Case Reports
Vol. 3 No. 2 (2025)
Enhancing surgical decision-making: the critical need for structured ultrasound training in residency. A case report of acute necrotic cholecystitis
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 24 September 2025
35
Views
13
Downloads
Authors
Acute necrotic cholecystitis (ANC), marked by gallbladder wall necrosis, carries high morbidity if diagnosis and treatment are delayed. Ultrasound is the first-line imaging for suspected cholecystitis, but its sensitivity for necrosis is limited. This case underscores the value of surgical ultrasound competency in emergency decision-making. A 57-year-old woman with diabetes, asthma, and hypothyroidism presented with severe epigastric pain and systemic inflammation. Emergency ultrasound showed gallbladder wall thickening, pericholecystic fluid, and gallstones. CT confirmed necrosis with possible microperforation. An informal ultrasound by surgical residents later that day identified microperforations, expediting the decision for subtotal laparoscopic cholecystectomy. Surgery was successful, and recovery was uneventful. Ultrasound, when performed by trained surgical teams, enables rapid diagnosis and management of complex cholecystitis. Structured ultrasound training during residency could enhance diagnostic accuracy, reduce treatment delays, and improve outcomes in acute surgical emergencies.
Downloads
Download data is not yet available.
Citations
Nve E, Badia JM, Amillo-Zaragüeta M, et al. Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines. J Clin Med 2023;12:4711. DOI: https://doi.org/10.3390/jcm12144711
Fugazzola P, Podda M, Tian BW, et al. Clinical update on acute cholecystitis and biliary pancreatitis: between certainties and grey areas. EClinicalMedicine 2024;77:102880. DOI: https://doi.org/10.1016/j.eclinm.2024.102880
Kiewiet JJ, Leeuwenburgh MM, Bipat S, et al. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology 2012;264:708-20. DOI: https://doi.org/10.1148/radiol.12111561
Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994;154:2573-81. DOI: https://doi.org/10.1001/archinte.1994.00420220069008
Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg 2020;15:61. DOI: https://doi.org/10.1186/s13017-020-00336-x
Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg 2014;57:162-8. DOI: https://doi.org/10.1503/cjs.027312
Borzellino G, Motton M, Minniti F, et al. Sonographic diagnosis of acute cholecystitis in patients with symptomatic gallstones. J Clin Ultrasound 2016;44:152-8. DOI: https://doi.org/10.1002/jcu.22305
Fidler J, Paulson EK, Layfield L. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR Am J Roentgenol 1996;166:1085-8. DOI: https://doi.org/10.2214/ajr.166.5.8615248
Marincek B. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol 2002;12:2136-50. DOI: https://doi.org/10.1007/s00330-002-1569-x
Wyrick DL, Smith SD, Burford JM, Dassinger MS. Surgeon-performed ultrasound: accurate, reproducible, and more efficient. Pediatr Surg Int 2015;31:1161-4. DOI: https://doi.org/10.1007/s00383-015-3758-0
Rozycki GS, Cava RA, Tchorz KM. Surgeon-performed ultrasound imaging in acute surgical disorders. Curr Probl Surg 2001r;38:141-212. DOI: https://doi.org/10.1067/msg.2001.112348
Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J 2021;13:16. DOI: https://doi.org/10.1186/s13089-021-00216-8
Beggs AD, Thomas PR. Point of use ultrasound by general surgeons: review of the literature and suggestions for future practice. Int J Surg 2013;11:12-7. DOI: https://doi.org/10.1016/j.ijsu.2012.11.014
Menon N, Kumar S, Keeler B, et al. A systematic review of point-of-care abdominal ultrasound scans performed by general surgeons. Surgeon 2021;19:e559-63. DOI: https://doi.org/10.1016/j.surge.2021.01.014
Martin R, Lau HA, Morrison R, et al. The Rising Tide of Point-of-Care Ultrasound (POCUS) in Medical Education: An Essential Skillset for Undergraduate and Graduate Medical Education. Curr Probl Diagn Radiol 2023;52:482-4. DOI: https://doi.org/10.1067/j.cpradiol.2023.06.003
Huang SS, Lin KW, Liu KL, et al. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 2023;18:54. DOI: https://doi.org/10.1186/s13017-023-00524-5
Lindelius A, Törngren S, Pettersson H, Adami J. Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg Med J 2009;26:561-6. DOI: https://doi.org/10.1136/emj.2008.062067
Kotagal M, Quiroga E, Ruffatto BJ, et al. Impact of point-of-care ultrasound training on surgical residents' confidence. J Surg Educ 2015;72:e82-7. DOI: https://doi.org/10.1016/j.jsurg.2015.01.021
Jiang Z, Wang J, Chen X, et al. Competency-based ultrasound curriculum for standardized training resident: a pre- and post-training evaluation. BMC Med Educ 2024;24:1516. DOI: https://doi.org/10.1186/s12909-024-06560-2
How to Cite
Enhancing surgical decision-making: the critical need for structured ultrasound training in residency. A case report of acute necrotic cholecystitis. (2025). Case Reports in Emergency Surgery and Trauma, 3(2). https://doi.org/10.4081/crest.2025.47
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
