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

Abstract

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.