Role of preoperative helical CT before laparoscopic cholecystectomy. Evaluation of gallbladder and peritoneal adhesion

The purpose of this study was to assess the value of preoperative helical CT for the detection of adhesion of the gallbladder or surrounding peritoneum. Dynamic-enhanced helical CT of the abdomen was obtained before laparoscopic cholecystectomy in 47 patients. Images were reconstructed with a 5-mm interval. Appearances on CT images were correlated with operative findings, and useful findings for predicting gallbladder or peritoneal adhesion were determined by univariate and multivariate analysis. Patients with gallbladder or peritoneal adhesion often have gallbladder wall thickening, gallbladder wall enhancement, and increased density of the pericholecystic fat more frequently than patients without adhesion on both precontrast and postcontrast CT. Each of these findings was significant on univariate analysis. On multivariate analysis, increased density of the pericholecystic fat and focal attenuation increase in the liver were significant factors for predicting gallbladder or peritoneal adhesion. Increased density or stranding of pericholecystic fat and transient focal hepatic attenuation increase at dynamic arterial-phase CT indicates gallbladder and peritoneal adhesion. (author)