Diagnostic accuracy of ultrasonography and C reactive protein concentration in acute cholecystitis: a prospective clinical study.

OBJECTIVE

To assess the value of ultrasonography together with C reactive protein concentration in predicting which patients with acute cholecystitis require immediate operation.

DESIGN

Prospective study.

SETTING

Oulu University Hospital, Finland.

SUBJECTS

129 consecutive patients admitted with suspected acute cholecystitis 1988-89.

MAIN OUTCOME MEASURES

Correlation of ultrasonographic findings and C reactive protein concentrations with histological findings.

RESULTS

Ultrasonography correctly classified 86 of 108 patients with acute cholecystitis (79%). When the findings were combined with those of increased concentrations of C reactive protein the accuracy rose to 105 of 108 (97%). Large increases in C reactive protein concentrations were associated with both infected bile and gangrene of the gall bladder.

CONCLUSIONS

The combination of ultrasonography and measurement of C reactive protein concentration is recommended in the routine investigation of all patients with suspected acute cholecystitis. Serum C reactive protein concentrations should be monitored regularly to select those patients who require emergency operation.