 2013 to July 2014, 117 patients were admitted through the emergency room with a preliminary diagnosis of AC. Overall, 106/117 (91%) of the patients received US preadmission and 34/117 (29%) received a HIDA post admission. Primary end points included: 1) diagnostic test reliability for AC, and 2) outcome and quality measures (time to surgery, LOS, costs, etc.).

Results

Laparoscopic cholecystectomy was performed in 96/117 (82%) and open cholecystectomy in 21/117 (18%) of the patients. Overall, histopathologic features consistent with AC was present in 46/117 (39%). AC alone was present in 23/117 (20%), and AC superimposed on chronic cholecystitis was present in 23/117 (20%). For AC, US had a sensitivity and specificity of 26% and 80%, respectively. HIDA scan had a sensitivity and specificity of 87% and 79%, respectively. Time to surgery (TTS) was 4 vs 2.3 days in patients who received HIDA vs US alone (p = 0.001), and length of stay (LOS) was 6.7 vs 4.3 days, respectively (p = 0.001). Age >50 years, glucose >140 (mg/dl), and WBC count >10 (×109 /L) were statistically significant independent variables associated with AC.

Conclusion

HIDA scan is superior to US as a diagnostic study in the setting of AC. Our current protocol of delayed HIDA (post-admission) was associated with increased TTS, LOS, and overall costs. Early confirmation with HIDA in high risk patients may hasten treatment allocation and improve outcomes in the setting of AC.

Keywords

HIDA
Ultrasound
Acute cholecystitis
Tokyo guidelines
Cholecystectomy

Cited by (0)