...Evaluation of C - reactive protein as a Biomarker in Predicting Gangrenous Cholecystitis and Difficult Emergency Cholecystectomy

Introduction: The acute inflammation of the gallbladder wall is known as acute cholecystitis (AC). The physical examination, laboratory, and imaging results provide the basis for the Tokyo guidelines criteria for the diagnosis and categorization of AC in three severity grades.Aim of the study: Evaluation of CRP as a predictor for gangrenous cholecystitis and difficult emergency laparoscopic cholecystectomy.Subjects and Methods: This study was conducted on a basis of a prospective randomized study included 50 patients presented with acute cholecystitis and admitted to the General Surgery Department at Fayoum University Hospital. They were subjected to emergency laparoscopic within the duration from March 2021 to January 2023. Preoperative serum CRP level is assessed for all patients on admission.Results: All fifty patients were subjected to laparoscopic cholecystectomy in a median time of 59.5 min, out of which, 9 cases were categorized as difficult based on the longer operative time (>90 min) with mean CRP level of (147.6 mg/dl). 4 patients were converted to open surgery with mean CRP level of (161 mg/dl). Two patients had partial cholecystectomy. 15 patients out of fifty suffered from Gangrenous cholecystitis with cut-off CRP level (48 mg/dl). As regards hospital stay, it ranged from 1 to 5 days with a median of 2 (IQR from 2 – 3 days).Conclusions: When patients with acute cholecystitis are admitted from the emergency room, elevated serum CRP is a reliable indicator of both the likelihood of a difficult laparoscopic cholecystectomy