DIAGNOSTIC ACCURACY OF ULTRASOUND IN ACUTE CHOLECYSTITIS AMONG IMMUNOSUPPRESSED PATIENTS afgm2011@gmail.com

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DIAGNOSTIC ACCURACY OF ULTRASOUND IN ACUTE CHOLECYSTITIS AMONG IMMUNOSUPPRESSED PATIENTS

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Andrés Gempeler Rojas andres.gempeler@fvl.org.co Fundación Valle del Lili Cali Colombia

Colombia

Oral or Poster

Immunosuppressed patients often present with an atypical inflammatory response during acute cholecystitis, which complicates both clinical and sonographic diagnosis, potentially delaying treatment or leading to unnecessary surgeries. Our objective was to evaluate the diagnostic accuracy of ultrasound findings for acute cholecystitis in immunosuppressed patients.

We conducted a diagnostic accuracy study in patients older than 14 years with immunosuppression who underwent cholecystectomy at a level IV hospital between 2011–2024. Sensitivity (S), specificity (E), and likelihood ratios (LR) of clinical and sonographic findings were assessed, using pathology as the reference standard.

Among 158 included patients, 87 (55.1%) had acute cholecystitis confirmed by pathology. The combination of gallbladder wall thickening, enlargement, and gallstones yielded S=100% and LR–=0 (no patient had acute cholecystitis when these findings were absent). The presence of intraluminal debris was highly specific (E=92%, LR+=3.52), and its combination with other clinical and sonographic findings reached E=100%. Fever showed very low sensitivity (S=9%) and paradoxically decreased diagnostic probability (LR+=0.82), highlighting the atypical presentation of this disease in immunosuppressed individuals. Pericholecystic fluid had limited diagnostic value.

In immunosuppressed patients, the absence of gallbladder wall thickening, enlargement, and gallstones effectively rules out acute cholecystitis. Intraluminal debris is the most reliable finding to confirm the disease; however, its absence, as well as the absence of fever or pericholecystic fluid, does not reduce diagnostic probability. Integrating present and absent findings according to their diagnostic value should guide surgical decision-making in immunosuppressed patients with suspected acute cholecystitis.