Deitch E A, Engel J M
Am Surg. 1981 May;47(5):211-4.
Perforation of the gallbladder is a life-threatening complication of acute cholecystitis that is often difficult to diagnose at an early stage. Standard radiographic and laboratory tests have not been reliable in identifying patients with this complication. In contrast, biliary sonography correctly diagnosed pericholecystic abscesses preoperatively in three patients with acute cholecystitis. The ultrasonic appearance of acute cholecystitis with a pericholecystic abscess was similar in all three patients. There was an extraluminal fluid collection located contiguous to a thick-walled gallbladder in the fundic region. The fluid collection was constant in location and could be seen in at least two different views. Two of these three patients had acalculous cholecystitis; the initial clinical diagnosis in one was pancreatitis, and in the other alcoholic hepatitis. Biliary sonography, by demonstrating a thickened gallbladder wall in the absence of ascites, strongly suggested that these two patients had acute acalculous cholecystitis, and not hepatitis or pancreatitis. The ultrasonic examination was a critical factor in the decision for prompt surgery instead of continued nonoperative management in these patients. These data suggest that not only can biliary sonography aid in the diagnosis of acute cholecystitis, calculous as well as acalculous, but can also visualize a pericholecystic abscess when it is present.
胆囊穿孔是急性胆囊炎的一种危及生命的并发症，在早期往往难以诊断。标准的影像学和实验室检查在识别患有这种并发症的患者方面并不可靠。相比之下，胆道超声在三名急性胆囊炎患者中术前正确诊断出胆囊周围脓肿。这三名急性胆囊炎合并胆囊周围脓肿患者的超声表现相似。在胆囊底部区域，有一个与厚壁胆囊相邻的腔外液体积聚。液体积聚位置固定，至少在两个不同视图中可见。这三名患者中有两名患有非结石性胆囊炎；其中一名最初的临床诊断为胰腺炎，另一名为酒精性肝炎。胆道超声通过在无腹水的情况下显示胆囊壁增厚，强烈提示这两名患者患有急性非结石性胆囊炎，而非肝炎或胰腺炎。超声检查是决定对这些患者进行及时手术而非继续非手术治疗的关键因素。这些数据表明，胆道超声不仅有助于诊断急性胆囊炎，包括结石性和非结石性，而且在存在胆囊周围脓肿时还能将其可视化。
