Asymptomatic Gangrenous Cholecystitis Discovered During Elective Laparoscopic Cholecystectomy
Bibliographic record
Abstract
Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis. It is associated with significant morbidity and mortality. A male with type 2 diabetes mellitus had been treated for acute cholecystitis and discharged home. The patient was admitted electively for a laparoscopic cholecystectomy 6 weeks post discharge at which time he was entirely asymptomatic. Intra-operatively the gallbladder was found to be necrotic but it was removed laparoscopically and without complication. Acute cholecystitis is the most common complication of cholelithiasis occurring in approximately 1-2% of asymptomatic patients annually; however, in approximately 2-29.6% of patients, the disease processes to GC. GC is associated with a significant morbidity and mortality; however, in spite of its grave prognosis, its diagnosis can be elusive both clinically and biochemically. Many factors have been implicated in the formation of GC, including diabetes mellitus, age is greater than or equal to 51 years, male sex, leucocytosis (WCC > 15 × 10 9 ) and a high CRP. Complications associated with GC include perforation, which has been reported to occur in up to 10% of cases of acute cholecystitis. When managing a patient with acute cholecystitis, a high index of suspicion is essential for the possibility of GC, especially in a diabetic and elderly patient even if the patient appears to be improving clinically and in the presence of normalizing laboratory investigations. There is a need to consider early or emergency cholecystectomy in these patients due to the high risk of gangrenous transformation with possibility of gallbladder perforation and a resultant increased morbidity and mortality. J Med Cases. 2014;5(11):576-578 doi: http://dx.doi.org/10.14740/jmc1530w
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".