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Pathomorphological aspects of the diagnosis and treatment of acute cholecystitis

Aim: to find out the possibilities of pathomorphological studies of destructive forms of acute cholecystitis in identifying the characteristics of etiology and pathogenesis factors for the clinical use of the data. 
Materials and methods. From 2016 to 2018, 266 patients with acute cholecystitis (AC) were operated on in the clinic of the Department of Surgery and Proctology of Shupik National Medical Academy of Postgraduate Education on the basis of Kyiv Regional Clinical Hospital. General clinical methods, ultrasound, X-ray methods, CT, MRI, mini-invasive methods, operative methods — mainly laparoscopic interventions, up to 10% — laparotomy surgeries were used in the diagnosis. The removed gall bladders underwent morphological examination. 
Results and discussion. Acute calculous cholecystitis was diagnosed in 245 operated patients (92%), stoneless — in 21 (8%). Catarrhal, serous, serous-fibrinous forms were found out in 32 patients (12%), destructive — in 234 (88%). Acute phlegmonous cholecystitis was detected in 147 patients (55%), gangrenous — in 56 (21%), perforated — in 11 (4%), including subhepatic abscess — 8 (3%). According to clinical, biochemical, intraoperative and macromorphological signs, enzymatic forms of AC were diagnosed in 37 patients (11%), emphysema in 4 (2%), vascular in 3 (1.5%) and post-traumatic in 1 (0.5%). In 96 patients with phlegmonous and gangrenous forms of AC, immune-allergic and vascular changes in the gallbladder wall were revealed by special pathomorphological techniques. 
Conclusion 
 
AC is a polyetiological disease with complex pathogenesis and nonspecific histomorphological changes. 
Phlegmonous (147 (55%) patients), gangrenous — 56 (21%) prevail among destructive forms of AC, perforated forms — 11 (4%), and subhepatic abscess with AC — 8 (3%) are rarely found. 
Clinical and instrumental intraoperative research methods allow to pre-diagnose special forms of AC, among which the most commonly diagnosed are enzymatic cholecystitis — 37 (11%) patients, the more rare are emphysema — 4 (2%), vascular — 3 (1.5%), and post-traumatic AC — 1 (0.5%). 
Morphological studies make it possible to verify the degree of inflammation and destruction of the gallbladder wall, to identify immune-allergic and vascular changes in the gallbladder wall. 
Results of microscopic and pathomorphological studies in patients with AC allow in the postoperative period to adjust antibiotic therapy, prevention of thromboembolic complications, allergic and immunological manifestations to reduce postoperative complications and mortality.