The diagnosis of acute cholecystitis in patients undergoing early laparoscopic cholecystectomy in a community hospital.

Background: Early laparoscopic cholesyctectomy is the procedure of choice for acute cholecystitis; however, the diagnosis of acute cholecystitis in a community hospital setting is not always a simple matter.

Methods: A retrospective review of 70 patients who have been admitted through the A&E department with the symptomatic gall bladder stones between July 2002 and May 2003.

Results: To diagnose acute cholecystitis, as a single test, the sensitivity and the predictive value of the clinical-based diagnosis were 72.72% and 57.1%, respectively, higher than ultrasonography-based diagnosis 27.2% and 42.8%, respectively. The diagnosis of acute cholecystitis was 100% correct in 5 patients when the clinical diagnosis, ultrasound, and abnormal liver function test suggested the diagnosis of acute cholecystitis. The same was true for the diagnosis of chronic cholecystitis in 15 patients when the clinical picture and the ultrasound together with a normal liver function test supported the diagnosis.

Conclusions: A detailed history and clinical examination are superior to ultrasonography for the diagnosis of acute cholecystitis. In a community hospital setting, a combination of clinical, radiologic, and laboratory tests are needed to accurately diagnose or exclude acute cholecystitis.