Acute cholecystitis is defined as an acute inflammation of the gallbladder wall whose most common cause is gall bladder stone. In Acute cholecystitis is a highly common complication of cholelithiasis, and as such, it is frequently seen in surgical practice. Acute cholecystitis may also occur without the presence of a stone, this condition known as acute acalculous cholecystitis. ^(1-3)

Acute cholecystitis is one of the most common illnesses seeking emergency general surgery. Many studies show that early cholecystectomy leads to better results, shorter hospital stays, and less medical expenses. Therefore, it is important to make the correct diagnosis early in the patient's visit to the emergency room, with an accurate clinical examination and appropriate diagnostic testing.

The patient's history, clinical signs, laboratory tests, and risk category scores are all important factors in detecting acute cholecystitis, but imaging method plays a major role in making an accurate diagnosis. The most common diagnostic methods for AC are ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRCP). ⁵

CT imaging can also be used to identify or rule out other conditions that can cause right upper quadrant pain. CT symptoms of uncomplicated acute cholecystitis include overdistended gallbladder, mural thickness, mural enhancement, pericholecystic fat stranding, and pericholecystic fluid. Characteristically, there is an enhancement rim in the adjacent liver. A calculus can generally be seen affected in the gallbladder neck or cystic duct.

From June 2023 to July 2024, around 80 patients who were diagnosed to have acute cholecystitis clinically and advised admission to the Department of General Surgery, Sardar Patel Medical College and PBM Hospitals were included in the study. Inclusion Criteria are-All patients of each gender with age > 18 years and Patients with Acute cholecystitis. Exclusion Criteria are-Patient with < 18 years of age, Chronic cholecystitis, Carcinoma gallbladder and Patients not willing to participate in study. All patients have to go through USG , CT and their findings to histopathological examination report.

The study was done in PBM and Attached group of hospitals under department of surgery during june 2023 to July 2024 Total 80 patients were taken in our study with age range of 19 – 68 years, maximum 42 (55%) patients were in 20- 40 yrs age group, in all patients 61 were females and 19 (24%) were male.All studied patients came with chief complaint of pain in right Upper abdomen (100%) and nausea/ vomiting (100%) followed by 61 with fever, 7 with yellowish discoloration of eye, 42 with acidity, 57 with bloating.  On clinical examination   maximum 69 (86 %) patients presented with tenderness in right hypochondrium (RHC) followed by 65 with guarding- rigidity in RHC,47 with Anemia, 46 with Lump in RHC ,24 with palpable GB and 7 with jaundice. Total leukocyte counts between <8000 to >18000 on routine blood investigation of all cases. 

USG examination diagnosed 69 patients as acute cholecystitis accurately and CT scan diagnosed 75 (94%) patients as acute cholecystitis accurately.  Which shows Sensitivity of USG and CT was 86 % and 94 % respectively.All patients were operated for cholecystectomy (Lap/Open).  Their intraoperative findings - maximum 68 were with thickened GB wall followed by adhesions in 62, GB stone in 60 patients, pericholecystic fluid in 56, Distended GB in 38, CBD dilatation in 6, pyocele / mucocele in 4, Distorted Calot’ anatomy in 3 patients.  On Histopathological examination of Gall bladder Acute cholecystitis in 62 patients and Chronic cholecystitis in 18 patients. Among 62 patients of Acute Cholecystitis (AC), 16 had calculous AC, 6 had acute acalculous cholecystitis and remained 40 had acute on chronic cholecystitis with cholelithiasis.  In The histopathologically diagnosed 62 patients. 54 diagnosed on USG and 59 on CT scan. Diagnostic accuracy of USG & CT scan, in various parameter was- sensitivity 87% & 95 %, specificity 17% & 28%, PPV(Positive predictive value)  78 % & 79%, NPV (negative predictive value) 27 % & 40%.One the basis of our study we can say CT scan more accurately diagnosing acute cholecystitis then USG. 

Patients which are included in our study were came with chief complaint of pain right Upper abdomen (100%), nausea/ vomiting (100%), fever, yellowish discoloration of eye, were with acidity, bloating. , Peter C Ambe (2016) on “A proposal for preoperative clinical scoring system for Acute cholecystitis” shows that acute cholecystitis’s mostly all cases presents with  pain in right upper  abdomen and fever. On clinical examination   maximum 69 (86 %) patients had tenderness in right hypochondrium (RHC) followed by guarding – rigidity, Anemia, Lump in RHC, palpebral GB, and jaundice. All patients were undergone through USG examination. USG findings were found as murphy’s sign, GB stone in 60 pts., GB wall thickness in 55(69%) patients, pericholecystic fluid in 51 patients, GB distention in 41(59%) patients, CBD dilatation in 7 patients, dirty shadow in 4 patients. Compare with study conducted by cyrus dara jokhi et al (2018)   on “study of clinical features, laboratory investigations and radiological finding of gall bladder disease” in this study, USG findings were GB stone in 113 cases, enlarged GB in 61 cases, thickened GB wall in 39. All cases gone through CT scan examination.   CT   scan examination Finding were – maximum 70 (93%) patients had GB wall thickness followed by   pericholecystic fluid in 65(81 %) patients, GB stone in 54 (72 %) patients, GB distention (>4cm) in 44 (55%) patients, increased enhancement of adjacent liver in 32 (42%) patients, CBD dilatation (>6mm) in 9 (12%) patients, Air within the GB lumen or wall in 5 (6%). Compare to study conducted by Ajay a vare etal on “Computed tomography evaluation of acute cholecystitis” shows CT findings pericholecystic fluid in 86.3%, GB distention in 85.5%, wall thickening in 76.3%, GB stone in 58.8% patients. On HPE examination of Gall bladder shows Acute cholecystitis in 62 (71%) patients and Chronic cholecystitis in 18 (29%) patients. Compare to study conducted by Teruyoshi Oda et al., 2021 on “Acute Cholecystitis: Comparison of Clinical Findings from Ultrasound and Computed Tomography” 103 patients taken in study and done laparoscopic cholecystectomy, of which 60 were diagnosed with acute cholecystitis based on histopathology. Among 62 patients of Acute Cholecystitis, 16 had calculous AC, 6 had acute acalculous cholecystitis and remained 40 had acute on chronic cholecystitis with cholelithiasis. Compare to study conducted by ES TAN et al 2018 conducted a study  “Acute Cholecystitis: Computed Tomography (CT) versus Ultrasound (US)”  There were no patients with a “normal” gallbladder on histology. 49 cases had evidence of acute-on-chronic cholecystitis on histology. Out of these cases, a small proportion (17 cases) showed acute cholecystitis in the absence of cholelithiasis (acalculous cholecystitis).

on comparison of diagnostic accuracy of USG v\s CT, sensitivity was 87 % v/s 95 %, specificity was 42 % v/s 25%, PPV was 78% v\s 92% and NPV was 58% v/s 68%. , CT scan was comparatively more accurately diagnosing acute cholecystitis then USG.  When we compare   when study conducted by - Joss R. Wertz et al 2018 conducted a study comparing the “diagnostic accuracy of USG and CT in evaluating acute cholecystitis” The sensitivity of CT for detecting AC was significantly greater than that of US: 85% versus 68% (p = 0.043), respectively; however, the negative predictive values of CT and US did not differ significantly: 90% versus 77% (p = 0.24-0.26). Because there were no false-positives, the specificity and positive predictive values for both modalities were 100%, Hamish et al (2014) on “does USG accurately diagnose Acute cholecystitis?” shows diagnostic accuracy parameters of USG and CT respectively- sensitivity 72% & 85%, specificity 100% & 100% , and NPV 77% & 77% . and Teruyoshi Oda et al., 2021 conducted a study “Acute Cholecystitis: Comparison of Clinical Findings from Ultrasound and Computed Tomography”.  The sensitivity of US and CT were comparatively analysed on the basis of the histological outcomes. 72% and 85% sensitivity for the diagnosis of acute cholecystitis, respectively. In our study we included only clinically diagnosed patients, improved diagnostic tools and radio diagnostic team with time . that’s why sensitivity of our study in more than these studies.

Acute cholecystitis is common acute abdomen condition in general population. It usually presents with acute abdomen conditions like pain and tenderness in  right hypochondrium ,nausea / vomiting and fever. Sometime presents with life threatening complications like GB Perforation etc. SO Precise diagnosis of  acute cholecystitis and  finding which are suggesting of upcoming complication require for better management of patient. If the patient clinically suggestive of acute Cholecystitis and USG is inconclusive then we should go for CT for precise and early diagnosis to prevent further complications. In this study the sensitivity of CT is more then USG. CT will  improve the diagnostic confidence in acute cholecystitis and will also help in differential diagnosis.  Despite of this USG is first line imaging diagnostic modality in acute cholecystitis preferred by majority of surgeons because of its low cost, better availability, and no radiation exposure. Wherever CT is costly, not easily available, high radiation exposure and iv contrast’s allergic reaction risk.

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