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Sample records for acute gallbladder perforation

  1. Spontaneous external gallbladder perforation

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    Noeldge, G.; Wimmer, B.; Kirchner, R.

    1981-04-01

    Spontaneous perforation of the gallbladder is one complication of cholelithiasis. There is a greater occurence of free perforation in the peritoneal cavity with bilary pertonitis, followed by the perforation into the stomach, small intestine and colon. A single case of the nowadays rare spontaneous perforation in and through the abdominal wall will be reported. Spontaneous gallbladder perforation appears nearly asymptomatic in its clinical course because of absent biliary peritonitis.

  2. Transhepatic perforation of the gallbladder: rare complication of a common disease

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    Shrestha KR

    2010-05-01

    Full Text Available Acute cholecystitis leading to gallbladder perforation is relatively common. However, transhepatic perforation of the gallbladder leading to biliary peritonitis is very rare. We present a rare case of biliary peritonitis caused by transhepatic perforation of the gallbladder.

  3. Diagnosis and treatment of gallbladder perforation

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    Hayrullah Derici; Cemal Kara; Ali Dogan Bozdag; Okay Nazli; Tugrul Tansug; Esra Akca

    2006-01-01

    AIM: To present our clinical experience with gallbladder perforation cases.METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated.RESULTS: Seven patients had type Ⅰ gallbladder perforation, 7 type Ⅱ gallbladder perforation, and 2 type Ⅲ gallbladder perforation according to Niemeier's classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess,pneumonia, pancreatitis, and acute renal failure were found in 6 patients.CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

  4. Gallbladder Volvulus: A Rare Emergent Cause of Acute Cholecystitis, if Untreated, Progresses to Necrosis and Perforation

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    Justin L, Regner, E-mail: Justin.Regner@BSWHealth.org; Angela, Lomas [Department of Surgery, Baylor Scott and White Health and Texas A& M Health Science Center College of Medicine, Temple, TX (United States)

    2016-03-25

    An 86 year-old woman with a past medical history significant for abdominal hernia and Alzheimer dementia presented to the Emergency Department with a 24 hour history of acute right upper quadrant pain associated with nausea and non-bilious emesis. Physical exam revealed right sided abdominal tenderness with associated mass. All laboratory values were within normal ranges. Both abdominal ultrasound and computed tomography of the abdomen/pelvis revealed a large distended gallbladder with wall thickening and gallstones. Based on presentation and radiologic findings, the emergency general surgery service was consulted for suspected acute cholecystitis. The patient was then admitted for intravenous antibiotics and scheduled for laparoscopic cholecystectomy the following day. Intra-operative findings revealed volvulus with acute necrosis of the entire gallbladder. The gallbladder had a long pedunculated cystic duct and artery that was detorsed before proceeding with resection. Postoperatively, the patient did well and was discharged a few days later tolerating a regular diet.

  5. Unusual presentation of gallbladder perforation

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    G. Jayasinghe

    2016-01-01

    Conclusions: Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified.

  6. Unusual presentation of gallbladder perforation

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    Jayasinghe, G.; Adam, J.; Abdul-Aal, Y.

    2016-01-01

    Introduction: Gall bladder perforation is associated with high mortality rates and therefore must be recognised and managed promptly. We present an unusual presentation of spontaneous gall bladder perforation. Case presentation: An elderly lady with multiple medical co-morbidities was admitted with sepsis following a fall. Initial assessment lead to a diagnosis of pneumonia, however a rapidly expanding right flank mass was incidentally noted during routine nursing care. Imaging studies wer...

  7. Clinical Analysis of 38 Elderly Patients with Acute Perforation of Gallbladder%老年急性胆囊穿孔38例临床分析

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    李恒力; 王艳静; 许丙辉; 刘昭明; 齐双玉

    2013-01-01

    Objective To explore the surgical treatment for acute perforation of gallbladder in elderly patients.Methods Clinical data of 38 elderly patients with acute perforation of gallbladder during January 2008 and June 2012 were retrospectively analyzed.Results All patients had different degrees of abdominal pain,and some patients ran a fever with peritoneal irritation sign and jaundice.All patients underwent B-mode ultrasonography examinations before operation,and 13 patients (34.2%) were misdiagnosed.Six patients were misdiagnosed as having cholecystolithiasis combined with cholecystitis,three misdiagnosed as having peptic ulcer perforation,two misdiagnosed as having acute pancreatitis and two misdiagnosed as having acute ileus.The 38 patients were confirmed perforation of gallbladder by surgical treatment.In 16 patients with postoperative complications,there were 5 patients with pulmonary infection,3 patients with incision infection,2 patients with subphrenic abscess,1 patient with multiple organ failure (MOF),1 patient with liver abscess,1 patient with toxic shock,1 patient with heart failure,1 patient with acute pulmonary embolism and 1-patient with deep venous thrombosis of the lower extremity.Four patients died,and fatality rate was 10.5%.Conclusion The acute perforation of gallbladder in elderly patients is atypical and tends to be misdiagnosed,and B-mode ultrasonography may be helpful in diagnosis.Surgical treatment should be performed as quickly as possible after confirming diagnosis.Postoperative complications have a close relation with combined diseases,which needs more attention.%目的 探讨老年急性胆囊穿孔的外科治疗方法.方法 回顾性分析2008年1月-2012年6月我院收治的38例老年胆囊穿孔的临床资料.结果 全组均有不同程度腹痛,部分患者伴发热、腹膜刺激征、黄疸,术前均行B超检查,13例误诊,误诊率34.2%.误诊为胆囊结石并胆囊炎6例,消化性溃疡穿孔3例,急性

  8. Spontaneous gallbladder perforation in a patient of situs inversus totalis, misdiagnosed as perforation peritonitis due to gas under the right dome of the diaphragm.

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    Kumar, Sanjeev; Kumar, Shailendra; Kumar, Suresh; Gautam, Shefali

    2015-06-29

    Acute biliary tract disease is a common condition in adults. Apart from bile duct perforation, spontaneous perforation of the gallbladder itself is very rare in all age groups; to date, all recorded cases are secondary to coexistent disease. We present the case report of a 60-year-old adult having an idiopathic gallbladder perforation. In our case, an unusual presentation was situs inversus totalis and fundal gas shadow was considered as free air under the right dome of the diaphragm by mistake. The patient underwent laparotomy and emergency cholecystectomy was performed in the perforated gallbladder. To date, no case has been described in the literature.

  9. Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with computed tomography

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    Hollanda, Erick Sabbagh de; Torres, Ulysses dos Santos; Gual, Fabiana; Oliveira, Eduardo Portela de; Cardoso, Luciana Vargas; Criado, Divanei Aparecida Bottaro, E-mail: usantor@yahoo.com.br [Faculdade de Medicina de Sao Jose do Rio Preto (Famerp), SP (Brazil). Hospital de Base

    2013-09-15

    Spontaneous perforation of gallbladder is a severe and infrequent complication of acute cholecystitis that requires early and accurate diagnosis. Concomitant development of intrahepatic collections is rarely observed in such cases. The present report emphasizes the relevance of imaging studies in this setting, describing the typical sonographic and tomographic findings for the diagnosis of such condition. (author)

  10. CT findings of hepatic abscess arising from perforated acute cholecystitis

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    Choi, Sang Hee; Lee, Kyoung Soo; Lee, Jin Seoung; Lee, Moon Gyu; Chung, Young Hwa; Lee, Young Sang; Lee, Sung Gyu; Auh, Yong Ho [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    The purpose of this study was to report the CT findings of four patients with hepatic abscess secondary to perforated acute cholecystitis. We retrospectively reviewed the CT findings of four patients with surgically proven hepatic abscess secondary to perforated acute cholecystitis. CT findings were analysed with respect to the observation of the gallbladder, pericholecystic space, hepatic lesions, and peritoneal cavity. All patients underwent cholecystectomy, with drainage of the hepatic abscess. CT findings of hepatic abscess secondary to perforated acute cholecystitis were hypodense mass formation in the pericholecystic space(n=3), irreguarity and wall defect of Gallbladder(n=4), thickened Gallbladder wall(n=4), stone with debris(n=4), and local or diffuse infiltration of the pericholecystic area(n=3), omentum, and mesentery. CT was helpful in diagnosing the hepatic abscess secondary to perforated acute cholecystitis.

  11. Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation

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    Myung Soo Kang; Do Hyun Park; Ki Du Kwon; Jeong Hoon Park; Suck-Ho Lee; Hong-Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2007-01-01

    Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. Because it is a rare entity, the treatment modality has not been fully established. We report for the first time a patient with an intrahepatic abscess due to gallbladder perforation successfully treated by endoscopic stent placement into the gallbladder who had a poor response to continuous percutaneous drainage.

  12. Spontaneous gallbladder perforation, pericholecystic abscess and cholecystoduodenal ifstula as the ifrst manifestations of gallstone disease

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    Vui Heng Chong; Kian Soon Lim; Varkey Vallickad Mathew

    2009-01-01

    BACKGROUND: Gallstone disease is common, and complications that are frequently encountered include acute cholecystitis and acute pancreatitis, but rarely gallbladder perforation. METHOD: Data were retrospectively collected from clinical case notes and a literature review is presented. RESULTS: A 72-year-old lady presented with spontaneous gallbladder perforation, pericholecystic abscess and cholecystoduodenal ifstula as the ifrst manifestations of gallstone disease. She was previously well and had no abdominal complaints. Her condition was successfully managed with initial antibiotic therapy followed by interval cholecystectomy and ifstula repair. CONCLUSIONS: Our case highlighted some uncommon but severe complications which occurred simultaneously as the ifrst manifestations of previously asymptomatic gallstone disease. Such complications need to be considered in patients suspected of intra-abdominal sepsis, even when there are no characteristic symptoms.

  13. Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation

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    Sefczek, D.M.; Sharma, P.; Isaacs, G.H.; Brodmerkel, G.J. Jr.; Adatepe, M.H.; Powell, O.M.; Nichols, K.

    1985-01-01

    A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine admininstration permitted visualization of the leak. Use of narcotic drugs may be a useful pharmocologic intervention in cases of peritonitis due to small obscure bile leaks.

  14. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.

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    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-03-04

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices.

  15. Gallbladder Volvulus Presenting as Acute Appendicitis

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    Zachary Bauman

    2015-01-01

    Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

  16. Pancreatobiliary Reflux Resulting in Pancreatic Ascites and Choleperitoneum after Gallbladder Perforation

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    Rachele Rapetti

    2008-11-01

    Full Text Available A 65-year-old man with chronic hepatitis C and no history of alcohol abuse was admitted to our liver unit for the recent development of massive ascites and presumed hepatorenal syndrome. In the preceding two weeks, he had received medical treatment for acute pancreatitis and cholecystitis. Abdominal paracentesis demonstrated a cloudy, orange peritoneal fluid, with total protein concentration 3.6 g/dl, serum-ascites albumin gradient 1.0 g/dl, and ratios of ascites-serum bilirubin and amylase approximately 8:1. Diagnostic imaging demonstrated no pancreatic pseudocysts. Ten days later, at laparotomy, acalculous perforation of the gallbladder was identified. After cholecystectomy, amylase concentration in the ascitic fluid dropped within a few days to 40% of serum values; ascites disappeared within a few weeks. We conclude that in the presence of a perforated gallbladder, pancreatobiliary reflux was responsible for this unusual combination of choleperitoneum and pancreatic ascites, which we propose to call pancreatobiliary ascites.

  17. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

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    Loabat Geranpayeh

    2006-01-01

    Full Text Available Spontaneous perforation of the uterus is rare, its incidence being about 0.01%–0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

  18. A case of gallbladder perforation detected by sonography after a blunt abdominal trauma.

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    Hongo, Maiko; Ishida, Hideaki; Naganuma, Hiroko; Yoshioka, Hiroshi; Kasuya, Takamitu; Niwa, Makoto

    2014-06-01

    Gallbladder (GB) perforation is a very rare posttraumatic abdominal injury. It is potentially life-threatening, and good outcome requires early diagnosis. We present a case of isolated posttraumatic GB perforation in which the precise sonographic (US) diagnosis led us to apply proper management. Color Doppler US showed a clear to-and-fro flow signal passing through the perforation site, and contrast-enhanced US confirmed the presence of a small defect in the GB wall. When examining posttraumatic patients, the possibility of GB perforation must be kept in mind. Color Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation.

  19. CT in acute perforated sigmoid diverticulitis

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    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Ghanem, Nadir [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Pache, Gregor [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Makowiec, Frank [Department of Surgery, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Kotter, Elmar [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)

    2005-10-01

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning.

  20. Sonographic changes of liver and gallbladder in acute viral hepatitis

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    Ebrahimi Daryani N

    2001-07-01

    Full Text Available Hepatomegaly, decrease in the liver paranchymal echo and increase in the gallbladder wall thickness has been shown in acute viral hepatitis. The present study was done to determine sonographic changes in acute viral hepatitis. We performed liver and bile ducts sonography and specific tests on 42 patients (mean age: 31.5 and 61% male with acute viral hepatitis. Gallbladder wall thickness was seen in 45.2% and hepatomegaly in 33.3% of patients and liver paranchymal echo was decreased in 19.3%. Age, sex, type of hepatitis, cholecystitis like symptoms, aspartate aminotransfrase, alanine aminotransfrase, alkaline phosphatase and bilirubin did not significantly corralate with these changes. Only raised prothrombin time was strongly correlated to the thickening of the gallbladder and decrease in the liver paranchymal echo and cholesistic like symptoms we can postulate that thickening of the gallbladder and decrease in the liver paranchymal echo is not dependent on the severity and speed of the paranchymal necrosis (as considered with ALT and AST but they depend on the liver function disturbance (as considered with PT because the thickening of the gall bladder is present in 45% of the patients and 10% of the normal population have gallbladder stones, one should not perform the diagnosis of acute cholecystitis, only on the basis of sonographic report without attention to the clinical and laboratory data.

  1. Acute gallbladder torsion - a continued pre-operative diagnostic dilemma

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    Desrochers Randal

    2011-04-01

    Full Text Available Abstract Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis.

  2. Pain patterns after distension of the gallbladder in patients with acute cholecystitis

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    Middelfart, H V; Jensen, P; Højgaard, L;

    1998-01-01

    and the cystic duct opening pressure. METHODS: Twelve patients (nine women, three men) treated with cholecystostomy for acute cholecystitis were investigated. Simultaneous cholescintigraphy and measurement of changes in intraluminal gallbladder pressure after injections of saline through a gallbladder catheter...

  3. Percutaneous cholecystostomy for gallbladder perforation : early response and final outcome in 10 patients

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    Lee, Jeong Min; Han, Young Min; Lee, Mi Suk [Namwon Medical Center, Namwon (Korea, Republic of ); Kim, Jin; Kowk, Hyo Seong; Lee, Sang Young; Chung, Gyung Ho; Kim, Chong Soo [Chonbuk Univ., Chonju (Korea, Republic of). Coll. of Medicine; Han, Hyeun Young; Chung, Jin Young [Eulgi Medical College, Seoul (Korea, Republic of)

    1998-01-01

    To evaluate the efficacy of percutaneous cholecystostomy (PC) as a therapeutic maneuver for patients with spontaneous gallbladder (GB) perforation. All procedures were technically successful, and no major procedure-related complications occurred. Eight patients (80%) responded favorably to PC. One, who did not respond, underwent emergency cholecystectomy next day due to worsening peritonitis, and the other who failed to respond within 72hr showed delayed response after drainage of a coexistent liver abscess at seven days after the procedure. A patient who responded to PC experience catheter dislodgement four days after the procedure but reinsertion was not required. Five of eight patients who responded positively underwent elective cholecystecomy after the improvement of clinical symptoms, and the three remaining patients improved without further surgery. (author). 23 refs., 4 figs.

  4. Cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage

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    Borly, L; Stage, J G; Grønvall, S;

    1995-01-01

    OBJECTIVE: To investigate gallbladder function by use of cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage. DESIGN: A cholescintigraphy was performed in 40 patients with acute cholecystitis before and after the performance of percutaneous...... gallbladder drainage. During the post-drainage cholescintigraphies, a cholecystokinin stimulation was performed to investigate gallbladder emptying in 12 selected patients. Gallbladder pressure and volume were measured before drainage in another group of 12 patients with acute cholecystitis. RESULTS...... treatment. Post-drainage cholescintigraphy revealed a mean gallbladder ejection fraction of 24%, which is significantly lower than the corresponding value in normal individuals and gallstone patients without cholecystitis (n = 12). Gallbladder pressure and volume were markedly increased compared with normal...

  5. Acute phlegmonous gastritis complicated by delayed perforation.

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    Min, Sun Young; Kim, Yong Ho; Park, Won Seo

    2014-03-28

    Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient's clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient's condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.

  6. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

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    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  7. Gallbladder Metastasis of Non-small Cell Lung Cancer Presenting as Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Yu-Sook Jeong; Seung-Taik Kim; Hye-Suk Han; Sung-Nam Lim; Mi-Jin Kim; Joung-Ho Han; Min-Ho Kang; Dong-Hee Ryu; Ok-Jun Lee; Ki-Hyeong Lee

    2012-01-01

    Although non-small cell lung cancer (NSCLC) can metastasize to almost any organ,metastasis to the gallbladder with significant clinical manifestation is relatively rare.Here,we report a case of gallbladder metastasis of NSCLC presenting as acute cholecystitis.A 79-year-old man presented with pain in the right upper quadrant and fever.A computed tomography (CT) scan of the chest and abdomen showed a cavitary mass in the right lower lobe of the lung and irregular wall thickening of the gallbladder.Open cholecystectomy and needle biopsy of the lung mass were performed.Histological examination of the gallbladder revealed a moderately-differentiated squamous cell carcinoma displaying the same morphology as the lung mass assessed by needle biopsy.Subsequent immunohistochemical examination of the gallbladder and lung tissue showed that the tumor cells were positive for P63 but negative for cytokeratin 7,cytokeratin 20 and thyroid transcription factor-1.A second primary tumor of the gallbladder was excluded by immunohistochemical methods,and the final pathological diagnosis was gallbladder metastasis of NSCLC.Although the incidence is extremely rare,acute cholecystitis can occur in association with lung cancer metastasis to the gallbladder.

  8. Perforation rate in acute appendicitis: association with different risk facotrs

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    B. Khorasani

    2006-08-01

    Full Text Available Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation. Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area. Results: One hundred twenty one of 1311 patients (9% had perforated appendicitis and 1190 patients (91% had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year. When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital. Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

  9. A Rare Acute Abdomen Reason: Perforated Jejunal Diverticulitis

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    Oktay Karakose

    2014-06-01

    Full Text Available Jejunal diverticulosis is a rare case that is diagnosed incidental. Although it is generally asymptomatic, it can cause non-spesific symptoms like stomachache, nausea, diarrhoea, malabsorption, bleeding, obstruction and / or perforation. Perforated jejunal diverticulitis is a very rare acute abdomen cause. The acute complications of jejunal diverticulosis can be cause of significant morbidity and mortality especially in old patients. In this text, we report a 81 year old woman case that was operated emergently because of perforated jejunal diverticulitis and was lost in postoperation term because of multiple organ failure.

  10. Diagnosis of clinically unsuspected gallbladder perforation in an obese patient, by Tc-99m IDA cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Mesgarzadeh, M.; Haines, J.E.; Bobba, V.R.; Von Dollen, L.E.; Jarboe, G.; Krishnamurthy, G.T.

    1983-11-01

    A male Pickwickian syndrome patient was admitted to the hospital with sudden onset of abdominal pain. Physical examination was equivocal. Due to patient's ileus and morbid obesity (weight 450 lb), neither TCT scan nor ultrasound was possible. A Tc-99m PIPIDA hepatobiliary imaging study revealed intraperitoneal leakage of radioactive bile with collection of the activity in both abdominal gutters, indicating gallbladder rupture. Prompt surgery confirmed the diagnosis.

  11. Internal gallbladder drainage prevents development of acute cholecystitis in a pig model: a randomized study

    DEFF Research Database (Denmark)

    Kjaer, Daniel W; Mortensen, Frank V; Møller, Jens K;

    2010-01-01

    BACKGROUND: Acute cholecystitis can be the result of retention of bile in the gallbladder with possible secondary infection and ischaemia. The aim of the present study was to investigate whether internal drainage of the gallbladder could protect against the development of acute cholecystitis...... in a pig model. MATERIALS AND METHODS: Twenty pigs were randomized to either internal drainage (drained) or not (undrained). Day 0 acute cholecystitis was induced by ligation of the cystic artery and duct together with inoculation of bacteria. Four days later the pigs were killed and the gallbladders were...... removed and histologically scored for the presence of cholecystitis. Bile and blood samples were collected for bacterial culturing and biochemical analyses. RESULTS: The histological examination demonstrated statistical significant differences in acute cholecystitis development between groups, the degree...

  12. An Unusual Case of Colon Perforation Complicating Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Anthony A. Aghenta

    2009-08-01

    Full Text Available Colonic complications of severe acute pancreatitis occur rarely. Although there have been several theories on how pancreatic pseudocysts rupture into the colon, the exact pathogenesis remains unknown. We report an unusual case of pseudocysts complicating severe acute pancreatitis presenting with colonic perforation in a 71-year-old man with a history of chronic mesenteric ischemia. Pressure effects from a giant pseudocyst and intravascular volume depletion with acute insult on chronic mesenteric ischemia are highlighted as possible etiologic factors.

  13. Perforation due to ileocaecal salmonellosis

    NARCIS (Netherlands)

    Willemsen, PJ

    2002-01-01

    A 54-year old male patient was admitted with a tentative diagnosis of biliary pancreatitis. After 3 days, he developed an acute abdomen with a pneumoperitoneum. A laparotomy was performed : multiple perforations of the terminal ileum and a necrotic gallbladder were found. A right hemicolectomy with

  14. Gallbladder radionuclide scan

    Science.gov (United States)

    ... ducts Cancer of the hepatobiliary system Gallbladder infection ( cholecystitis ) Gallstones Infection of the gallbladder, ducts, or liver ... Saunders; 2010:chap 65. Read More Acute Acute cholecystitis Bile Bile duct obstruction Cyst Gallstones Liver cancer - ...

  15. [Acute Meckel's diverticulitis perforated by a foreign body].

    Science.gov (United States)

    Pahomeanu, M; Anghelide, A; Mandache, F

    1976-01-01

    The authors present the case of a patient with acute, right iliac fossa abdominal syndrome, simulating acute apendicitis. In the course of the intervention it was noted that the syndrome was determined by an acute Meckel diverticulitis, perforated by a foreign body (fish bone). In view of making the diagnosis of acute diverticulitis, that cannot be assessed before surgery, the importance is stressed of the correlation of the clinical aspects with the apendicular lesions found in the course of the operation, and, when there is no satisfactory concordance, careful checking of the cecum becomes necessary, as well as of the right annexe and of the ileon over at least three feet.

  16. Perforated jejunal diverticulum: a rare presentation of acute abdomen.

    Science.gov (United States)

    Kavanagh, Crystal; Kaoutzanis, Christodoulos; Spoor, Kristen; Friedman, Paul F

    2014-03-22

    Jejunal diverticulosis is a rare entity with a reported clinical incidence of 0.5%. However, symptoms relating to its presence are non-specific, which does not only delay diagnosis, but also increases the risk of serious complications approaching 15%. We report a case of perforated jejunal diverticulum presented with a 6-month history of significant weight loss and acute abdominal pain. We discuss clinical presentation in both simple and complex cases, diagnostic pitfalls and management strategies.

  17. Cholecystoduodenal fistula in a porcelain gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Delpierre, I.; Tack, D.; Delcour, C. [Department of Radiology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Moisse, R. [Department of Gastroenterology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Boudaka, W. [Department of Surgery, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium)

    2002-09-01

    Calcification of the gallbladder wall (porcelain gallbladder) is rare. Its appearance is quite characteristic on plain films, ultrasonography and computed tomography. Sporadic cases of cholecystitis have been described in porcelain gallbladders. Enterobiliary fistula may complicate acute or chronic cholecystitis in non-calcified gallbladder. We report a unusual case of acute cholecystitis with cholecystoduodenal fistula in a porcelain gallbladder. (orig.)

  18. Metastatic melanoma of the gallbladder: An unusual clinical presentation of acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Spiridon Vernadakis; Georgios Rallis; Nikolaos Danias; Costas Serafimidis; Evangelos Christodoulou; Michail Troullinakis; Nikolaos Legakis; Georgios Peros

    2009-01-01

    Metastatic disease from cutaneous melanoma can affect all organs of the body, and varies in its biological behavior and clinical presentation. We present the case of a 58-year-old man who arrived at our clinic with acute abdominal pain, which, after investigation, was diagnosed as acute cholecystitis. The patient underwent laparotomy and cholecystectomy. Two years ago, he underwent surgical removal of a primary cutaneous melanoma on his right upper back. Pathological examination revealed the presence of malignant melanoma with a metastatic lesion of the gallbladder.

  19. Spontaneous Perforation of Pyometra Presented as an Acute Abdomen: A Case Report

    Science.gov (United States)

    Saha, Pradip Kumar; Gupta, Pratiksha; Mehra, Reeti; Goel, Poonam; Huria, Anju

    2008-01-01

    Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality. PMID:18324325

  20. Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

    Institute of Scientific and Technical Information of China (English)

    Kazunari Sasaki; Goro Watanabe; Masamichi Matsuda; Masaji Hashimoto

    2012-01-01

    AIM:To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG).METHODS:One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis,respectively.A retrospective review was performed not only between SILC for AIG and non-AIG,but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period.RESULTS:Comparison between SILC for AIG and nonAIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min,P =0.03).The open conversion rate (2/26 vs 2/84,P =0.24) and complication rate (1/26 vs 3/84,P =1.00) showed no differences,but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82,P =0.01).Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis.CONCLUSION:Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.

  1. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Tahsin Colak

    2013-01-01

    Full Text Available Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT. The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.

  2. Ultrasonographic Findings of the Gallbladder in Patients with Acute Hepatitis A: Do They Have Clinical Relevance?

    Energy Technology Data Exchange (ETDEWEB)

    An, Ji Young; Kim, Hyoung Jung; Lee, Dong Ho; Lim, Joo Won; Ko, Young Tae; Choi, Bong Keun [Dept. of Radiology, Graduate School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, Seoul (Korea, Republic of)

    2012-06-15

    To determine the association of gallbladder (GB) abnormalities on ultrasonography (US) of patients with acute hepatitis A with demographic, clinical, and biochemical factors, and with other US findings. This retrospective study was approved by our institutional review board, which waived the requirement for informed consent. We retrospectively evaluated 152 consecutive patients with acute hepatitis A who underwent US. The diagnosis of acute hepatitis A was made during acute illness by demonstrating anti- HAV of the IgM class. US images were reviewed simultaneously by two abdominal radiologists and a consensus was reached for GB wall thickening, GB collapse, lymphadenopathy, and hepatic echogenicity. The associations between demographic, clinical, biochemical, and US findings and GB wall thickening or collapse were then assessed. GB wall thickening was present in 123 (81%) and GB collapse in 96 (63%) of the 152 patients. Total bilirubin level and GB collapse differed significantly (p < 0.05) between patients with and without GB wall thickening. Gender ratio, total and peak total bilirubin level, and GB wall thickness differed significantly (p < 0.05) between patients with and without GB collapse. Multivariate analysis showed that GB wall thickening was associated with GB collapse and vice versa. GB wall thickening and GB collapse are common US abnormalities associated with each other in patients with acute hepatitis A. However, GB wall thickening or collapse is not associated with any demographic, clinical, or biochemical factors, or with other US findings, in patients with acute hepatitis A.

  3. Amylase: creatinine clearance ratio and urinary excretion of lysozyme in acute pancreatitis and acute duodenal perforation.

    Science.gov (United States)

    Berger, G M; Cowlin, J; Turner, T J

    1976-09-18

    The amylase:creatinine clearance ratio in patients suffering from acute pancreatitis or acute duodenal perforation was higher than normal in both groups of patients. These findings cast doubt on the value of this parameter as a specific index of acute pancreatitis. The mechanism or mechanisms underlying the increased amylase excretion have not been determined. However, the markedly elevated urinary excretion of lysozyme observed in some patients suggests, by analogy, that diminished tubular reabsorption of amylase may contribute towards the elevated amylase:creatinine ratio.

  4. Perforated Jejunal Diverticula Secondary to a Large Faecolith: A Rare Cause of the Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Peter John Webster

    2014-01-01

    Full Text Available Jejunal diverticula are uncommon and usually asymptomatic. Very rarely, they can lead to acute complications such as bleeding, obstruction, and perforation. This report describes our experience of a case of jejunal diverticula perforation secondary to a large faecolith, with particular focus on the aetiology and management of this rare condition.

  5. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    Energy Technology Data Exchange (ETDEWEB)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro [Centro Hospitalar do Porto, Radiology Department, Porto (Portugal); Silva, Donzilia [Centro Hospitalar do Porto, Surgery Department, Porto (Portugal); Peixoto, Carlos [Centro Hospitalar do Porto, Pathology Department, Porto (Portugal)

    2010-10-15

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  6. Reversibility of central neuronal changes in patients recovering from gallbladder stones or acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Daniel W Kjaer; Marek Stawowy; Lars Arendt-Nielsen; Asbjφrn Mohr Drewes; Peter Funch-Jensen

    2006-01-01

    AIM: To investigate the referred pain area in patients 2-7 years after cholecystectomy in order to test the hypothesis that neuroplastic changes could give rise to post cholecystectomy pain.METHODS: Forty patients were tested. Twenty five were cholecystectomized due to uncomplicated gallbladder stones and 15 because of acute cholecystitis. Sensitivity to pinprick, heat, cold, pressure and single and repeated electrical stimulation was studied both in the referred pain area and in the control area on the contra lateral side of the abdomen.RESULTS: Five patients still intermittently suffered from pain. But in the objective test of the 40 patients, no statistical significant difference was found between the referred pain area and the control area.CONCLUSION: This study does not support the hypothesis that de novo neuroplastic changes could develop several years after cholecys-tectomy.

  7. Human gallbladder pressure and volume: validation of a new direct method for measurements of gallbladder pressure in patients with acute cholecystitis

    DEFF Research Database (Denmark)

    Borly, L; Højgaard, L; Grønvall, S;

    1996-01-01

    Increased gallbladder (GB) pressure is probably a part of the pathogenesis of acute cholecystitis, and measurements of GB pressure might therefore be of interest. The aim of this study was to validate a microtip pressure transducer for intraluminal GB pressure measurements. In vitro precision...... and accuracy was within 0.2 mmHg, (SD) and 0.6 +/- 0.1 mmHg (mean +/- SD), respectively. Pressure rise rate was 24.8 +/- 5.5 mmHg s-1. Zero drift was in the range 0.3 +/- 0.4 to 0.8 +/- 0.9 mmHg (mean +/- SD). GB pressure was investigated in 16 patients with acute cholecystitis treated with percutaneous...

  8. Acute primary haemorrhagic omental torsion mimicking perforated appendicitis: an unorthodox surgical paradox.

    Science.gov (United States)

    Rehman, Abdul

    2014-08-01

    Acute primary haemorrhagic omental torsion is an atypical and deceptive cause of acute abdomen that could closely mimic a myriad of intra-abdominal catastrophes, especially perforated appendicitis. The author reports a 30 years man who had presented with gradually worsening right-sided abdominal pain of 2 days duration. Laboratory work-up and abdominal radiographs were inconclusive. Abdominal sonography detected presence of free fluid in the pelvic cul-de-sac. Based on clinical and sonographic findings, presumptive diagnosis of perforated appendicitis was made and the patient was explored through extended Rockey-Davis incision. About 500 - 700 ml of dark-coloured blood (haemoperitoneum) was present in the peritoneal cavity and the pelvis secondary to acute haemorrhagic omental torsion. The appendix was grossly normal. Omentectomy and prophylactic appendicectomy resulted in uneventful recovery of the patient. Acute primary omental torsion is an uncommon pathology that must be kept in mind during differential diagnosis of acute abdomen, especially acute or perforated appendicitis.

  9. Peptic ulcer in the gallbladder. A case report

    DEFF Research Database (Denmark)

    Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

    1985-01-01

    Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented.......Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

  10. Gallbladder Cancer

    Science.gov (United States)

    ... your gallbladder and liver to your small intestine. Cancer of the gallbladder is rare. It is more ... the abdomen It is hard to diagnose gallbladder cancer in its early stages. Sometimes doctors find it ...

  11. Acute gastric ulcer perforation in a 35 weeks' nulliparous patient with gastric banding.

    Science.gov (United States)

    Erez, Offer; Maymon, Eli; Mazor, Moshe

    2004-11-01

    We present a case of a primiparous patient at 35 weeks' gestation who had had laparoscopic gastric banding, and who presented to labor and delivery with protracted vomiting followed by an acute abdomen and fetal distress. An emergency surgery revealed acute gastric ulcer perforation. This complication, although rare, should be considered.

  12. Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

    Science.gov (United States)

    Shapey, IM; Nasser, T; Dickens, P; Haldar, M; Solkar, MH

    2012-01-01

    Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required. PMID:23131215

  13. Case report of idiopathic cecal perforation presenting as acute appendicitis on ultrasound

    Directory of Open Access Journals (Sweden)

    Calista Harbaugh

    2016-08-01

    Full Text Available Cecal perforation is an uncommon phenomenon in a pediatric population. It has been linked to a number of underlying medical conditions, which may result in focal inflammation or relative ischemia including hematologic malignancy, infection, and inflammatory bowel disease. We present an otherwise healthy 16-year-old male diagnosed with acute uncomplicated appendicitis on ultrasound, who was found to have cecal perforation with normal appendix intraoperatively, ultimately requiring ileocectomy. With this report, we aim to present the numerous pathophysiologic etiologies of cecal perforation, and to promote a comprehensive differential diagnosis despite the clinical and radiologic findings consistent with uncomplicated appendicitis.

  14. Perforated duodenal ulcer a rare cause of acute abdomen in infancy: A report of two cases

    Directory of Open Access Journals (Sweden)

    Kadian Yogender

    2008-01-01

    Full Text Available Duodenal ulcer perforation is very uncommon in infants and children, that is why it is not usually considered in the differential diagnosis of acute abdomen in this age group. Moreover, the diagnosis of this condition is usually overlooked because of vague and variable symptoms and low index of suspicion on the part of the treating physicians. In this brief report, we are reporting two cases of successfully managed perforated duodenal ulcer in infancy.

  15. Influence of delays on perforation risk in adults with acute appendicitis.

    LENUS (Irish Health Repository)

    Kearney, D

    2012-02-03

    PURPOSE: This study analyzed whether prehospital or in-hospital delay was the more significant influence on perforation rates for acute appendicitis and whether any clinical feature designated patients requiring higher surgical priority. METHODS: A retrospective analysis was conducted over one year at a tertiary referral hospital without a dedicated emergency surgical theater. Admission notes, theater logbook, and the Hospital Inpatient Enquiry system were reviewed to identify the characteristics and clinical course of patients aged greater than 16 years who were operated upon for histologically confirmed acute appendicitis. RESULTS: One hundred and fifteen patients were studied. The overall perforation rate was 17 percent. The mean duration of symptoms prior to hospital presentation was 38.1 hours with the mean in-hospital waiting time prior to operation being 23.4 hours. Although body temperature on presentation was significantly greater in patients found to have perforated appendicitis (P < 0.05), only patient heart rate at presentation and overall duration of symptoms, but not in-hospital waiting time, independently predicted perforation by stepwise linear regression modeling. CONCLUSION: In-hospital delay was not an independent predictor of perforation in adults with acute appendicitis although delays may contribute if patients are left to wait unduly. Tachycardia at presentation may be a quantifiable feature of those more likely to have perforation and who should be given higher surgical priority.

  16. The research progress of acute small bowel perforation

    Institute of Scientific and Technical Information of China (English)

    Rudolf Schiessel

    2015-01-01

    This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multiorgan failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  17. The research progress of acute small bowel perforation

    Directory of Open Access Journals (Sweden)

    Rudolf Schiessel

    2015-08-01

    Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  18. [Gallbladder diaphragm: an unusual cause of acute alithiasic cholecystitis complicated of biliary peritonitis].

    Science.gov (United States)

    Abid, M; Mzali, R; Feriani, N; Derbel, R; Frikha, F; Ben Amar, M; Beyrouti, M I

    2010-09-01

    The gallbladder diaphragm is a very rare abnormality of the embryogenesis. It is an exceptional cause of biliary peritonitis. We report a 54-year-old man who presented with hepatic colic for the past 2 years. Imaging disclosed evidence of alithiasic cholecystitis on gallbladder diaphragm. The coelioscopic exploration confirmed the diagnosis and an associated presence of a biliary peritonitis. A cholecystectomy and a peritoneal washing were performed. The histological examination ruled in the diagnosis of cholecystitis on gallbladder diaphragm. The embryogenesis, the histological and morphological features as well as the treatment are discussed.

  19. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Toshihiro Kitai

    2014-01-01

    Full Text Available Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  20. Perforated jejunal diverticulitis as a rare cause of acute abdomen

    Energy Technology Data Exchange (ETDEWEB)

    Peters, R.; Grust, A.; Fuerst, G. [Department of Radiology, Heinrich-Heine-University, Duesseldorf (Germany); Gerharz, C.D. [Department of Pathology, Heinrich-Heine-University, Duesseldorf (Germany); Dumon, C. [Department of Surgery, Heinrich-Heine-University, Duesseldorf (Germany)

    1999-09-01

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. (orig.) With 3 figs., 13 refs.

  1. A Rare Cause of Acute Abdomen: Jejunal Diverticulosis with Perforation

    Directory of Open Access Journals (Sweden)

    Ibrahim Aydin

    2013-01-01

    Full Text Available Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis.

  2. Spontaneous uterine perforation of pyometra presenting as acute abdomen.

    Science.gov (United States)

    Kitai, Toshihiro; Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  3. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

    Directory of Open Access Journals (Sweden)

    Bakhshaeekia Alireza

    2009-01-01

    Full Text Available Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.

  4. Congenital duplication of the gallbladder.

    Science.gov (United States)

    Safioleas, Michael C; Papavassiliou, Vassilios G; Moulakakis, Konstantinos G; Angouras, Dimitrios C; Skandalakis, Panagiotis

    2006-03-01

    Duplication of the gallbladder is a rare congenital anomaly of the biliary system. In this article, two cases of gallbladder duplication are presented. The first case is a patient with double gallbladder and concomitant choledocholithiasis. The probable diagnosis of double gallbladder was made preoperatively by computed tomography. The patient underwent a successful open cholecystectomy and common bile duct exploration. In the second case, two cystic formations in the place of gallbladder are demonstrated with ultrasound scan in a woman with acute cholecystitis. At surgery, two gallbladders were found. A brief review of epidemiology and anatomy of double gallbladder is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.

  5. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    Science.gov (United States)

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi; Imai, Atsushi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

  6. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    Directory of Open Access Journals (Sweden)

    Takahiro Yamada

    2015-01-01

    Full Text Available Gastrointestinal (GI perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

  7. Gallbladder duplication

    Directory of Open Access Journals (Sweden)

    Yagan Pillay

    2015-01-01

    Conclusion: Duplication of the gallbladder is a rare congenital abnormality, which requires special attention to the biliary ductal and arterial anatomy. Laparoscopic cholecystectomy with intraoperative cholangiography is the appropriate treatment in a symptomatic gallbladder. The removal of an asymptomatic double gallbladder remains controversial.

  8. A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation

    Science.gov (United States)

    Huang, Yuan-Chun; Cheng, Ching-Yuan; Liao, Chiung-Ying; Hsueh, Ching; Tyan, Yeu-Sheng; Ho, Shang-Yun

    2017-01-01

    Patient: Female, 60 Final Diagnosis: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess • esophageal perforation Symptoms: Fever • painful swallowing • chest pain Medication: — Clinical Procedure: Drainage • debridement • esophageal reconstruction Specialty: Surgery Objective: Rare disease Background: Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. Case Report: A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days. She had a past history of uncontrolled type 2 diabetes mellitus. On physical examination, general weakness, chest pain, odynophagia, and a fever up to 38.9°C were found. Positive laboratory findings included leukocytosis (leukocyte count of 14.58×103/μL, neutrophils 76.8%) and serum glucose 348 mg/dL (HbA1c 11.3%). A diagnosis of acute phlegmonous esophagogastritis with hypopharyngeal abscess was made based on typical computed tomography image features and clinical signs of infection. The patient received empirical antibiotic therapy initially; however, esophageal perforation with mediastinitis and empyema developed after admission. Emergency surgery with drainage and debridement was performed and antibiotics were administered. She was discharged in a stable condition on the 56th day of hospitalization. Six months later, a delayed esophageal reconstruction was performed. The patient has performed well for 9 months to date since the initial diagnosis. Conclusions: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess and esophageal perforation is extremely rare, and requires immediate medical

  9. Ileum perforation due to accidental chicken bone ingestion a rare cause of the acute abdomen

    Directory of Open Access Journals (Sweden)

    Doklestić Krstina S.

    2012-03-01

    Full Text Available Ingestion of foreign bodies is not an uncommon occurrence, but most of them will pass through the gastrointestinal tract without consequences. Complication such as perforation is rare. We present a case of small bowel perforation secondary to the accidental ingestion of a chicken bone. The patient presented with abdominal pain, constipation and vomiting. Clinical examination confirmed generalized abdominal tenderness and rebound tenderness. Abdominal radiography showed multiple dilated loops of small bowel, and abdominal ultrasound (US showed inflammatory changes on small bowel loops, with free fluid and fluid collection around intestinal loops. The patient underwent an emergency laparotomy. Intra operative findings revealed diffuse fibro purulent peritonitis with abscess between central small bowels loops. At about 60 cm from Bauchini valve we found a perforation of ileum at the anti-mesenteric site caused by a sharp chicken wishbone. The patient was treated with resection of the ileum segment (10 cm and primary end-to-end anastomosis. Even that intestinal perforation by a foreign body is rare, physicians should consider possibility of intestinal perforation by a foreign body in the differential diagnosis of acute abdomen in patients presenting with abdominal pain.

  10. Acute effect of smoking on gallbladder emptying and refilling in chronic smokers and nonsmokers: A sonographic study

    Institute of Scientific and Technical Information of China (English)

    Bumin Degirmenci; Ramazan Albayrak; Alpay Haktanir; Murat Acar; Aylin Yucel

    2006-01-01

    AIM: To ultrasonographicaly evaluate the acute effects of smoking on gallbladder contraction and refilling in chronic smokers and nonsmokers.METHODS: Fifteen chronic smokers (21-30 years old) and fifteen nonsmokers (21-35 years old) participated in this study. Chronic smokers were selected among the volunteers who had been smoking for at least 5 years and 10 cigarettes per day (mean 17.5/d). Examinations were performed in two separate days. In the first day, basal gallbladder (GB) volumes of volunteers were measured after 8-h fasting. After the examinations, participants had a meal containing at least 30-40 gram fat. Gallbladder volume was assessed at 5, 15, 30, 60, 120 and 180 min after the meal. In the second day, participants smoked 2 cigarettes after 8-h fasting. Then,they had the same meal, and gallbladder measurements were repeated at the same time points. Same procedures were applied to both groups.RESULTS: The mean starving GB volumes were 23.3± 3.3 mL in the first day, 21.9 ± 3.0 mL in the second day in nonsmoker group and 18.3 ± 3.0 mL in the first day, 19.5 ± 2.8 mL in second day in smoker group.There was no significant difference between starving GB volumes. We did not find any significant difference between the GB volumes measured at 5, 15, 30, 60, 120and 180 min in the first and second days in nonsmoker group. In smokers, post cigarette GB volume was found significantly higher at 5, 15 and 30 min which corresponded to GB contraction phase (P < 0.05).Control GB volume measurements were not significantly different between the two groups. Post-smoking GB volumes were also not significantly different between the two groups.CONCLUSION: Smoking prolongs the maximal GB emptying time both in smokers and in nonsmokers though it is not significant. It delays GB contraction in chronic smokers and causes a significant decrease in GB emptying volume. Smoking causes no significant delay in GB refilling in both smokers and nonsmokers. These effects of smoking

  11. Porcelain Gallbladder

    Science.gov (United States)

    Machado, Norman O.

    2016-01-01

    Gallbladder calcification, also referred to as porcelain gallbladder, has received significant attention in the medical literature due to its perceived role in increasing the risk of developing a gallbladder carcinoma. However, recent reports raise questions challenging this purported high risk. While previous studies reported a concomitant incidence of gallbladder cancer in porcelain gallbladder ranging from 7–60%, more recent analyses indicate the incidence to be much lower (6%). Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients. However, it is important to note that a nonoperative approach may require prolonged follow-up. A laparoscopic cholecystectomy is a feasible therapeutic option for patients with porcelain gallbladder, although some researchers have indicated a higher incidence of complications and conversion due to technical difficulties. PMID:28003886

  12. Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality.

    Science.gov (United States)

    Yin, Wan-Bin; Wei, Yan-Hua; Liu, Guang-Wei; Zhao, Xiao-Tang; Zhang, Mao-Shen; Hu, Ji-Lin; Zhang, Nan-Yang; Lu, Yun

    2016-04-01

    Pyometra is an uncommon and potentially lethal disease that occurs mainly in postmenopausal women. Spontaneous perforation of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, and the patients are always admitted to the emergency department. An additional case is reported herein. In addition, a literature review was performed between 1949 and 2015. A correct preoperative diagnosis was made in 21.05% of all the cases. Of all cases, 25.71% were associated with malignant disease. The mortality rate of spontaneous perforation of pyometra is 31.88%. Thus, it should be considered in the differential diagnosis of acute abdomen in elderly women. Total hysterectomy along with bilateral salpingo-oophorectomy is the preferred treatment. Administration of broad-spectrum antibiotics and postoperative intensive care support are essential to reduce the high mortality.

  13. EVALUATION OF HYPERBILIRUBINAEMIA AS A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS ROLE IN THE PREDICTION OF APPENDICULAR PERFORATION

    Directory of Open Access Journals (Sweden)

    Lalit Kumar Regar

    2016-07-01

    Full Text Available BACKGROUND There are various investigations recommended to diagnose acute appendicitis; however, till date there is no confirmatory laboratory marker to diagnose preoperatively acute appendicitis & appendicular perforation. The purpose of study is to evaluate hyperbilirubinaemia as a new diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation. Preoperative assessment of serum bilirubin appears to be a promising new laboratory marker for diagnosing acute appendicitis & have a predictive potential for the diagnosis of appendicular perforation. METHODS A prospective analytical study of 100 cases comprising of a non-randomised cohort. RESULTS Hyperbilirubinaemia was found in most of the patients diagnosed with acute appendicitis (68.23% or appendicular perforation (73.33%. The mean total bilirubin level in patients diagnosed with acute appendicitis was 1.34 mg% while in patients diagnosed with appendicular perforation was 2.12 mg%. CONCLUSIONS Preoperative assessment of serum bilirubin should be routinely performed in cases of acute appendicitis as it can help in diagnosis of acute appendicitis as well as also serve as an important maker of acute gangrenous appendicitis.

  14. Pain patterns after distension of the gallbladder in patients with acute cholecystitis

    DEFF Research Database (Denmark)

    Middelfart, H V; Jensen, P; Højgaard, L;

    1998-01-01

    BACKGROUND: Visceral pain is characterized by poor pain localization and a referred or radiating pain pattern. Its clinical importance in the abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better understanding of sympt......BACKGROUND: Visceral pain is characterized by poor pain localization and a referred or radiating pain pattern. Its clinical importance in the abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better understanding...... of symptoms arising from the gallbladder and the underlying pathophysiology is therefore desirable. The aim of the present study was consequently primarily to characterize the symptom patterns after distension of the gallbladder. Secondary aims were to describe the pressure-volume relation in the gallbladder...... were performed. After each injection of saline the localization of pain and the presence of nausea and vomiting were registered. The injections continued until the patient felt abdominal pain necessitating cessation of the investigation or until the cystic duct opened (visualized on cholescintigraphy...

  15. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Institute of Scientific and Technical Information of China (English)

    Michael J Forster; Jacob A Akoh

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  16. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    Science.gov (United States)

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  17. INCIDENCE, RISK FACTORS AND COMPLICATIONS OF ACUTE PERFORATED AND NON - PERFORATED APPENDICITIS IN A RURAL SETUP OF ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Anil Kumar

    2015-05-01

    Full Text Available Appendicitis is one of the most common surgical emergencies. The incidence of appendicitis and chances of complication in the form of perforation are dependent on both the patients and non - patient factors . There are various studies conducted to address this problem, but there are no studies conducted to look in to the incidence of appendicitis in east Godavari district of Andhra Pradesh. Our study was aimed to bridge thi s gap. METHOD S AND MATERIALS: this was a retrospective study, patient data from 2009 - 2014 was analyzed and the age, distance from hospital, educational and socioeconomic background of the patients was collected. The duration between first appearance of sy mptoms and hospitalization was recorded. The incidence of post - op complication was also recorded. RESULTS: T he incidence of perforation was 15% in our study population, most of the patients were from low socioeconomic group and having income less than 5000 /month. The middle age group between 30 - 40 years was commonly affected by the appendicitis. The time laps between appearance of symptoms and hospitalization was found to be a predominant factor in the perforation. Surgical site infection was most common co mplication in the patients treated. CONCLUSION: T he incidence of perforation is still high and the time laps between first appearance of symptoms and hospitalization is a major determinant of perforation or complication in the appendicitis.

  18. Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

    Directory of Open Access Journals (Sweden)

    Niv G

    2013-04-01

    Full Text Available Galia Niv,1 Tamar Grinberg,2 Ram Dickman,3 Nir Wasserberg,4 Yaron Niv1,3 1Risk Management and Quality Assurance, 2Emergency Department, 3Department of Gastroenterology, 4Department of Surgery B, Rabin Medical Center, Beilinson Hospital and Tel Aviv University, Tel Aviv, Israel Objectives: Constipation is a common complaint, frequently treated with cleansing enema. Enemas can be very effective but may cause serious adverse events, such as perforation or metabolic derangement. Our aim was to evaluate the outcome of the use of cleansing enema for acute constipation and to assess adverse events within 30 days of therapy. Methods: We performed a two-phase study: an initial retrospective and descriptive study in 2010, followed by a prospective study after intervention, in 2011. According to the results of the first phase we established guidelines for the treatment of constipation in the Emergency Department and then used these in the second phase. Results: There were 269 and 286 cases of severe constipation in the first and second periods of the study, respectively. In the first study period, only Fleet® Enema was used, and in the second, this was changed to Easy Go enema (free of sodium phosphate. There was a 19.2% decrease in the total use of enema, in the second period of the study (P < 0.0001. Adverse events and especially, the perforation rate and the 30-day mortality in patients with constipation decreased significantly in the second phase: 3 (1.4% versus 0 (P = 0.0001 and 8 (3.9% versus 2 (0.7% (P = 0.0001, for perforation and death in the first and second period of the study, respectively. Conclusion: Enema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully. Perforation, hyperphosphatemia (after Fleet Enema, and sepsis may cause death in up to 4% of cases. Guidelines for the treatment of acute constipation and for enema administration are urgently needed. Keywords

  19. ACUTE PERFORATED PEPTIC ULCER: A CLINICAL, DIAGNOSTIC AND MANAGEMENT ANALYSIS IN A TERTIARY HOSPITAL OF TELANGANA

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    Boda

    2015-12-01

    Full Text Available Treatment of Peptic Ulcer Disease in major hospitals is now limited to managing their complications like perforations of stomach or duodenum. This is also a common cause of peritonitis and remains a challenge to the surgeon. Diagnosis is based on clinical parameters like pain in the abdomen, shock, abdominal guarding/rigidity and abdominal distension. The diagnosis is confirmed by ultrasound examination of the abdomen, x-ray abdomen in erect posture. The predisposing factors include the age, smoking, alcohol intake, steroids and NSAIDs usage. The risk factors of mortality are presence of shock and pre-existing medical conditions and time of arrival to the casualty. The mortality and morbidity may be predicted using different scoring systems like ASA scoring and Boey’s scoring. AIM To analyze the different risk factors, clinical features and surgical treatment options of Acute Peptic Ulcer perforation in patients attending a Tertiary Hospital. To evaluate the prognostic factors causing death and complications in this condition. MATERIALS AND METHODS One hundred and sixty five patients attending with signs and symptoms of Acute Perforation of Peptic Ulcer were included. Males were predominantly affected than females with a 1.94:1 ratio. The median duration of illness was 9.64 days. History of smoking in 93.5%, NSAIDs in 78%, alcohol intake in 93.8% and steroids in 84% of the patients was present. Previous history of peptic ulcer disease was reported in 90% of the patients. Gastric ulcers were more common than with duodenal ulcer with a ratio of 1.32:1. The mortality rate was 6.66%. Among the complications wound infection was highest with 26% followed by paralytic ileus 23%. ASA and Boey’s scoring showed statistical significance in predicting the mortality with a P value of 0.00003. RESULTS The incidence of APPU was 0.35% of the total 46080 emergency surgical patients in a 4-year period. The incidence was high among the manual laborers and in

  20. Realtime ultrasonographic findings in gallbladder carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Y. T.; Woo, S. K.; Suh, I. J.; Lim, J. H.; Kim, H. K.; Kim, S. Y.; Ahn, C. Y. [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2010-05-15

    It is well known that realtime ultrasonography is the primary diagnostic modality to evaluate gallbladder diseases. The authors studied ultrasonographic findings of 10 pathologically proven gallbladder carcinoma patients, and it was compared with the findings of 4 cases of ERCP and 2 cases of CT which were performed at the same period. The results were as follows: 1. They were 6 males and 4 females with over 50 years of age except a 41 year old female. 2. The ultrasonographic classifications of the cases were 4 of fungating mass types, 3 of mass filling gallbladder types, 2 wall thickening types and 1 of mixed type, wall thickening and fungating mass. 3. Seven cases of cholecystitis, 6 cases of intrahepatic biliary duct dilatation, 5 cases of gallstone, 4 cases of common bile duct dilatation, 4 cases of sludge bile, 2 cases of gallbladder dilatation, 1 case of right sub phrenic and pericholecystic abscess due to perforated gallbladder. 4. Five cases of mesenteric infiltrations, 3 cases of hepatic infiltration adjacent to gallbladder, 2 cases of lymphatic metastasis to right lobe of liver and 2 cases of pericholedochal and pericaval lymph node metastasis. 5. The indistinct margin between gallbladder and surrounding organ adjacent to gallbladder mass or gallbladder wall thickening suggest cancer infiltration to adjacent organ such as liver or omentum. 6. If gallstone is engulfed in thickened gallbladder wall, the wall thickening suggests gallbladder carcinoma. 7. The differentiation between fungating mass and sludge bile, and the determination of mass could be done by positional change. 8. The preoperative ultrasonic diagnositc accuracy was in 9 out of 10 cases (90%). 9. Because of the frequent cystic duct obstruction by associated inflammation, the diagnostic accuracy of ERCP for gallbladder carcinoma was low.

  1. Primary resection with and without anastomosis for perforation of acute diverticulitis.

    Science.gov (United States)

    Saccomani, G E; Santi, F; Gramegna, A

    1993-01-01

    The results of management of perforated large bowel diverticulitis were retrospectively studied over a 7-year period. 38 patients underwent operation, 20 for generalized peritonitis, 12 for local peritonitis, 5 for colovesical fistula and 1 for colovaginal fistula. The mean age of patients was 63 years (range 30-85 years). Depending on the symptoms, the spreading of the peritonitis and associated cardiovascular and pulmonary disease and diabetes mellitus, 4 types of operation were performed: primary left hemicolectomy and anastomosis with and without defunctioning colostomy, Hartmann procedure, suture and drainage with diverting colostomy. The overall mortality was 10.5%: resection and primary anastomosis entailed 3.8% mortality (1 case), while 3 deaths were observed in the 8 patients group having underwent an Hartmann procedure (37.5%). Drainage and/or diverting colostomy performed in 5 patients entailed no hospital mortality, but was followed by a 80% complication rate, requiring reoperation and several hospital admissions. The low mortality and morbidity rates obtained in the group having primary resection and anastomosis encourage wider application of this operation for perforated acute diverticulitis. Even the Hartmann procedure allows removal of the diseased colon but in a great proportion of cases reconstitution of continuity is not performed; nevertheless staged operation entailing major mortality and morbidity, expose these aged patients to remarkable hazard. Prerequisite of safe primary excision and anastomosis is vigorous intraperitoneal lavage and drainage, by the case associated to on table large bowel irrigation if concomitant obstruction is present.

  2. Peritonitis Aguda por Diverticulo Apendicular Perforado / Acute perforated diverticulum appendiceal peritonitis

    Directory of Open Access Journals (Sweden)

    Martinez Villalba N

    2015-11-01

    Full Text Available Appendix diverticular disease is a casual finding after appendectomies or pathological studies of surgical samples. Most patients are male adults between the fourth and fifth decade of life. 16 years old male consults for a 48 hours stitch pain in right iliac fossa of moderate intensity radiating to lower abdomen with nausea and fever, without vomiting or diarrhea. Presents lower abdominal pain with muscle guarding and pain on physical examination. Bowel sounds negative. Laboratory routine study shows leukocytosis with neutrophilia. A perforated diverticulum of about 15cm diameter is found during surgery in the middle third of the cecum appendix with 200cc purulent fluid in and multiple adhesions to transverse colon, omentum and small intestine. A conventional appendectomy is performed. Acute appendix diverticulitis is a rare entity and its finding is by casualty. It is important to consider it a differential diagnosis especially in the intraoperative treatment which in most cases does not differ from conventional appendectomy.

  3. Spontaneous Perforation of Common Bile Duct in a Child with a Clinical Manifestation of Acute Abdominal Distension: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Rok; Namkyung Sook; Kim, Heung Cheol; Hong, Myung Sun [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2011-09-15

    Spontaneous perforation of common bile duct (CBD) is extremely rare in children, but potentially a fatal disorder that requires an emergency laparotomy. Most of the patients present with insidious symptoms including slowly progressive abdominal distension with accumulation of the ascites, fluctuating mild jaundice, and clay-colored stools. We report a case of surgically confirmed spontaneous perforation of the CBD in a 3-year-old girl who presented with acute abdominal distension with no biliary symptoms or signs, and who showed imaging findings consistent with anomalous pancreaticobiliary ductal union with a focal stenosis in the CBD.

  4. Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

    Science.gov (United States)

    Lim, Siew Fung; Lee, Song Liang; Chiow, Adrian Kah Heng; Foo, Chek Siang; Wong, Andrew Siang Yih; Tan, Su-Ming

    2012-01-01

    Summary Background: The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide. Case Report: We report 2 cases of spontaneously perforated pyometra in our hospital’s general surgery department. Both underwent exploratory laparotomy: one had a total hysterectomy and bilateral salpingo-oophorectomy, while the other had an evacuation of the uterine cavity, primary repair of uterine perforation and a peritoneal washout. A literature search was conducted and all reported cases reviewed in order to describe the clinical presentations and management of the condition. Of the 40 cases to date, including 2 of our cases, the most common presenting symptoms were abdominal pain (97.5%), fever (37.5%) and vomiting (25.0%). The main indication for exploratory laparotomy was pneumoperitoneum (97.5%). Conclusions: Pyometra is an unusual but serious condition in elderly women presenting with an acute abdomen. A high index of suspicion is needed to make the appropriate diagnosis. PMID:23569488

  5. Gallbladder carcinoid masquerading as gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Mallika Tewari; Vinay Kumar; Raghvendra Raman Mishra; Hari S Shukla

    2009-01-01

    BACKGROUND: Carcinoid of the gallbladder is rare. Since it often presents as a gallbladder mass it may be confused with gallbladder carcinoma. METHODS: A 35-year-old lady presented with pain in the right upper abdomen, and was radiologically found to have a gallbladder mass. A provisional diagnosis of gallbladder carcinoma was made. Laparotomy revealed a 20×20 cm, exophytic, friable growth arising from the fundus of the gallbladder. It was excised with segmentⅣb andⅤ of the liver and regional lymphadenectomy. RESULT: Histopathological examination revealed it was a neuroendocrine carcinoma, atypical carcinoid of the gallbladder. CONCLUSION: Gallbladder carcinoid has a poor outcome, requires aggressive treatment, and should be considered as one of the rare but possible gallbladder lesions.

  6. Gallbladder removal - open

    Science.gov (United States)

    Cholecystectomy - open; Surgery - gallbladder - open ... a medical instrument called a laparoscope ( laparoscopic cholecystectomy ). Open gallbladder surgery is used when laparoscopic surgery cannot ...

  7. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis.

    Science.gov (United States)

    Sagrini, Elisabetta; Pecorelli, Anna; Pettinari, Irene; Cucchetti, Alessandro; Stefanini, Federico; Bolondi, Luigi; Piscaglia, Fabio

    2016-02-01

    Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

  8. Torsion of Wandering Gallbladder following Colonoscopy

    Directory of Open Access Journals (Sweden)

    Sean R. Warfe

    2013-01-01

    Full Text Available Torsion of the gallbladder is an uncommon condition that may present as an acute abdomen. Its preoperative diagnosis can often be challenging due to its variable presentation, with specific sonographic signs seen infrequently. We describe, to our knowledge, the first case of torsion of a wandering gallbladder following a colonoscopy in a 69-year-old female who presented with acute abdominal pain after procedure. This was discovered intraoperatively, and after a subsequent cholecystectomy, she had an uncomplicated recovery.

  9. High cytokine levels in perforated acute otitis media exudates containing live bacteria.

    Science.gov (United States)

    Skovbjerg, S; Roos, K; Nowrouzian, F; Lindh, M; Holm, S E; Adlerberth, I; Olofsson, S; Wold, A E

    2010-09-01

    Acute otitis media (AOM) is an inflammatory response to microbes in the middle ear, sometimes associated with rupture of the tympanic membrane. Human leukocytes produce different patterns of inflammatory mediators in vitro when stimulated with Gram-positive and Gram-negative bacteria, respectively. Here, we investigated the cytokine and prostaglandin E2 (PGE2) responses in middle ear fluids (MEFs) from children with spontaneously perforated AOM, and related the mediator levels to the presence of pathogens detected by culture (live) or PCR (live or dead). Furthermore, the in vivo cytokine pattern was compared with that induced in leukocytes stimulated by dead bacteria in vitro. MEFs with culturable pathogenic bacteria contained more interleukin (IL)-1β (median: 110 μg/L vs. bacteria. Cytokine levels were unrelated to bacterial species and to the presence or absence of virus. Similar levels of TNF and IL-6 as found in the MEFs were obtained by in vitro stimulation of leukocytes, whereas 11 times more IL-1β and 3.5 times more IL-8 were produced in vivo, and 22 times more IL-10 was produced in vitro. Vigorous production of proinflammatory cytokines accompanies AOM with membrane rupture, regardless of the causative agent, but the production seems to cease rapidly once the bacteria are killed and fragmented. IL-6 and PGE2, however, remain after bacterial disintegration, and may play a role in the resolution phase.

  10. Gallbladder tuberculosis: case report

    Institute of Scientific and Technical Information of China (English)

    余日胜; 刘奕青

    2002-01-01

    @@ Abdominal tuberculosis is common in developing countries, but gallbladder involvement is extremely rare. The diagnosis of gallbladder tuberculosis is often not suspected prior to surgery or biopsy.This paper describes the CT and ultrasonographic features of gallbladder tuberculosis in a 35-year-old patient and reviews the literature of gallbladder tuberculosis.

  11. A CALCULUS CHOLECYSTITIS PERFORATING AT THE NECK

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    Jayashri

    2014-08-01

    Full Text Available Gallbladder perforation is a rare complication of cholecystitis and cholelithiasis. The high morbidity and mortality rates associated with this condition are due to delays in diagnosis and treatment since signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. We report a case of 17 year old boy who presented with perforation at the neck of gall bladder with extrusion of a stone. It was associated with bile infected with S. typhi.

  12. Bacteriological examination of gallbladder contents

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    Petaković Goran

    2002-01-01

    Full Text Available Introduction Acute calculous (obstructive cholecystitis develops as a consequence of cystic obstruction and obstruction of bile flow into choledochus. Most often it is a result of impacted gallstones in Hartman's pouch or the cystic duct. Their direct pressure on gallbladder mucosa causes ischemia, necrosis and ulceration with consequential wall edema and obstructed venous flow. This mechanism is further increasing and spreading the inflammatory process. Ulcerations may be that extensive, that mucosa is highly recognizable on the microscopic preparation. Leukocyte infiltration of all segments occurs. Results of necrosis are as follows: perforation with pericholecystic abscess formation, fistulization or biliary peritonitis. Aim The aim of this investigation was to use microbial sensitivity tests in order to establish possibilities of antibiotic therapy in patients with acute cholecystitis. Material and methods Using random sampling a total of 240 patients with acute cholecystitis were included in the investigation. They were all treated at the Clinic of Abdominal and Endocrine Surgery of the Clinical Center Novi Sad in the period 1997-1999. All patients underwent bacteriological examination and were coherent in regard to sex and age. Microbial sensitivity tests analyzed two groups of bacteria: Group I Escherichia coli, Klebsiella and Staphylococcus and Group II: other isolated bacteria (Citrobacter, Enterobacter, Enterococcus, Proteus, Pseudomonas Serratia and Streptococcus. Results In our material Escherichia coli was isolated in most patients - 32 (55.17%, Klebsiella and Staphylococcus in 6 (10.34% patients and Streptococcus in 4 (6.90%, whereas other bacteria were infrequent (Citrobacter and Serratia in 3.45%, Enterobacter, Proteus and Pseudomonas in 1.75%. Thus, E. coli, Klebsiella and Staphylococcus were established in 75.85% of bacteriologic findings, and all the rest in 24.15%. Assessment regarding premedication with antibiotics started

  13. Central vein perforation during tunneled dialysis catheter insertion: principles of acute management.

    Science.gov (United States)

    Pua, Uei

    2014-10-01

    Central venous perforation during dialysis catheter insertion is a potentially fatal complication. Prompt recognition and judicious initial steps are important in optimizing the outcome. The purpose of this manuscript is to illustrate the imaging features and steps in initial management.

  14. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis

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    Mushira Abdulaziz Enani

    2014-01-01

    Full Text Available Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.

  15. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis.

    Science.gov (United States)

    Enani, Mushira Abdulaziz; Alharthi, Bandar N; Dewanjee, Nancy; Bhat, Nadeem A; Fagih, Mosa

    2014-07-01

    Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.

  16. Magnetic Resonance Imaging of the Gallbladder: Spectrum of Abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Elsayes, K.M.; Oliveira, E.P.; Narra, V.R.; EL-Merhi, F.M.; Brown, J.J. [Dept. of Radiology, Univ of Michigan Health Center, Ann Arbor, Michigan (United States)

    2007-07-15

    Various pathologies involving the gallbladder can manifest clinically, producing nonspecific clinical symptoms and making diagnosis difficult and challenging. Real-time sonography is the most widely used diagnostic study for the gallbladder and the primary screening examination of choice. With increasing use of magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP), gallbladder pathology is frequently seen. Understanding the basic patterns of various disease manifestations and appearance on MRI is the key to making an accurate diagnosis. Given its inherent tissue contrast and contrast sensitivity, MRI in conjunction with MRCP can be a very valuable test in evaluating gallbladder pathology. Gallbladder pathology can be classified into congenital (such as absence), inflammatory (acute, hemorrhagic, and chronic cholecystitis), traumatic, benign (polyps) and malignant tumors (gallbladder carcinoma and lymphoma), and other disease processes can be seen in cholelithiasis, cholesterosis, thickened gallbladder wall, and Mirrizzi syndrome.

  17. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

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    Tom Eisele

    2016-01-01

    Full Text Available The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

  18. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

    Science.gov (United States)

    Kamata, Ken; Takenaka, Mamoru; Kitano, Masayuki; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-01

    AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction. PMID:28216973

  19. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation

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    Tika Ram Bhandari

    2016-01-01

    Full Text Available Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  20. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation).

    Science.gov (United States)

    Bhandari, Tika Ram; Shahi, Sudha; Poudel, Rajesh; Chaudhary, Nagendra

    2016-01-01

    Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  1. Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort

    NARCIS (Netherlands)

    S. Vennix (Sandra); D.J. Lips; S. Di Saverio (Salomone); B.A. van Wagensveld (Bart); W.J. Brokelman (Walter J.); M.F. Gerhards (Michael); A.A. van Geloven (Anna); S. Van Dieren (Susan); J.F. Lange (Johan); W.A. Bemelman (Willem)

    2016-01-01

    textabstractBackground: Hartmann’s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compare

  2. Management of biliary perforation in children

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    Mirza Bilal

    2010-01-01

    Full Text Available Background: To study the aetiology, management and outcome of biliary perforations in paediatric age group. Patients and Methods: In a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed. Results: Eight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3 patients, had common bile duct (CBD perforation, and Group B (n=5 patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy. In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up. Conclusion: Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

  3. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

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    S. Fosi

    2014-01-01

    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  4. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    Science.gov (United States)

    Fosi, S.; Giuricin, V.; Girardi, V.; Di Caprera, E.; Costanzo, E.; Di Trapano, R.; Simonetti, G.

    2014-01-01

    Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration. PMID:25136471

  5. Color doppler sonography in thickened gallbladder wall

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    Han, Sang Suk; Choi, Seok Jin; Seo, Chang Hae; Eun, Choong Ki [Inje Univ. College of Medicine, Kimhae (Korea, Republic of)

    1996-11-01

    The thickening of the gallbladder wall is a valuable finding for the diagnosis of cholecystitis, but may be seen in non-cholecystic disease as well as in acute or chronic cholecystitis. The purpose of this study is to determine the value of color Doppler sonography in differentiating the causes of thickened gallbladder wall. Ninety eight patients with thickened gallbladder wall(more than 3mm) which was not due to gallbladder cancer were prospectively evaluated with color Doppler sonography. Sixty-six cases, confirmed by pathologic reports and clinical records, were analyzed for correlation between thickened gallbladder wall and color flow signal according to the underlying causes. Of the 66 patients, 28 cases were cholecystitis and 38 cases had non-cholecystic causes such as liver cirrhosis, ascites, hepatitis, pancreatitis, renal failure, and hypoalbuminemia. Of the 28 patients with cholecystitis(12 acute, 16 chronic), 23(82%) had color Doppler flow signals in the thickened gallbladder wall. Of the 38 patients with non-cholecystic causes, eight(21%) had color Doppler flow signals. There was a statistically significant difference of color Doppler flow signals between the cholecystitis and non-cholecystic groups(p=0.0001). No significant difference of color Doppler flow signals was found between cases of acute and chronic cholecystitis. Of the 23 patients with color Doppler flow signals in 28 cases of cholecystitis, 18(78.3%) showed a linear pattern and five(21.7%) showed a spotty pattern. Of the eight patients with color Doppler flow signals in the 38 non-cholecystic cases, four(50%) showed a linear pattern and four(50%) showed a spotty pattern. In cholecystitis, a linear color Doppler flow signal pattern is a much more frequent finding than a spotty pattern. Color Doppler sonography is a useful and adequate method for determining whether a thickened gallbladder wall is the result of cholecystitis or has non-cholecystic causes.

  6. Acute pseudo-obstruction of the large bowel with caecal perforation following normal vaginal delivery: a case report

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    Seenath Marlon

    2010-04-01

    Full Text Available Abstract Introduction Acute pseudo-obstruction of the large bowel following normal vaginal delivery is an extremely rare complication of normal vaginal delivery. It can be fatal if not recognized early. Only one previous report has been found in the English literature. Case presentation A 36-year old Caucasian, normally fit woman presented with abdominal distension and vomiting five days post-normal vaginal delivery at term. Localised peritonitis in the right iliac fossa developed in the next few days, and caecal perforation was found at laparotomy, without evidence of appendicitis or colitis. Conclusion Although very rare, Ogilvie's syndrome should be considered by obstetricians, general surgeons and general practitioners as a potential cause of vomiting and abdominal pain following normal vaginal delivery. Early recognition and management are essential to minimize the possibility of developing serious complications.

  7. Point-of-Care Ultrasound in Necrotizing Acute Pancreatitis Complicated by Perforated Ileum Due to Nonocclusive Mesenteric Ischemia

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    Sonia López-Cuenca

    2016-09-01

    Full Text Available Necrotizing acute pancreatitis is the most severe form of pancreatitis, and it is a potentially life-threatening condition. Its diagnosis and severity are based on radiological signs. Although computed tomography is the most used imaging tool, ultrasound can be a quick and useful technique in emergency and intensive care scenarios. The use of abdominal ultrasound is generally limited to ruling out cholecystitis. Bowel gas can limit the accuracy of pancreatic imaging. When the pancreas is visualized, ultrasound can reveal pancreatic enlargement, echotextural changes, and peripancreatic fluid. We present a patient with necrotizing pancreatitis who developed peritonitis due to ileal perforation, where the use of ultrasound as a bedside imaging technique was very useful.

  8. Perforated peptic ulcer in an adolescent boy with acute appendicitis: a case report

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    Aazam Khorassani

    2013-06-01

    Full Text Available Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

  9. Comparison between cryoablation and irreversible electroporation of rabbit livers at a location close to the gallbladder

    Science.gov (United States)

    Qin, Zilin; Zhou, Liang; Fang, Gang; Chen, Jibing; Li, Jialiang; Niu, Lizhi; Liang, Bing; Xu, Kecheng

    2017-01-01

    Abstract Background The ablation of liver tumors located close to the gallbladder is likely to lead to complications. The aim of this article is to compare the safety and efficacy of irreversible electroporation (IRE) and cryoablation in rabbit livers at a location close to the gallbladder. Materials and methods We performed cryoablation (n = 12) and IRE (n = 12) of the area of the liver close to the gallbladder in 24 New Zealand white rabbits in order to ensure gallbladder damage. Serum aminotransferase and serum bilirubin levels were measured before and after the ablation. Histopathological examination of the ablation zones in the liver and gallbladder was performed on the 7th day after the ablation. Result Seven days after the ablation, all 24 animals were alive. Gallbladder perforation did not occur in the IRE group; only mucosal epithelial necrosis and serous layer edema were found in this group. Gallbladder perforation occurred in four rabbits in the cryoablation group. Serum aminotransferase and serum bilirubin levels obviously increased in both groups by Day 3 and decreased gradually thereafter. The elevation in aminotransferase and bilirubin levels was greater in the cryoablation group than the IRE group. Pathological examination revealed complete necrosis of the liver parenchyma from the ablation center to the gallbladder in both groups, but bile duct and granulation tissue hyperplasia were observed in only the IRE group. Full-thickness gallbladder-wall necrosis was seen in the cryoablation group. Conclusions For ablation of the liver area near the gallbladder, IRE is superior to cryoablation, both in terms of safety (no gallbladder perforation in the IRE group) and efficacy (complete necrosis and rapid recovery in the IRE group).

  10. Treatment of Acute Gastric Ulcer Perforation%胃十二指肠溃疡急性穿孔的治疗体会

    Institute of Scientific and Technical Information of China (English)

    刘海威

    2015-01-01

    Objective To Dinvestigate the clinical treatment of acute gastric ulcer perforation experience. Methods A retrospective analysis of February 2013 to August 36 cases in our hospital patients with acute gastric ulcer perforation. Results 32 cases of simple suture, surgical lesions localized three cases, one case of gastrectomy. There were no blood transfusions, no complications. Conclusion Surgery remains the treatment of acute gastric ulcer perforation effective method, should be early diagnosis, early surgery for perforated shorter atypical symptoms should be closely observed.%目的:探讨胃十二指肠溃疡急性穿孔的临床治疗体会。方法回顾性分析2013年2月~8月我院收治的36例胃十二指肠溃疡急性穿孔患者。结果单纯缝合修补32例,病灶局部切除缝合3例,1例胃大部分切除。术中无患者输血,无并发症发生。结论外科手术仍然是治疗胃十二指肠溃疡急性穿孔行之有效的方法,应早诊断、早手术,对穿孔时间短症状不典型者应严密观察。

  11. Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation

    OpenAIRE

    King, Angela; Peters, Christopher John; Shorvon, Philip

    2012-01-01

    Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Furthe...

  12. Torsion of the gallbladder: a case report

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    Ijaz Samia

    2008-07-01

    Full Text Available Abstract Introduction Torsion of the gallbladder is a rare condition that most commonly affects the elderly. Pre-operative diagnosis is the exception rather than the rule. Any delay in treatment can be fatal as the gallbladder may rupture, leading to biliary peritonitis. Case presentation We present the case of an 80-year-old woman who was admitted with right upper quadrant pain initially thought to be secondary to acute cholecystitis. Subsequent ultrasound and computed tomography scans of the abdomen revealed signs suggestive of acute cholecystitis but neither modality detected any gallstones. As the patient's symptoms failed to resolve on conservative management, she was taken to theatre for an open cholecystectomy. Intra-operatively, the gallbladder had undergone complete torsion and appeared gangrenous. A routine cholecystectomy followed and she recovered from the operation without incident. Conclusion It is rare to diagnose torsion of the gallbladder pre-operatively despite advances in diagnostic imaging. However, this differential diagnosis should be borne in mind particularly in the elderly patient, without proven gallstones, who fails to improve on conservative management. An emergency cholecystectomy is indicated in the event of diagnosing torsion of the gallbladder to avert the potentially lethal sequelae of biliary peritonitis.

  13. Diagnosis of Acute Upper Gastrointestinal Perforation with Spiral CT%急性上消化道穿孔的螺旋CT诊断

    Institute of Scientific and Technical Information of China (English)

    林春; 张楚和; 吕怀志; 唐振国; 李亮平

    2014-01-01

    目的:探讨螺旋CT对急性上消化道穿孔的诊断价值。方法对49例经手术证实的急性上消化道穿孔患者的 CT 影像资料进行回顾性分析。结果49例患者中,十二指肠溃疡穿孔33例(67.35%);胃溃疡穿孔16例(32.65%),其中胃窦前壁穿孔9例(56.25%),胃小弯前壁穿孔7例(43.75%)。腹腔游离气体49例(100.00%),腹腔积液46例(93.88%),胃肠道壁不规则增厚或周围脂肪层模糊23例(46.94%)。结论通过螺旋CT诊断上消化道穿孔的患者,可以明确患者穿孔的病灶,能弥补X线平片的不足,为临床外科急腹症提供快速而可靠的诊断依据。%Objective To explore the diagnostic value of spiral CT in acute upper gastrointestinal perforation.Methods CT image data of 49 patients with acute upper gastrointestinal perforation confirmed by surgery were retrospectively analyzed. Results Among the 49 patients, duodenal ulcer perforation was observed in 33 (67.35%),gastric ulcer perforation in 16 (32.65%),intraperitoneal free gas in 49 (100.00%),ascites in 46 (93.88%),and irregular thickening of digestive wall and fuzzy fatty layer in 23(46.94%).Among the 16 patients with gastric ulcer perforation, perforation was located at anterior wall of the gastric antrum in 9 (56.25%) and at anterior wall of the lesser gastric curvature in 7 (43.75%). Conclusion Spiral CT can confirm perforated lesions, make up the deficiency of radiology and provide rapid and reliable diagnosis in patients with acute upper gastrointestinal perforation.

  14. Polyarteritis Nodosa of the Gallbladder : A Case Report

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    Kim, Yong Soo; Jeon, Eui Yong; Rhim, Hyun Chul; Kon, Byung Hee; Cho, On Koo; Park, Dong Woo; Park, Choong Ki; Baik, Hong Kyu; Jang, Se Jin [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1996-12-15

    Polyarteritis nodosa is a necrotizing vasculitis involving predominantly small and medium sized arteries, which may affect various organs, especially heart and kidney. In autopsy series, gallbladder involvement is found in 10{approx}40% of cases. Rarely, it presents initially as acute cholecystitis, clinically. We report a case of polyarteritis nodosa initially presented as an acute acalculous hemorrhagic cholecystitis, which showed thickened gallbladder wall and characteristic nondependent and nonlayering intraluminal echoes on ultrasonogram, and was pathologically diagnosed

  15. Torsion of the Gallbladder

    NARCIS (Netherlands)

    Boonstra, Elizabeth A.; van Etten, Boudewijn; Prins, Ted R.; Sieders, Egbert; van Leeuwen, Barbara L.

    2012-01-01

    A 77-year-old woman was seen with progressive abdominal pain. A CT scan was made and showed a large gallbladder extending into the right lower abdomen. Ultrasound was performed but demonstrated no gallstones. Laparoscopy showed a tordated, necrotic gallbladder that was attached to the liver only by

  16. Retroperitoneal abscess and acute acalculous cholecystitis after iatrogenic colon injury: report of a case

    Science.gov (United States)

    Dong, Chengwei; Wang, Yuxu; Hu, Sanyuan; Du, Futian; Ding, Wei

    2015-01-01

    Acute acalculous cholecystitis has a high mortality rate due to the difficulties in early diagnosis and high rate of complications like empyema, gangrene and perforation. We report a case of 20-year-old male with acute severe pancreatitis, acute renal failure and acute peripancreatic fluid collection who was transferred to our department after blood filtration treatment in ICU. After percutaneous catheter drainage for 20 hours, the patient got a high fever. Computed tomography revealed retroperitoneal colon injury. In this case, percutaneous catheter drainage was performed again and the pus cavity was flushed regularly, after which the patient’s state gradually improved. Unpredictably, septic shock appeared on the 51st day. Repeated computed tomography revealed acute acalculous cholecystitis and abscess formation. After percutaneous transhepatic gallbladder catheterization and drainage, the patient got better gradually. Three months later the retroperitoneal catheter was removed. Four months later, ultrasound examination showed normal gallbladder and the catheter was removed. PMID:26131252

  17. Analysis of clinical data in 56 patients with acute upper gastrointestinal perforation%56例上消化道穿孔临床资料分析

    Institute of Scientific and Technical Information of China (English)

    杨光明; 吴根信

    2012-01-01

    Objective To investigate the clinical features and treatment of acute upper gastrointestinal perforation. Methods Retrospective analysis was performed for clinical data of 56 cases of gastrointestinal perforation patients. Results Forty - eight cases were diagnosed as peptic ulcer perforation, including 29 cases of duodenal ulcer perforation and 19 cases of gastric ulcer perforation, 8 cases were gastric malignancy perforation. Simple perforation repair was performed in 42 cases, partial gastrectomy in 10 cases and repair plus gastrojeju-nostomy in 4 cases. One case had anastomotic fistula who died of septic shock and hypoalbuminemia. Conclusion Early diagnosis and early surgery are closely corrlated with prognosis. With the aim to save lives, simple and effective surgery should be implemented to minimize the complications, which is the key to the surgical treatment of acute upper gastrointestinal perforation.%目的 探讨急性上消化道穿孔的临床特点和治疗方法.方法 回顾性分析56例上消化道穿孔患者的临床资料.结果 48例消化性溃疡穿孔(其中十二指肠溃疡穿孔29例,胃溃疡穿孔19例),8例胃恶性肿瘤穿孔.单纯穿孔修补术42例,胃大部分切除术10例,修补加胃空肠吻合术4例,1例术后发生吻合口瘘致感染性休克、低蛋白血症死亡.结论 早期确诊、早期手术与急性上消化道穿孔患者预后密切相关,以抢救生命为主要导向,实施简单有效的手术方式及尽可能减少并发症是外科治疗急性上消化道穿孔的关键.

  18. Stages of Gallbladder Cancer

    Science.gov (United States)

    ... cancer. Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage ... cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain ...

  19. 老年急性胃十二指肠穿孔的治疗分析%The treatment analysis of acute gastroduodenal perforation in elderly

    Institute of Scientific and Technical Information of China (English)

    石秀全

    2015-01-01

    目的:观察单纯穿孔修补术加复尔凯营养管肠内营养治疗高龄急性胃十二指肠溃疡穿孔临床效果。方法总结、分析本院2012年7月~2014年4月行胃十二指肠溃疡穿孔单纯修补术的25例患者的临床资料。结果术后并发切口感染2例,炎性肠梗阻2例,24例患者治愈出院,1例死亡。结论胃十二指肠溃疡穿孔单纯修补术,操作简单、创伤小,配合术中置入复尔凯营养管、术后早期肠内营养、中药应用,可使高龄急性胃十二指肠穿孔患者获得更满意治疗效果。%Objective To observe the clinical efficacy of simple perforation repair plus complex Marche feeding tube enteral nutrition in the treatment of acute gastroduodenal perforation in elderly. Methods The clinical data of 25 cases of patients with acute gastroduodenal perforation in elderly treated in our hospital from July 2012 to April 2014 who were taken with alone gastric and duodena ulcer perforation repair were summarized and analyzed. Results Postopera-tive wound infection were 2 cases,inflammatory bowel obstruction were 2 cases,24 patients were cured,and 1 died. Conclusion Gastroduodenal perforation repair is simple,has small wounds,combined with feeding tube placed during surgery,early postoperative enteral nutrition,can get more satisfactory therapeutic effect in elderly patients with acute gastroduodenal perforation.

  20. 急性下消化道穿孔的 MSCT 诊断%CT diagnosis of acute lower gastrointestinal perforation

    Institute of Scientific and Technical Information of China (English)

    叶明; 胡志; 周泉生

    2015-01-01

    目的:分析急性下消化道穿孔的多层螺旋 CT(MSCT)表现,探讨其诊断价值。方法对21例手术证实的急性下消化道穿孔患者的 MSCT 图像进行回顾性分析。结果21例下消化道穿孔的主要 MSCT 表现为腹腔游离气体10例、腹腔积液18例、肠壁节段性增厚14例、肠壁破口3例、穿孔周围气泡征10例、局限性腹膜炎20例、穿孔周围粪块或肠内容物4例。结论MSCT 可直接显示穿孔部位,准确判断游离气液体有无,同时能发现部分穿孔病因、合并症等有价值的信息,对急性下消化道穿孔有较高的临床诊断价值。%Objective To analyze multi-slice spiral CT findings of acute lower gastrointestinal perforation and explore its diagnos-tic value.Methods Multi-slice spiral CT findings of 21 patients with acute lower gastrointestinal perforation proved by surgery were analyzed retrospectively.Results Multi-slice spiral CT manifestations of 21 patients with lower digestive tract perforation were as following:peritoneal free gas in 10 cases,abdominal fluid 18 cases,intestinal segmental wall thickening 14 cases,intestinal wall rupture 3 cases,bubble sign around the perforation 10 cases,local peritonitis 20 cases,peripheral turd or intestinal contents 4 cases. Conclusion Multi-slice CT can directly show the site of perforation,display the accurate judgment of free gas or liquid and find the part of perforation etiology,complications and other valuable information for clinical diagnosis of acute lower digestive tract.

  1. Human gallbladder pressure and volume

    DEFF Research Database (Denmark)

    Borly, L; Højgaard, L; Grønvall, S;

    1996-01-01

    Increased gallbladder (GB) pressure is probably a part of the pathogenesis of acute cholecystitis, and measurements of GB pressure might therefore be of interest. The aim of this study was to validate a microtip pressure transducer for intraluminal GB pressure measurements. In vitro precision...... and accuracy was within 0.2 mmHg, (SD) and 0.6 +/- 0.1 mmHg (mean +/- SD), respectively. Pressure rise rate was 24.8 +/- 5.5 mmHg s-1. Zero drift was in the range 0.3 +/- 0.4 to 0.8 +/- 0.9 mmHg (mean +/- SD). GB pressure was investigated in 16 patients with acute cholecystitis treated with percutaneous...

  2. Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation

    Institute of Scientific and Technical Information of China (English)

    Se-Jin Baek; Jin Kim; Sung-Ho Lee

    2012-01-01

    Here,we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation.On admission,the patient complained of severe acute abdominal pain,with physical examination findings suspicious for a perforated peptic ulcer.Of note,the patient had no history of other medical conditions or recent trauma,and the initial chest radiography and laboratory findings were not specific.A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver,gallbladder,transverse colon and omentum through a right diaphragmatic defect.The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation.A primary repair of the duodenal perforation was performed,and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated.This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose.Additionally,the best treatment for such large diaphragmatic defects is still controversial,especially in cases of intrathoracic or intra-abdominal contamination.

  3. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... Disorders Overview of Gallbladder and Bile Duct Disorders Cholecystitis Gallstones Biliary Pain Without Gallstones Narrowing of the ... ducts are blocked, the gallbladder may become inflamed ( cholecystitis ). Biliary pain without gallstones (acalculous biliary pain) can ...

  4. A case of Crohn's disease involving the gallbladder

    Institute of Scientific and Technical Information of China (English)

    Akira Andoh; Yoshihiro Endo; Ryoji Kushima; Kazunori Hata; Tomoyuki Tsujikawa; Masaya Sasaki; Eiji Mekata; Toru Tani; Yoshihide Fujiyama

    2006-01-01

    Crohn's disease is well known to affect any part of the gastrointestinal tract including the oral cavity and anus.Various extraintestinal complications have been reported in Crohn's disease, but extraintestinal involvement characterized by granulomatous lesions is uncommon. Here, we have reported a case about the involvement of the gallbladder in Crohn's disease. A 33-year-old woman was diagnosed having panperitonitis due to intestinal perforation and cholecystitis. The patient was moved to the surgical service for an emergency operation. On the resected specimen, there was a broad longitudinal ulcer at the mesenteric side. The mucosa of the gallbladder was nodular and granular, and the wall was thickened.The surface epithelium of the gallbladder was partially eroded and pyloric gland metaplasia was observed focally. Rokitansky-Aschoff sinuses were also present.From the lamina propria to the subserosal layer, there were several well-formed epithelioid cell granulomas,which were the non-caseating sarcoidal type different from the foreign-body and xanthomatous granulomas.Periodic-acid Schiff and acid fast stains revealed no organism within the granulomas. Lymphoid aggregates were present throughout the gallbladder wall. Sections from the resected ileum showed typical features of the Crohn's disease. When cholecystectomy is performed in a patient with Crohn's disease, the possibility of gallbladder involvement should be carefully examined by histopathological tests.

  5. Perforating pilomatricoma.

    Science.gov (United States)

    Zulaica, A; Peteiro, C; Quintas, C; Pereiro, M; Toribio, J

    1988-12-01

    A case of perforating pilomatricoma is described. A few published cases have shared the following features: rapid development, reddish exophytic clinical appearance with surface alterations suggestive of perforation, relatively shallow location making contact with the epidermis, and the occurrence of transepithelial elimination phenomena.

  6. Severe stomatitis and ileocecal perforation developed after all-trans retinoic acid monotherapy in an HLA-B51-positive patient with acute promyelocytic leukemia.

    Science.gov (United States)

    Kimura, Kenji; Takeuchi, Masahiro; Hasegawa, Nagisa; Togasaki, Emi; Shimizu, Ryoh; Kawajiri, Chika; Muto, Tomoya; Tsukamoto, Shokichi; Takeda, Yusuke; Ohwada, Chikako; Sakaida, Emiko; Sakai, Shio; Mimura, Naoya; Ota, Satoshi; Iseki, Tohru; Nakaseko, Chiaki

    2016-06-01

    A 34-year-old man who had been referred to our hospital was diagnosed with acute promyelocytic leukemia (APL). All-trans retinoic acid (ATRA), oral administration, was initiated. On day 25, he developed fever and respiratory distress with bilateral pulmonary infiltrates, suggesting differentiation syndrome (DS) caused by ATRA. These symptoms showed amelioration after discontinuing ATRA and initiating methylprednisolone. ATRA was re-started on day 29 at half the original dose because of residual APL blasts. The patient subsequently developed fever, severe stomatitis, and oropharyngeal ulcers, which persisted even after discontinuing ATRA. On day 48, he suddenly developed severe abdominal pain with free air, observable on an abdominal X-ray, and underwent emergency ileocecal resection. Pathological examination of the resected ileocecal intestines revealed multiple ulcers and perforations. No leukemic cell infiltration was observed. In this case, only ATRA was administered for APL treatment. These findings suggest that ileocecal ulcerations and perforations, as well as oropharyngeal ulcers, might have been caused by DS or ATRA. Furthermore, DNA typing of the HLA-B locus revealed that the patient had HLA-B51 associated with Behçet's disease. Therefore, hypercytokinemia with DS might have induced Behçet's disease-like symptoms, including stomatitis and ileocecal perforation, complications that are particularly observed in patients with HLA-B51.

  7. Spontaneous Perforation of Pyometra.

    Science.gov (United States)

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-04-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.

  8. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.

    Science.gov (United States)

    Chow, Louis Tsun Cheung

    2014-12-01

    The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.

  9. [Gallbladder motor activity in patients with virus hepatitis B].

    Science.gov (United States)

    Mamos, Arkadiusz; Wichan, Paweł; Chojnacki, Jan; Grzegorczyk, Krzysztof

    2003-12-01

    In acute stage of virus hepatitis B patients often complain of dyspeptic discomfort. They may be a consequence of alimentary tract motor activity disorders including these of gallbladder. Routine ultrasonography in an early phase of virus hepatitis often reveals gallbladder wall thickening what may confirm the above thesis. Thus, a group of 15 patients in an acute phase of virus hepatitis B was subjected to examinations. Gallbladder motor activity was assessed by ultrasonographic method determining its total volume and ejection fraction and volume after test meal stimulus. First examination was performed in the first week since the appearance of yellowing of the walls, successive in 4 and 8 week of the disease. Obtained results were compared to the values obtained in the group of 25 healthy volunteers. It was found out that gallbladder volume was significantly decreased and ejection fraction increased in the acute phase of virus hepatitis B than in the controls. This may speak for gallbladder hyperreactivity in patients in the course of virus hepatitis B. These disorders decreased during two-month observation but even in the 8 week the investigated parameters differed from those found in the control group.

  10. Gallbladder tuberculosis: False-positive PET diagnosis of gallbladder cancer

    Institute of Scientific and Technical Information of China (English)

    JM Ramia; K Muffak; A Fernández; J Villar; D Garrote; JA Ferron

    2006-01-01

    Gallbladder tuberculosis (GT) is an extremely rare disease, and very few cases have been reported in the literature. The first case of GT was described in 1870 by Gaucher. A correct preoperative diagnosis of GT is unusual, and it is frequently confused with various gallbladder diseases. We present a new case of a patient who underwent surgery with the preoperative diagnosis of gallbladder cancer after a false positive positron emission tomography scan in the diagnostic work-up.

  11. Primary Gallbladder Small Lymphocytic Lymphoma as a Rare Postcholecystectomy Finding

    Directory of Open Access Journals (Sweden)

    Kyriakos Psarras

    2014-01-01

    Full Text Available Introduction. Primary lymphoma of the gallbladder is an extremely rare entity with approximately 50 cases reported so far. In many of these cases the presenting symptoms were mimicking symptomatic gallstone disease and the diagnosis was made postoperatively, especially when the preoperative imaging results were far from suspicious for malignant disease. Patients and Methods. We report a case of primary lymphoma of the gallbladder in an 85-year-old man with gallstone disease, who was admitted for elective cholecystectomy 2 months after an episode of acute cholecystitis and pancreatitis. Histological evaluation of the specimen revealed a small lymphocytic lymphoma of the gallbladder. This type of primary gallbladder lymphoma has not been previously reported. Discussion. The most common primary lymphomas of the gallbladder are MALT lymphomas and diffuse large B-cell lymphomas, although a variety of other histological types have been reported. The association of these lesions with chronic inflammation is the most convincing theory for their pathogenesis. For lesions confined to the gallbladder, cholecystectomy is considered to be sufficient, while supplementary chemotherapy significantly improves prognosis in more advanced disease.

  12. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma].

    Science.gov (United States)

    Ahn, Yeon Jeong; Kim, Tae Hyo; Moon, Sung Won; Choi, Su Nyoung; Kim, Hyun Jin; Jung, Woon Tae; Lee, Ok Jae; Ko, Gyung Hyuck

    2011-09-25

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

  13. Laparoscopic Appendectomy for Acute Gangrenous Perforated Appendicitis%腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎

    Institute of Scientific and Technical Information of China (English)

    王东君; 张新元; 张震波; 刘瑞鹏; 孙宏伟

    2016-01-01

    目的:探讨腹腔镜切除术治疗急性坏疽穿孔性阑尾炎的临床价值。方法2011年6月~2014年9月对36例急性坏疽穿孔性阑尾炎施行腹腔镜下阑尾切除术,腹腔镜下探查腹腔,吸净脓液及渗液,提起阑尾显露系膜,用双极电凝钳切断阑尾系膜,编织线双重套扎阑尾根部,阑尾残端予以荷包包埋,放置腹腔引流。结果36例均顺利完成手术,无中转开腹,无并发症发生。手术时间45~115 min,平均65 min。术后引流管留置2~4 d。术后5~7 d出院。33例随访3~6个月,无腹痛、腹胀等表现。结论腹腔镜阑尾切除术治疗急性坏疽穿孔性阑尾炎安全、有效,可直视下腹腔冲洗,放置准确有效的引流管。%Objective To explore the clinical value of laparoscopic appendectomy for acute gangrenous perforated appendicitis . Methods A total of 36 patients with acute gangrenous perforated appendicitis underwent laparoscopic appendectomy from June 2011 to September 2014.After laparoscopic exploration and suction of purulent fluid and exudate , the appendix was lifted to expose and cut off mesenterium with bipolar electrocoagulation .The appendix root was double-ligated and the stump was purse string sutured.An abdominal drainage was placed . Results All the 36 cases were successfully operated .There was no conversion to laparotomy and complications .The operation continued for 45 -115 min, with a mean of 65 min.The postoperative drainage was indwelled for 2-4 d.All the patients recovered and went home after 5-7 d.Follow-ups for 3-6 months in 33 patients found no abdominal pain or distention . Conclusion Laparoscopic appendectomy for acute gangrenous perforated appendicitis is safe and effective, with advantages of peritoneal washing under direct vision and accurately and effectively placing drainage tube .

  14. Treatment progress of acute perforation of gastroduodenal ulcer%胃十二指肠溃疡急性穿孔治疗进展

    Institute of Scientific and Technical Information of China (English)

    胡晓群

    2014-01-01

    In this paper,the author analyzes the clinical treatment of acute perforation of gastroduodenal ulcer in recent years to explore the effective treatment way.Acute perforation of gastroduodenal ulcer has conservative treatment and operation treatment. The operation treatment has laparoscopy and laparotomy perforation suture technique,subtotal gastrectomy and gastric neurectomy. The clinical scholars are more inclined to minimally invasive class laparoscopic simple repair.The conservative treatment is also favored by patients and doctors.The subtotal gastrectomy is an effective complement.Laparoscopic subtotal gastrectomy has great development prospect.but no matter which kind of treatment is choosed,we must strictly grasp the indications,and combine with drug therapy,which can improve the cure rate.%目的:本文分析了近年来胃十二指肠溃疡急性穿孔的临床治疗方法,探讨有效的治疗方式。胃十二指肠溃疡急性穿孔有保守治疗和手术治疗,手术治疗有腹腔镜和开腹穿孔缝合术、胃大部切除术和迷走神经切断术。临床学者更倾向于微创类的腹腔镜单纯修补术,保守治疗也受到患者和医生的青睐,胃大部切除术是一种有效的补充,腹腔镜胃大部切除术也有较大的发展前景;但不管选择哪种治疗方式,都必须严格把握适应证,并结合有效的药物治疗,才能真正提高治愈率。

  15. Ectopic pancreas in gallbladder: clinical significance, diagnostic and therapeutic implications

    Directory of Open Access Journals (Sweden)

    Elena M. Sanchiz-Cárdenas

    2015-11-01

    Full Text Available Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue in an anatomical place not related to the pancreas, being it most frequent locations the stomach and small bowel. Its finding in the gallbladder is exceptional. Since the first case was reported by Otschkin in 1916, about 30 cases have been described in literature. We report the case of a 43 years-old male patient who had an urgent laparoscopic cholecystectomy with the diagnosis of acute cholecystitis, which pathological study showed the existence of chronic cholecystitis with heterotopic pancreatic tissue in the gallbladder wall.

  16. Gallbladder small cell carcinoma: a case report and literature review.

    Science.gov (United States)

    Adachi, Toshiyuki; Haraguchi, Masashi; Irie, Junji; Yoshimoto, Tomoko; Uehara, Ryohei; Ito, Shinichiro; Tokai, Hirotaka; Noda, Kazumasa; Tada, Nobuhiro; Hirabaru, Masataka; Inoue, Keiji; Minami, Shigeki; Eguchi, Susumu

    2016-12-01

    Gallbladder small cell carcinoma (SCC) comprises only 0.5 % of all gallbladder cancer and consists of aggressive tumors with poor survival outcomes against current treatments. These tumors are most common in elderly females, particularly those with cholecystolithiasis. We report the case of a 79-year-old woman with gallbladder small cell carcinoma. The patient had intermittent right upper quadrant abdominal pain and was admitted to our hospital due to suspected acute cholecystitis. She regularly received medical treatment for diabetes, hypertension, and dyslipidemia. On initial laboratory evaluation, the levels of aspartate aminotransferase (AST), total bilirubin, and C-reactive protein (CRP) were markedly elevated. She underwent computed tomography (CT) for screening. CT images showed a thick-walled gallbladder containing multiple stones and multiple 3-cm-sized round nodular lesions, which were suggestive of metastatic lymph nodes. After percutaneous transhepatic gallbladder drainage was performed, endoscopic ultrasound-guided fine needle aspiration of enlarged lymph nodes resulted in a diagnosis of small cell carcinoma or adenocarcinoma. However, we could not identify the primary lesion before the surgery because of no decisive factors. We performed cholecystectomy because there was a possibility of cholecystitis recurrence risk and also partial liver resection because we suspected tumor invasion. The final pathological diagnosis was neuroendocrine carcinoma of the gallbladder, small cell type. The tumor stage was IVb, T3aN1M1. The patient died 13 weeks after the surgery. In the present paper, we review the current available English-language literature of gallbladder SCC.

  17. Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis Microcolecistolitíase: papel da ecoendoscopia em pacientes com pancreatite aguda sem causa aparente

    Directory of Open Access Journals (Sweden)

    José Celso Ardengh

    2010-01-01

    Full Text Available OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75% had microlithiasis confirmed by histology and nine did not (25%. EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval were 92.6% (74.2-98.7%, 55.6% (22.7-84.7%, 86.2% (67.4-95.5% and 71.4% (30.3-94.9%, respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.OBJETIVOS: Cerca de 30% dos doentes com PA rotulada como sem causa aparente apresentam

  18. Successful topical dissolution of cholesterol gallbladder stones using ethyl propionate.

    Science.gov (United States)

    Hofmann, A F; Amelsberg, A; Esch, O; Schteingart, C D; Lyche, K; Jinich, H; Vansonnenberg, E; D'Agostino, H B

    1997-06-01

    Topical dissolution of cholesterol gallbladder stones using methyl tert-butyl ether (MTBE) is useful in symptomatic patients judged too ill for surgery. Previous studies showed that ethyl propionate (EP), a C5 ester, dissolves cholesterol gallstones rapidly in vitro, but differs from MTBE in being eliminated so rapidly by the liver that blood levels remain undetectable. Our aim was to test EP as a topical dissolution agent for cholesterol gallbladder stones. Five high-risk patients underwent topical dissolution of gallbladder stones by EP. In three patients, the solvent was instilled via a cholecystostomy tube placed previously to treat acute cholecystitis; in two patients, a percutaneous transhepatic catheter was placed in the gallbladder electively. Gallstone dissolution was assessed by chromatography, by gravimetry, and by catheter cholecystography. Total dissolution of gallstones was obtained in four patients after 6-10 hr of lavage; in the fifth patient, partial gallstone dissolution facilitated basketing of the stones. In two patients, cholesterol dissolution was measured and averaged 30 mg/min. Side effects were limited to one episode of transient hypotension and pain at the infusion site; no patient developed somnolence or nausea. Gallstone elimination was associated with relief of symptoms. EP is an acceptable alternative to MTBE for topical dissolution of cholesterol gallbladder stones in high-risk patients. The lower volatility and rapid hepatic extraction of EP suggest that it may be preferable to MTBE in this investigational procedure.

  19. KaiXie Compound in the Treatment for 42 Cases of Acute Cholecysititis of Liver-gallbladder Dampness-heat Pattern%开泄复方治疗肝胆湿热型急性胆囊炎42例

    Institute of Scientific and Technical Information of China (English)

    狄建新

    2015-01-01

    目的:观察开泄复方治疗肝胆湿热型急性胆囊炎(acute cholecystitis,AC)的临床疗效。方法:将85例肝胆湿热型 AC 患者随机分为对照组43例和观察组42例,对照组予以西医常规治疗,观察组联合开泄复方辨证论治,比较2组临床疗效。结果:总有效率观察组为97.62%,对照组为83.75%,2组比较差异有统计学意义(P<0.05);主症积分、次症积分、总积分观察组均明显低于对照组(P<0.05);发热、恶心呕吐、胁痛、白细胞计数、胆红素、B 超胆囊恢复时间观察组均明显短于对照组(P<0.05)。结论:开泄复方治疗肝胆湿热型 AC 患者,有助于改善患者临床症状,提高疗效。%Objective: To observe clinical effects of KaiXie compound in treating acute cholecystitis (AC) of liv-er-gallbladder dampness-heat pattern. Methods: All 85 patients were randomly divided into 43 cases of the control group and 42 cases of the observation group, the control group received routine treatment of western medicine and the observation group KaiXie compound combined with routine treatment on the foundation of syndrome differentiation and treatment, clinical effects of both groups were compared. Results: Total effective rate of the observation group was 97.62%, higher than 83.75% of the control group, the difference demonstrated statistical meaning (P<0.05); the obser-vation group was lower than the control group in main symptom scores, secondary symptom scores and total scores ob-viously (P<0.05); the observation group was shorter than the control group in fever, nausea and vomiting, costalgia, WBC, bilirubin and B-ultrasound gallbladder recovery time notably (P<0.05). Conclusion: KaiXie compound in treat-ing AC patients of liver-gallbladder dampness-heat pattern is helpful to improve clinical symptoms of the patients and curative effects.

  20. Contrast enhanced sonography of the gallbladder: A tool in the diagnosis of cholecystitis?

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, Boris [Institute of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen (Germany)]. E-mail: boris.adamietz@idr.imed-uni-erlangen.de; Wenkel, Evelyn [Institute of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen (Germany)]. E-mail: evelyn.wenkel@idr.imed.uni-erlangen.de; Uder, Michael [Institute of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen (Germany)]. E-mail: michael.uder@idr.imed-uni-erlangen.de; Meyer, Thomas [Department of Surgery, University of Erlangen, Krankenhausstrasse 12, 91054 Erlangen (Germany)]. E-mail: thomas.meyer@chir.imed-uni-erlangen.de; Schneider, Ignaz [Department of Surgery, University of Erlangen, Krankenhausstrasse 12, 91054 Erlangen (Germany)]. E-mail: ignaz.schneider@chir.imed-uni-erlangen.de; Dimmler, Arno [Department of Pathology, University of Erlangen, Krankenhausstrasse 8-10, 91054 Erlangen (Germany)]. E-mail: arno.dimmler@patho.imed-uni-erlangen.de; Bautz, Werner [Institute of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen (Germany)]. E-mail: werner.bautz@idr.imed-uni-erlangen.de; Janka, Rolf [Institute of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen (Germany)]. E-mail: rolf.janka@idr.imed-uni-erlangen.de

    2007-02-15

    Rationale and objectives: To evaluate if contrast enhanced sonography (CES) can help to detect gallbladder inflammation and differentiate between acute and chronic cholecystitis. Materials and methods: Thirty-three patients with clinical suspicion of acute cholecystitis were examined with CES before cholecystectomy. Thirty patients with no history of gallbladder disease served as control. CES was performed using 2.5 mL SonoVue. A small mechanical index was chosen (0.1). The enhancement pattern of the gallbladder was ranked in a three-point scale: no enhancement, low enhancement and strong enhancement. 28/33 patients underwent surgery. Sonographic findings were compared to histological results. Results: In 16/20 cases with histological proven acute cholecystitis, the gallbladder wall showed a strong enhancement. Low enhancement was found in four patients with acute and in six patients with chronic cholecystitis. The gallbladder wall of two patients with chronic inflammation and all patients (30/30) of the control group showed no enhancement. Conclusion: CES is a feasible tool for detecting gallbladder inflammation. Differentiating between acute and chronic cholecystitis seems to be possible.

  1. Quantitative PCR of ear discharge from Indigenous Australian children with acute otitis media with perforation supports a role for Alloiococcus otitidis as a secondary pathogen

    Directory of Open Access Journals (Sweden)

    Marsh Robyn L

    2012-10-01

    Full Text Available Abstract Background Otitis media is endemic in remote Indigenous communities of Australia’s Northern Territory. Alloiococcus otitidis is an outer ear commensal and putative middle ear pathogen that has not previously been described in acute otitis media (AOM in this population. The aims of this study were to determine the presence, antibiotic susceptibility and bacterial load of A. otitidis in nasopharyngeal and ear discharge swabs collected from Indigenous Australian children with AOM with perforation. Methods Paired nasopharyngeal and ear discharge swabs from 27 children with AOM with perforation were tested by A. otitidis quantitative PCR (qPCR. Positive swabs were cultured for 21 days. Total and respiratory pathogen bacterial loads in A. otitidis-positive swabs were determined by qPCR. Results A. otitidis was detected by qPCR in 11 ear discharge swabs from 10 of 27 (37% children, but was not detected in paired nasopharyngeal swabs. A. otitidis was cultured from 5 of 11 qPCR-positive swabs from four children. All A. otitidis isolates had minimum inhibitory concentrations consistent with macrolide resistance. All A. otitidis qPCR-positive swabs were culture-positive for other bacteria. A. otitidis bacterial load ranged from 2.2 × 104-1.1 × 108 cells/swab (median 1.8 × 105 cells/swab. The relative abundance of A. otitidis ranged from 0.01% to 34% of the total bacterial load (median 0.7%. In 6 of 11 qPCR-positive swabs the A. otitidis relative abundance was A. otitidis bacterial load and relative abundance measures were comparable to that of Haemophilus influenzae. Conclusions A. otitidis can be a dominant species in the bacterial communities present in the ear discharge of Indigenous children with AOM with perforation. The absence of A. otitidis in nasopharyngeal swabs suggests the ear canal as the likely primary reservoir. The significance of A. otitidis at low relative abundance is unclear; however, at higher relative

  2. Safety Analysis of Emergency Treatment of Acute Perforation of Gastric and Duodenal Ulcer%浅析胃十二指肠溃疡急性穿孔急诊治疗安全性

    Institute of Scientific and Technical Information of China (English)

    熊清平

    2015-01-01

    Objective Ef ect of acute perforation of gastroduodenal ulcer emergency treatment and safety observation analysis.Methods Data of selected self court in July 2012~July 2014 treated 62 cases of patients with acute perforation of gastroduodenal ulcer as the research object,randomly divided into control group and research group,control group underwent surgical treatment,traditional emergency perforation repair team line laparoscopic emergency perforation repair surgery,and the clinical data of two groups of patients were retrospectively analyzed.Results The treatment group ef ective rate was 96.77%,significantly higher than the control group treatment ef ective rate was 83.87%;And operative blood loss and operation time of the team were bet er than the control group,with significant dif erence ( <0.05).Conclusion Emergency perforation repair in laparoscopic surgery in the treatment of acute perforation of gastroduodenal ulcer curative ef ect,good safety,the incidence of complications is low,is an ef ective treatment for acute perforation of gastroduodenal ulcer.%目的对胃十二指肠溃疡急性穿孔急诊治疗的效果及安全性进行观察分析。方法资料选自我院2012年7月~2014年7月收治的胃十二指肠溃疡急性穿孔患者62例作为研究对象,随机均分为对照组及研究组,对照组行传统急诊穿孔修补手术治疗,研究组行腹腔镜急诊穿孔修补手术治疗,并对两组患者的临床资料进行回顾性分析。结果研究组治疗的有效率为96.77%,显著高于对照组治疗的有效率83.87%;且研究组手术出血量及手术时间均优于对照组,差异具有显著性(<0.05)。结论腹腔镜急诊穿孔修补手术治疗胃十二指肠溃疡急性穿孔的疗效确切,安全性好,并发症的发生率低,是胃十二指肠溃疡急性穿孔的有效治疗措施。

  3. Perforated Peptic Ulcer: new insights

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta)

    2011-01-01

    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often le

  4. Treatment Options for Gallbladder Cancer

    Science.gov (United States)

    ... cancer. Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage ... cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain ...

  5. Treatment Option Overview (Gallbladder Cancer)

    Science.gov (United States)

    ... cancer. Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage ... cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain ...

  6. Computed tomography of the gallbladder.

    Science.gov (United States)

    Havrilla, T R; Reich, N E; Haaga, J R; Seidelmann, F E; Cooperman, A M; Alfidi, R J

    1978-06-01

    Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.

  7. Helicobacter pylori in gastroduodenal perforation

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    Bharat B Dogra

    2014-01-01

    Full Text Available Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92% turned out to be positive for H. pylori and only four cases (8% were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers.

  8. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

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    Rafailidis Vasileios

    2013-01-01

    Full Text Available Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity.

  9. 胃、十二指肠溃疡急性穿孔手术治疗的术前、术后护理%Preoperative and postoperative nursing care for patients with acute perforation of gastric and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    王瑞梅

    2016-01-01

    Objective:Acute perforation of gastric and duodenal ulcer is a common clinical emergency, and the nursing care of patients before and after surgery plays an important role in the rehabilitation of patients.The nursing of acute perforation of stomach and duodenum will be briefly introduced in this paper.%胃、十二指肠溃疡急性穿孔是临床常见的急症,手术前后的护理对患者的康复起着至关重要的作用.本文简要介绍胃、十二指肠急性穿孔手术前后的护理.

  10. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience

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    Ur-Rahman Shafiq

    2008-11-01

    Full Text Available Abstract Background Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. Methods A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK Pakistan, from 1st September 2005 – 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. Results The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6% and gastric ulcer 1.3%. followed by small bowel tuberculosis (21% and typhoid (17%. large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%. Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%. Conclusion The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular

  11. Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis

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    Fahri Yetisir

    2016-01-01

    Full Text Available Introduction. We report the management of a septic Open Abdomen (OA patient by the help of negative pressure therapy (NPT and abdominal reapproximation anchor (ABRA system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S with confounding factor of mild acute pancreatitis (AP. Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR. There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient.

  12. Non-Hodgkin lymphoma as a cause of acute intestinal obstruction/perforation in patients with adenocarcinoma of the sigmoidcolon: a case report

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    Marcelo Pandolfi Basso

    2011-12-01

    Full Text Available Report of a rare case of an 83-year-old patient with lymphoma of the terminal ileum causing obstructive/perforated acute abdomen synchronous with sigmoid colon adenocarcinoma and review of literature data about small bowel malignancies, particularly lymphomas. It seems to correspond to a rare disease (2% of all bowel cancers, more prevalent in elderly and immunocompromised patients, whose symptoms are vague and early diagnosis is difficult, often making it impossible to establish the correct therapy.Relato de caso raro de um paciente de 83 anos, com linfoma de íleo terminal causador de abdome agudo obstrutivo/perfurativo sincrônico à adenocarcinoma de cólon sigmoide e revisão dos dados disponíveis na literatura acerca das neoplasias de intestino delgado, em especial os linfomas. Constata-se que corresponde a uma afecção rara (2% de todas as neoplasias intestinais, mais predominante em pacientes idosos e imunodeprimidos, cuja sintomatologia é vaga e o diagnóstico precoce difícil, fato que impossibilita muitas vezes a instituição da terapêutica correta.

  13. An incidental case of triple gallbladder

    Institute of Scientific and Technical Information of China (English)

    Banu Alicioglu

    2007-01-01

    Triplication of the gallbladder is a very rare congenital anomaly of the biliary tract; there are only elevenreported cases to date. Gallbladder multiplications are not likely to be discovered unless associated with cholelithiasis, sludge, cholecystitis and carcinoma. Here we report an incidentally diagnosed triplicate gallbladder in a patient with sigmoid diverticulitis; two of the triplicate gallbladder were demonstrated with ultrasound and computed tomography, and an additional galballder was found at surgery.

  14. SEPTATE GALLBLADDER - A RARE CASE REPORT

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    Santhosh Kumar

    2016-10-01

    Full Text Available BACKGROUND Septate gallbladders are rare variations associated with the extrahepatic biliary system. The present report is a morphological study of a septate gallbladder. Septations in the gallbladder have been reported to be single or multiple. In our case, we report gallbladder was found to have multiple septa extending into the whole cavity. The cystic duct and artery were single and normal. Histology revealed marked smooth muscle hyperplasia with prominent septa with Aschoff Rokitansky sinuses

  15. A Review of Porcelain Gallbladder Mimicking a Gallbladder Stone on Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Sim, Hyun Sun [Dept. of Preventive Medicine, Cheju National University College of Medicine, Cheju (Korea, Republic of); Jung, Hong Rayang; Lim, Chung Hwan [Dept. of Radiological Science, Hanseo University, Seosan (Korea, Republic of)

    2008-12-15

    Porcelain gallbladder is a rare disorder by deposition of calcium in the wall of gallbladder. The chronic cholecystitis is reported to produce mural calcification and obstruction to the cystic duct by stone. Since porcelain gallbladder is commonly associated with gallbladder cancer, cholecystectomy is performed to prevent it. We report here a case of a patient with porcelain gallbladder. This case showed the typical ultrasonographic, computer tomographic and radiographic findings of the disease.

  16. Gallbladder cancer: epidemiology and outcome

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    Hundal R

    2014-03-01

    Full Text Available Rajveer Hundal, Eldon A Shaffer Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Abstract: Gallbladder cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%-95% of biliary tract cancers. An early diagnosis is essential as this malignancy progresses silently with a late diagnosis, often proving fatal. Its carcinogenesis follows a progression through a metaplasia-dysplasia-carcinoma sequence. This comprehensive review focuses on and explores the risks, management, and outcomes for primary gallbladder carcinoma. Epidemiological studies have identified striking geographic and ethnic disparities – inordinately high occurrence in American Indians, elevated in Southeast Asia, yet quite low elsewhere in the Americas and the world. Age, female sex, congenital biliary tract anomalies, and a genetic predisposition represent important risk factors that are immutable. Environmental triggers play a critical role in eliciting cancer developing in the gallbladder, best exemplified by cholelithiasis and chronic inflammation from biliary tract and parasitic infections. Mortality rates closely follow incidence; those countries with the highest prevalence of gallstones experience the greatest mortality from gallbladder cancer. Vague symptoms often delay the diagnosis of gallbladder cancer, contributing to its overall progression and poor outcome. Surgery represents the only potential for cure. Some individuals are fortunate to be incidentally found to have gallbladder cancer at the time of cholecystectomy being performed for cholelithiasis. Such an early diagnosis is imperative as a late presentation connotes advanced staging, nodal involvement, and possible recurrence following attempted resection. Overall mean survival is a mere 6 months, while 5-year survival rate is only 5%. The dismal prognosis, in part, relates to the

  17. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern

    Energy Technology Data Exchange (ETDEWEB)

    Jung, S.E.; Lee, J.M.; Hahn, S.T. [Catholic University of Korea, Department of Radiology, St Mary' s Hospital, Seoul (Korea); Lee, K. [Catholic University of Korea, Department of Clinical Pathology, St Mary' s Hospital, Seoul (Korea); Rha, S.E.; Choi, B.G. [Catholic University of Korea, Department of Radiology, Kangnam St Mary' s Hospital, Seoul (Korea); Kim, E.K. [Catholic University of Korea, Department of Surgery (E.K.K), St Mary' s Hospital, Seoul (Korea)

    2005-04-01

    The aim of this study was to correlate MR findings of gallbladder wall thickening with pathologic findings on the basis of the layered pattern and to evaluate the diagnostic value of MR imaging in gallbladder disease. We retrospectively evaluated the source images of HASTE sequences for MR cholangiography in 144 patients with gallbladder wall thickening. The layered pattern of thickened wall was classified into four patterns. Type 1 shows two layers with a thin hypointense inner layer and thick hyperintense outer layer. Type 2 has two layers of ill-defined margin. Type 3 shows multiple hyperintense cystic spaces in the wall. Type 4 shows diffuse nodular thickening without layering. MR findings of a layered pattern of thickened gallbladder were well correlated with histopathology. Chronic cholecystitis matched to type 1, acute cholecystitis corresponded to type 2, adenomyomatosis showed type 3, and the gallbladder carcinomas showed type 4. All four layered patterns were associated with PPV of 73% or greater, sensitivity of 92% or greater and specificity of 95% or greater. Our results indicate that MR findings of gallbladder wall thickening are characteristic in each entity and correlate well with pathologic findings. The classification of the layered pattern may be valuable for interpreting thickened gallbladder wall. (orig.)

  18. The rare histological forms of gallbladder cancer

    OpenAIRE

    Lytvynenko M.V.; Rosha L.G.; Chetverykov S.G.; Vododuk V.U.; Sherstiuk S.A.; Katsap A.V.

    2011-01-01

    In the practice of surgeons meet the rare forms of gallbladder cancer, with atypical clinical course. The aim of ourinvestigation was revealed peculiarity of clinical display the rarely forms of gallbladder cancer. According to literaturesquamous cell carcinoma found in the gallbladder in 7% case.

  19. Intestinal perforation secondary to metastasic lung carcinoma

    Directory of Open Access Journals (Sweden)

    M. C. Álvarez Sánchez

    2014-11-01

    Full Text Available Secondary symptomatic gastrointestinal metastases from lung primary tumor are rare. They can cause a variety of clinical conditions such as perforation, obstruction and bleeding. Intestinal perforations of intestinal metastases have a very poor prognosis. We present a case of a patient with metastatic lung cancer who presents with intestinal perforation and pneumoperitoneum. A 67 year old male, immunosuppressed and smoker is diagnosed with acute abdomen secondary to perforation of a tumor of the terminal ileum, as well as three other similar injuries. Resection and anastomosis. The patient died two months after surgery. The final pathological diagnosis supports epidermoidide poorly differentiated lung carcinoma. It was concluded that given an intestinal perforation in a patient diagnosed with lung carcinoma, it shouldn´t be excluded the metastases origen . Surgery is a purely palliative procedure.

  20. The treatment of acute gastric ulcer perforation most of gastric resection%急性胃溃疡穿孔行胃大部切除术治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    王明会; 郭爱芬

    2015-01-01

    Objective Analysis of stomach was the clinical curative effect of treatment of acute gastric ulcer perforation. Methods Selected from December 2012 to October 2014 received 80 cases of patients with acute gastric ulcer perforation, all use most of gastric resection on the treatment, and analyze the treatment effect. Results After most of gastric resection in patients with acute gastric ulcer perforation, no death phenomenon; Average treatment time was (163.7 + / - 18.2) min. 66.25% of the patients after the operation, restore to Ⅰ Ⅱon 23.75% of the patients recover an 10% of the patients recoverⅢlevel; Early postoperative concurrent stomach bleeding (3.75%of the patients, and 3 cases with infection after the operation. Conclusions To implement most of gastric resection treatment of patients with acute ulcer perforation, can be fundamentally solved perforated ulcer disease, surgical treatment effect is remarkable, less postoperative complications, mortality is low, worth clinical promotion.%目的:分析胃大部切除术治疗急性胃溃疡穿孔的临床疗效。方法:选取我院2012年12月~2014年10月接收的急性胃溃疡穿孔患者80例,均对其使用胃大部切除术进行治疗,并对治疗效果进行分析。结果:急性胃溃疡穿孔患者进行胃大部切除术后,无死亡现象;患者平均治疗时间为(163.7±18.2)m i n;手术后66.25%的患者恢复为Ⅰ级,23.75%的患者恢复为Ⅱ级,10%的患者恢复为Ⅲ级;术后早期3.75%的患者出现并发胃出血症状,3例患者手术后感染。结论:实施胃大部切除术对急性溃疡穿孔患者进行治疗,可以根本解决溃疡穿孔病症,手术治疗效果显著,术后并发症少,死亡率低,值得临床进行推广。

  1. Gallbladder agenesis in a Chihuahua.

    Science.gov (United States)

    Kamishina, Hiroaki; Katayama, Masaaki; Okamura, Yasuhiko; Sasaki, Jun; Chiba, Satoshi; Goryo, Masanobu; Sato, Reeko; Yasuda, Jun

    2010-07-01

    A 4-year-old neutered male Chihuahua was presented with a history of anorexia and vomiting. Continuous elevation of liver enzymes was found on repeated blood examinations and the dog was referred to us for further evaluation. The absence of gallbladder was suspected on ultrasonography. Exploratory laparotomy and retrograde cholangiography confirmed gallbladder agenesis and a possible hypoplasia of the right medial and lateral liver lobes. Histologically, proliferation of bile ductules associated with portal fibrosis and pseudolobular formation were apparent in the liver lobes.

  2. Compared to placebo, long-term antibiotics resolve otitis media with effusion (OME and prevent acute otitis media with perforation (AOMwiP in a high-risk population: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Morris Peter S

    2008-06-01

    Full Text Available Abstract Background For children at high risk of chronic suppurative otitis media (CSOM, strategies to prevent acute otitis media with perforation (AOMwiP may reduce progression to CSOM. Methods In a double blind study in northern Australia, 103 Aboriginal infants with first detection of OME were randomised to receive either amoxicillin (50 mg/kg/d BD or placebo for 24 weeks, or until bilateral aerated middle ears were diagnosed at two successive monthly examinations (success. Standardised clinical assessments and international standards for microbiology were used. Results Five of 52 infants in the amoxicillin group and none of 51 infants in the placebo group achieved success at the end of therapy (Risk Difference = 9.6% [95% confidence interval 1.6,17.6]. Amoxicillin significantly reduced the proportion of children with i perforation at the end of therapy (27% to 12% RD = -16% [-31,-1], ii recurrent perforation during therapy (18% to 4% RD = -14% [-25,-2], and iii reduced the proportion of examinations with a diagnosis of perforation during therapy (20% to 8% adjusted risk ratio 0.36 [0.15,0.83] p = 0.017. During therapy, the proportion of examinations with penicillin non-susceptible (MIC > 0.1 microg/ml pneumococci was not significantly different between the amoxicillin group (34% and the placebo group (40%. Beta-lactamase positive non-capsular H. influenzae (NCHi were uncommon during therapy but more frequent in the amoxicillin group (10% than placebo (5%. Conclusion Aboriginal infants receiving continuous amoxicillin had more normal ears, fewer perforations, and less pneumococcal carriage. There was no statistically significant increase in resistant pneumococci or NCHi in amoxicillin children compared to placebo children who received regular paediatric care and antibiotic treatment for symptomatic illnesses.

  3. Duodenal Perforation Precipitated by Scrub Typhus.

    Science.gov (United States)

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  4. Duodenal perforation precipitated by scrub typhus

    Directory of Open Access Journals (Sweden)

    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  5. CLINICAL STUDY OF DUODENAL PERFORATION

    Directory of Open Access Journals (Sweden)

    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  6. Computed tomography of the pancreas and gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Onizuka, H.; Matsuura, K. (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine)

    1982-03-01

    The authors viewed the present status of CT diagnosis in pancreatic and biliary diseases, referring to its future. CT imaged neither normal intrahepatic biliary ducts nor normal pancreatic ducts because of a relatively low resolution. The accuracy of CT in diagnosing obstructive jaundice has been 85 - 100%. CT showed a higher reproducibility than that of ultrasound in follow-up of intrahepatic gallstones. On the other hand, ultrasound was superior to CT in detecting gallstones. Diagnosis of cholecystitis by CT was usually impossible. Detecting early stage of gallbladder cancer by CT is very rare, but it was of value for investigating the extent of advanced cancers. This tendency was also observed in biliary duct carcinoma, acute and chronic pancreatitis, and carcinoma of the pancreas. Consequently, it was concluded that CT is not appropriate for the purpose of early detection of pancreatic and other cancers. The use of CT with NMR is expected in future.

  7. Porcelain Gallbladder; Decoding the malignant truth

    Directory of Open Access Journals (Sweden)

    Norman O. Machado

    2016-11-01

    Full Text Available Gallbladder calcification, also referred to as porcelain gallbladder, has received significant attention in the medical literature due to its perceived role in increasing the risk of developing a gallbladder carcinoma. However, recent reports raise questions challenging this purported high risk. While previous studies reported a concomitant incidence of gallbladder cancer in porcelain gallbladder ranging from 7–60%, more recent analyses indicate the incidence to be much lower (6%. Based on evidence in the current literature, a prophylactic cholecystectomy is not routinely recommended for all patients with porcelain gallbladder and should be restricted to those with conventional indications, such as young patients. However, it is important to note that a nonoperative approach may require prolonged follow-up. A laparoscopic cholecystectomy is a feasible therapeutic option for patients with porcelain gallbladder, although some researchers have indicated a higher incidence of complications and conversion due to technical difficulties.

  8. Gall bladder perforation in acalculous cholecystitis

    OpenAIRE

    Dayananda Srinivasan; Sujith Sherigar; Durganna Thimmappa

    2014-01-01

    Acute acalculous cholecystitis is relatively rare as compared to the calculous cholecystitis. But complications like gangrenous changes and Gall bladder (GB) perforation is more common with acalculous variety than calculous cholecystitis.GB perforation following acalculous cholecystitis has a mortality of 10-50 % as compared to that of 1% following calculous cholecystitis. The literarature pertaining to this is very few and does not conclude a standard mangement in such cases. ...

  9. Angiosarcoma of the Gallbladder: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Alexandre N Odashiro

    2005-01-01

    Full Text Available A 62-year-old white woman with an unremarkable past medical history presented with acute cholecystitis. A cholecystectomy was performed, revealing an acute hemorrhagic and chronic cholecystitis associated with cholelithiasis. Two months after the operation, the patient developed a massive hemoperitoneum and died by hypo-volemic shock. At autopsy, an angiosarcoma measuring 5 cm in diameter was found in the liver, at the site of the gallbladder fossa. There were multiple hepatic, splenic, ovarian and peritoneal metastases and a massive hemoperitoneum consisting of 8 L of blood and blood clots. Review of the tissue sections from the patient's gallbladder confirmed the presence of an acute hemorrhagic and chronic cholecystitis and also revealed residual foci of an angiosarcoma. A review of eight previously reported cases of gallbladder angiosarcoma is also presented.

  10. Colonic perforation in Behcet's syndrome

    Institute of Scientific and Technical Information of China (English)

    Catherine M Dowling; Arnold DK Hill; Carmel Malone; John J Sheehan; Shona Tormey; Kieran Sheahan; Enda McDermott; Niall J O'Higgins

    2008-01-01

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  11. Colonic perforation in Behcet's syndrome.

    Science.gov (United States)

    Dowling, Catherine-M; Hill, Arnold-Dk; Malone, Carmel; Sheehan, John-J; Tormey, Shona; Sheahan, Kieran; McDermott, Enda; O'Higgins, Niall-J

    2008-11-14

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  12. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    Science.gov (United States)

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-05-08

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

  13. Experience of Laparoscopic Technology in the Early Diagnosis and Treatment of Digestive Tract Perforation%腹腔镜技术在消化道穿孔早期诊断和治疗中的应用体会

    Institute of Scientific and Technical Information of China (English)

    陶亮; 翁晓晖; 孔晓武; 陆逸庭

    2015-01-01

    Objective To summarize the clinical experience of laparoscopic technique in the diagnosis and treatment of acute perforation of digestive tract . Methods A retrospective analysis was made on 122 cases of acute gastrointestinal perforation treated by laparoscopic surgery in our hospital from January 2009 to January 2013, 95 of which were definitely diagnosed as digestive tract perforation before surgery and 27 of which were suspected as acute gastrointestinal perforation for laparoscopic exploration . Results There were 72 cases of gastric ulcer perforation , 38 cases of duodenal ulcer perforation , 3 cases of gallbladder perforation , 2 cases of intra-abdominal hernia , 3 cases of small bowel perforation , 1 case of malignant neoplasm perforation of transverse colon , 1 case of spontaneous perforation of sigmoid colon , and 2 cases of appendiceal perforation .The perforation diameter was 0.3-1.3 cm ( mean, 0.6 cm).All the operations were successful without complications .Mild postoperative pain was noted in patients without use of analgesics.Postoperative hospital stay was 5-9 days (mean, 6.5 days).Follow-up observations in 110 patients for 3-18 months (mean, 16 months) showed no recurrence and complications such as perforation or bowel obstruction . Conclusion Laparoscopic surgery in the treatment of perforated gastric or duodenal ulcer is safe and reliable .For unconfirmed perforation of digestive tract , early abdominal exploration is applicable .%目的:总结腹腔镜技术诊治急性消化道穿孔的临床经验。方法回顾性分析2009年1月~2013年1月122例术前考虑急性消化道穿孔施行腹腔镜手术的临床资料,其中术前95例明确诊断为消化道穿孔,27例考虑急性消化道穿孔行腹腔镜探查。结果胃溃疡穿孔72例,十二指肠球部溃疡穿孔38例,胆囊穿孔3例,腹内疝2例,小肠穿孔3例,横结肠恶性肿瘤穿孔1例,乙状结肠自发性穿孔1例,阑尾穿孔2例;穿孔直径0

  14. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    OpenAIRE

    Olfa Kassar; Feten Kallel; Manel Ghorbel; Hatem. Bellaaj; Zeineb Mnif; Moez Elloumi

    2015-01-01

    Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patie...

  15. Reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Yadav Mukesh

    2009-01-01

    Full Text Available Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  16. Nursing Observation of Peptic Ulcer Perforation Acute Perioperative%探析消化性溃疡急性穿孔围手术期的护理效果观察

    Institute of Scientific and Technical Information of China (English)

    王雅秋

    2015-01-01

    目的:探讨消化性溃疡急性穿孔围手术期的护理效果。方法选取本院收治的消化性溃疡急性穿孔手术患者84例,比较围手术期护理干预与常规护理的效果。结果干预组患者的并发症发生率明显低于对照组,护理满意度明显高于对照组,P<0.05,具有统计学意义。结论对消化性溃疡急性穿孔患者进行围手术期护理干预,可以有效减少术后并发症,提高患者痊愈率和治疗效果,提高患者的护理满意度,值得临床广泛应用。%Objective To investigate the acute peptic ulcer perforation effect of perioperative nursing. Methods Select our hospital with acute peptic ulcer perforation 84 cases of surgical patients, comparing perioperative nursing intervention and usual care results. Results Complications in patients in the intervention group were signiifcantly lower than the control group, Significantly higher satisfaction with care, P<0.05, statistically significant. Conclusion Patients with peptic ulcer perforation acute perioperative nursing intervention can effectively reduce postoperative complications. Improve the cure rate and treatment of patients, improve patient care and satisfaction, is worthy of wider application.

  17. Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

    Institute of Scientific and Technical Information of China (English)

    Tomohide Hori; Takashi Wagata; Kenji Takemoto; Takanobu Shigeta; Haruko Takuwa; Koichiro Hata; Shinji Uemoto; Naoki Yokoo

    2008-01-01

    A 71-year-old Japanese man with acute cholecystitis and an incarcerated gallbladder (GB) stone was admitted. Plain ultrasonography (US) incidentally detected a mass-like lesion in the fundus. Doppler US revealed that this elevated lesion had no blood flow. Computed tomography showed a relatively low-density mass, measuring 5 cm×4 cm in diameter, with no positive enhancement. Magnetic resonance imaging showed a mass in the fundus with a slightly low intensity on T1-weighted images and a slightly high intensity on T2-weighted images. We were agonized in making the qualitative diagnosis of mass-like lesions of the fundus, such as a benign tumor, cancer, or debris. We performed laparoscopic cholecystectomy, because the incarcerated GB stone clearly caused acute cholecystitis. Intra-operative cholangiography clearly revealed pancreaticobiliary maljunction. Amylase levels in the common bile duct and gallbladder were quite high. The elevated lesion in the fundus clearly showed severe necrosis. Although this necrotic nodule included non-viable adenocarcinoma cells, viable cancer cell nests were located in the muscularis propria and subcutaneous layer. Histopathological examination confirmed a solid adenocarcinoma. Thus, we diagnosed it as a gallbladder cancer, based on histopathological analysis of the resected specimen. We therefore undertook radical surgery, including wedge resection of the liver, radical dissection of regional lymph nodes, and resection of the extrahepatic bile duct. Histopathological findings revealed no cancer, hyperplasia or dysplasia in the additionally resected specimens. The patient was finally staged as T2, NO, H0, P0, M(-), stage 11. We present the first case of spontaneous necrosis of solid gallbladder adenocarcinoma, with a review of previous studies.

  18. Relationship between cholecystolithiasis and polypoid gallbladder

    Institute of Scientific and Technical Information of China (English)

    吴爱姣; 李英奇; 杜理安

    2003-01-01

    Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder( PLG),260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B( without cholecystolithiasis) . The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyper-plasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P < 0.01).Conclusion : Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.

  19. Relationship between cholecystolithiasis and polypoid gallbladder

    Institute of Scientific and Technical Information of China (English)

    吴爱姣; 李英奇; 杜理安

    2003-01-01

    Objective: To study the relationship between cholecystolithiasis and polypoid gallbladder(PLG), 260 patients with polypoid gallbladder were investigated. The patients were divided into 2 groups: group A (PLG combined with cholecystolithiasis) and group B(without cholecystolithiasis). The clinical pathological characteristics were analyzed. The intestinal epithelium metaplasia and atypical hyperplasia of the gallbladder mucosa were observed under light microscope. Results: Intestinal epithelium metaplasia and atypical hyperplasia of gallbladder mucosa were found in 47 of the 260 cases. The pathological lesions included 16 gallbladder carcinoma, 11 adenomatosis polyp, 5 myoadenoma, 7 cholesterol polyp, 4 inflammatory polyp and 4 adenomatosis hyperplasia, which occurred in 26 and 21 patients in group A and group B , i.e. 44.0% and 10.3% respectively. The difference between group A and group B was statistically significant (P<0.01). Conclusion: Cholecystolithiasis and the succeeding inflammatory reaction is a risk-factor for the polypoid gallbladder to develop tumour.

  20. Intestinal perforation by an ingested foreign body*

    Science.gov (United States)

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F. S.; de Castro, Francisco Gomes; Miller, Wagner Peitl; de Lima, Raphael Rodrigues; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    Objective To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. PMID:27818542

  1. Intestinal perforation by an ingested foreign body

    Directory of Open Access Journals (Sweden)

    Gabriel Cleve Nicolodi

    Full Text Available Abstract Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases, increased density of mesenteric fat (in all four cases, identification of the foreign body passing through the intestinal wall (in three cases, and gas in the peritoneal cavity (in one case. Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

  2. Patient with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas.

    Science.gov (United States)

    Kanehiro, Tetsuya; Tsumura, Hiroaki; Ichikawa, Toru; Hino, Yuji; Murakami, Yoshiaki; Sueda, Taijiro

    2008-01-01

    We report an 84-year-old man with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. The patient was admitted for abdominal pain, abdominal swelling, and consciousness disorder 18 days after the onset. Abdominal computed tomography (CT) revealed emphysema in the gallbladder and a small amount of intraperitoneal free gas. Intraoperative findings suggested gangrenous cholecystitis. The gallbladder wall was perforated, and an abscess involving the right subphrenic region, the periphery of the liver and gallbladder, and the right paracolonic groove, was detected. The flare on the body surface may have reflected abscess formation in the right abdominal cavity. Emphysematous cholecystitis induces necrosis and perforation in many patients, and immediate strategies such as emergency surgery are important.

  3. The clinical effect and value in the treatment of elderly patients with severe acute cholecystitis with CT guided gallbladder drainage tube%CT引导胆囊穿刺引流在高龄急性重症胆囊炎治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    张安红; 马杰; 张宝民; 胡孝祯; 姜远辉

    2014-01-01

    目的:分析CT引导下胆囊穿刺置管引流在治疗高龄急性重症胆囊炎病人中的临床效果及价值。方法回顾性分析2014年2月至2015年8月共38例高龄急性重症胆囊炎病人,经CT引导下胆囊穿刺置管引流,观察并分析此干预方法在病人临床转归中的作用和价值。结果38例病人均经急诊行CT引导胆囊穿刺引流成功且效果明显,术后2天体温恢复正常,术后当天腹痛缓解率84.2%(32/38)。其中28例(73.7%)病人术后1~8周顺利实施二期手术治疗,无1例死亡。结论CT引导胆囊穿刺引流作为一种安全有效的高龄急性重症胆囊炎的急症干预手段,不仅能缓解病人的急症病情,而且能为二期手术治疗创造有利准备条件。%Objective TTo analyze the clinical effect and value in the treatment of elderly patients withsevere acute cholecystitis with CT guided gallbladder drainage tube. Methods To review and analyze the 38cases of elderly patients with severe acute cholecystitis, since February 2014 to August 2014, in order to observe andanalyze the role of this intervention method in the patient's clinical outcomes and value. Results 38 patientsreceived successfully emergency row CT guided puncture drainage of gallbladder and had obvious effects; thetemperature returned to normal after two days of postoperative; the abdominal pain remission rate is 84.2%(32/38) at that day. 28 cases (73.7%) patients received the surgical treatment after the drainage treatment 1 to8 weeks, no one case died. Conclusion CT guided puncture drainage of gallbladder as a safe and effectiveemergency interventions - severe acute cholecystitis, can not only alleviate the acute illness of the patient, butalso gain the better conditions for the second stage surgery treatment.

  4. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Rosenberg, Jacob; Alamili, Mahdi

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration...... in patients with acute perforated appendicitis....

  5. [Mucoprotein secretion in calculous gallbladder].

    Science.gov (United States)

    Fernández Lobato, R; Ortega, L; Balibrea, J L; Torres, A J; García-Calvo, M; Alvarez Sánchez, J A

    1994-05-01

    Secretion of mucoproteins or mucine (MP) have been studied as possible markers in several pathological conditions of the digestive tract, such us colonic polyposis or gastric dysplasia. In the gallbladder (VB) it has been established that form the core of crystalization for the calculi. A study in 100 gallbladders have been made based on the utility of the analysis of the qualitative and quantitative modifications of MP in lithogenesis. It was been determined by histochemical techniques the three main types of MP (neutral, low and high sulphated acid) to evaluate the alterations in the process of lithiasis. Results show a high production of the MP in VB with lithiasis, presenting in 97% a mixed composition of MP (48.9% of 2 types, and 3 types in 46%), without a predominating type in this pathology.

  6. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  7. Computed Tomography Features of Spontaneously Perforated Pyometra: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Chan, K.S.; Tan, C.K.; Mak, C.W.; Chia, C.C.; Kuo, C.Y.; Yu, W.L. [Chi-Mei Medical Center, Tainan, Taiwan (China). Depts. of Intensive Care Medicine, Radiology, Obstetrics and Gynecology, and Surgery

    2006-03-15

    Spontaneous perforation of pyometra is an extremely rare emergent gynecologic disease. We report a 73-year-old woman with a spontaneously perforated pyometra presenting with acute abdomen in the emergency department. A dedicated computed tomography examination of the abdominal and pelvic regions revealed the diagnosis. The patient recovered well after surgical intervention and antibiotic treatment.

  8. An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report

    Science.gov (United States)

    Agarwal, Rachna; Suneja, Amita; Sharma, Abha; Vaid, Neelam Bala

    2011-01-01

    Introduction By presenting this case we aimed to describe an uncommon complication of generalized peritonitis following spontaneous pyometra perforation in untreated cervical carcinoma. Case Presentation This report describes a 60-year-old postmenopausal woman presenting with clinical features mimicking intestinal perforation who was later diagnosed as cervical carcinoma with pyometra perforation at exploratory laparotomy. The patient had good post-operative recovery following drainage and peritoneal lavage. Conclusion Spontaneous pyometra perforation in a case of untreated carcinoma of cervix is a rare condition, yet it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. PMID:23926508

  9. Spontaneous common bile duct perforation due to periampullary growth

    Directory of Open Access Journals (Sweden)

    Pandiaraja Javabal

    2014-06-01

    Full Text Available Spontaneous common bile duct perforations are an unusual cause of acute abdomen. In spontaneous common bile duct perforation, malignant growth is even rare. It is a rare entity usually reported in infants and children due to congenital anomalies. It is rarely reported in adults. In this case report, a 55 - year - old male patient who was diagnosed as a duodenal perforation in the pre - operative period, but the intra - operative findings was common bile duct perforation due to periampullary growth, is reported

  10. An alien in the gallbladder. A rare case of biliary ascariasis in an Italian emergency department

    Directory of Open Access Journals (Sweden)

    Enrico Ferri

    2016-04-01

    Full Text Available Ascariasis is a common infection in many developing countries. The prevalence of ascariasis is related to poverty, poor hygienic and sanitary conditions. The adult form of Ascaris lumbricoides usually resides in the human intestinal lumen (more frequently in the jejunum and middle ileum and does not cause symptoms. However, it can occasionally cause severe complications such as intestinal obstruction or perforation peritonitis. Its migration into the biliary tract is not uncommon but gallbladder involvement is very rare. Abdominal ultrasonography is essential to detect the presence of this parasite. In this article, we describe the radiologic findings, clinical manifestations and successful medical treatment of a patient with gallbladder ascariasis diagnosed in an emergency setting.

  11. Design and application of a new series of gallbladder endoscopes that facilitate gallstone removal without gallbladder excision

    Science.gov (United States)

    Qiao, Tie; Huang, Wan-Chao; Luo, Xiao-Bing; Zhang, Yang-De

    2012-01-01

    In recent years, some Chinese doctors have proposed a new concept, gallstone removal without gallbladder excision, along with transition of the medical model. As there is no specialized endoscope for gallstone removal without gallbladder excision, we designed and produced a new series of gallbladder endoscopes and accessories that have already been given a Chinese invention patent (No. ZL200810199041.2). The design of these gallbladder endoscopes was based on the anatomy and physiology of the gallbladder, characteristics of gallbladder disease, ergonomics, and industrial design. This series of gallbladder endoscopes underwent clinical trials in two hospitals appointed by the State Administration of Traditional Chinese Medicine. The clinical trials showed that surgeries of gallstones, gallbladder polyps, and cystic duct calculus could be smoothly performed with these products. In summary, this series of gallbladder endoscopes is safe, reliable, and effective for gallstone removal without gallbladder excision. This note comprehensively introduces the research and design of this series of gallbladder endoscopes.

  12. Tempol protects the gallbladder against ischemia/reperfusion.

    Science.gov (United States)

    Gomez-Pinilla, Pedro J; Camello, Pedro J; Tresguerres, Jesus A F; Pozo, María José

    2010-06-01

    Impairment in gallbladder emptying, increase in residual volume, and reduced smooth muscle contractility are hallmarks of acute acalculous cholecystitis and seem to be related to ischemia/reperfusion (I/R). This study was designed to determine the effects of tempol, a general antioxidant, on I/R-induced changes in gallbladder contractile capacity, the mechanisms involved in the contractile process, and the level of inflammatory mediators. Experimental gallbladder I/R was induced in male guinea pigs by common bile duct ligation for 2 days, then a deligation of the duct was performed and after 2 days the animals were sacrificed. A group of animals was treated with tempol, administered in the drinking water at 1 mmol/l for 10 days prior the bile duct ligation and until animal sacrifice. Isometric tension recordings showed that KCl and cholecystokinin-induced contractions were impaired by I/R, which correlated with decreased F-actin content and detrimental effects on Ca(2+) influx. In addition, I/R depolarized mitochondrial membrane potential, as indicated by the reduction of the heterogeneity of the rhodamine123 fluorescence signal, and increased the expression of NF-kappaB, COX-2, and iNOS. Tempol treatment improved contractility via normalization of Ca(2+) handling and improvement of F-actin content. Moreover, the antioxidant ameliorated mitochondrial polarity and normalized the expression levels of the inflammatory mediators. These results show that antioxidant treatment protects the gallbladder from I/R, indicating the potential therapeutic benefits of tempol in I/R injury.

  13. Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

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    Psaila Josephine

    2009-10-01

    Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

  14. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    M. Bröker (Mirelle); E.M.M. van Lieshout (Esther); M. van der Elst (Maarten); L.P. Stassen (Laurents); T. Schepers (Tim)

    2012-01-01

    textabstractBackground: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. Methods: All consecutive patients who have under

  15. Infantile perforated appendicitis: A forgotten diagnosis

    Directory of Open Access Journals (Sweden)

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  16. Traumatic and nontraumatic perforation of hollow viscera.

    Science.gov (United States)

    Espinoza, R; Rodríguez, A

    1997-12-01

    Hollow viscus injuries are usually managed with few complications. However, if their diagnosis is delayed, or if reparative suture closure should fail, the patient is placed at risk of multiple organ failure. This article presents diagnostic approaches, emphasizing imaging modalities, and therapeutic strategies for three clinical scenarios of hollow viscus perforation: 1) acute appendicitis, 2) gastroduodenal peptic ulcer disease, and 3) trauma.

  17. Postoperative chemoradiotherapy for gallbladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Chie, E.K.; Ha, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Seoul National Univ. (Korea, Republic of). Inst. of Radiation Medicine; Jang, J.Y.; Kim, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Surgery; Han, S.W.; Oh, D.Y.; Im, S.A.; Kim, T.Y.; Bang, Y.J. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Internal Medicine

    2012-05-15

    The goal of this work was to analyze the outcome of adjuvant chemoradiotherapy for patients with gallbladder cancer who underwent surgical resection and to identify the prognostic factors for these patients. Between August 1989 and November 2006, 47 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 26 females, and median age was 60 years (range 44-75 years). Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40-50 Gy at 2 Gy/fraction; 41 patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 48 months for survivors. There were 2 isolated locoregional recurrences, 14 isolated distant metastases, and 7 combined locoregional and distant relapses. The 5-year overall survival rate was 43.7%. According to the extent of resection, the 5-year overall survival rates were 52.8%, 20.0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p = 0.0038). On multivariate analysis incorporating extent of resection, T stage, N stage, performance of lymph node dissection, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p = 0.0075). Among the 37 patients with R0 resection, there was no difference of 5-year overall survival rates in patients with N0, N1, and Nx diseases (46.2%, 60.0%, and 44.4%, respectively, p = 0.6246). As for significant treatment-related morbidity, there was only 1 patient with grade 4 gastric ulcer. Adjuvant chemoradiotherapy after R0 resection can achieve a good long-term survival rate in gallbladder cancer patients, even in those with lymph node metastases, and may play a role for patients who underwent R0 resection of primary tumor without lymph node dissection. (orig.)

  18. Perforated jejunal diverticulum in the use of mycophenolate mofetil

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    Charat Thongprayoon

    2014-01-01

    Full Text Available Context: Jejunal diverticulosis is a rare disease. Common acute complications include diverticulitis, intestinal obstruction, bleeding and perforation. Gastrointestinal tract perorations have also been rarely observed in the use of mycophenolate mofetil. Case Report: We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued. Conclusion: The present case illustrates jejunal diverticulum perforation in the use of mycophenolate mofetil. Physicians should increase the awareness of this association of perforated jejunal diverticulum in patients using mycophenolate mofetil.

  19. Perforated duodenal ulcer: Emerging pattern

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    Murtaza Ali Asger Calcuttawala

    2014-01-01

    Full Text Available Background: A total of 27 patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied. Materials and Methods: All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham′s omental patch was carried out. This was followed by triple regimen for Helicobacter pylori eradication. Results: All patients were male, maximum incidence (61.54% was noted in the age group of 21-30, ′O′ +ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between the start of symptoms and surgery was 43 h. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series. Conclusion: We conclude that although a number of definitive surgeries have been described for acid peptic disease, but the requirement of such procedures has come down due to increasing use of H. pylori eradication therapy and proton pump inhibitors. However, surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence is greater in young males.

  20. Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding

    Institute of Scientific and Technical Information of China (English)

    Andrea Cavallaro; Gaetano Piccolo; Vincenzo Panebianco; Emanuele Lo Menzo; Massimiliano Berretta; Antonio Zanghì; Maria Di Vita; Alessandro Cappellani

    2012-01-01

    AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography (CT)].Patients with gallbladder cancer (GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival (DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients (11 women and eight men) were found to have GBC.The male to female ratio was 1∶1.4 and the mean age was 68 years (range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis (1),pT1a (2),pT1b (4),pT2 (6),pT3 (4),pT4 (2); five cases with stage Ⅰa (T1 a-b); two with stage Ⅰb (T2 N0); one with stage Ⅱa (T3 N0); six with stage Ⅱb (T1-T3 N1); two with stage Ⅲ (T4 Nx Nx); and one with stage Ⅳ (Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage (≤ Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT (nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case),porcelain gallbladder (one case),gallbladder adenoma (one case),and chronic cholelithiasis (eight cases

  1. Duodenal Perforation Precipitated by Scrub Typhus

    OpenAIRE

    Raghunath Rajat; David Deepu; Arul Jeevan Jonathan; Abhilash Kundavaram Paul Prabhakar

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical explora...

  2. Clinical effect of 50 cases of laparoscopic surgery for acute gastric ulcer perforation%腹腔镜手术治疗急性胃十二指肠溃疡穿孔50例疗效分析

    Institute of Scientific and Technical Information of China (English)

    王丽丽; 赵鸿雁

    2015-01-01

    目的:探讨腹腔镜手术治疗急性胃十二指肠溃疡穿孔的临床疗效。方法:收治急性胃十二指肠溃疡穿孔患者50例,随机分为观察组和对照组,各25例。对照组应用传统开腹手术治疗,观察组应用腹腔镜手术治疗,比较两组的术中出血量、术后肛门排气时间、住院时间及术后并发症情况。结果:治疗后观察组的术中出血量少于对照组(P<0.05);观察组术后肛门排气时间、住院时间明显短于对照组(P<0.05);治疗结束时观察组并发症少于对照组(P<0.05)。结论:腹腔镜手术治疗急性胃十二指肠溃疡穿孔临床效果良好,能减少出血、缩短住院时间,避免并发症。%Objective:To discuss the clinical effect of laparoscopic surgery for acute gastric ulcer perforation.Methodds:50 patients with acute gastric ulcer perforation were selected.They were randomly divided into the observation group and the control group,each of 25 cases.The control group were treated with the traditional open operation.The observation group were treated with laparoscopic operation.The amount of bleeding,postoperative anal exhaust time,hospitalization time and postoperative complications were compared between the two groups.Results:The amount of bleeding in the observation group was less than that of the control group(P<0.05).The postoperative anal exhaust time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05).At the end of treatment of complications in the observation group was less than the control group(P<0.05).Conclusion:The clinical effect of laparoscopic surgery for acute gastric ulcer perforation is outstanding.It can reduce the bleeding,shorten the hospital stay,avoid complications.

  3. Observation on the Clinical Effect of Different Surgical Treatment of Acute Gastric Perforation%不同术式治疗急性胃穿孔的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    向波

    2013-01-01

      目的:观察并分析采用不同术式来进行急性胃穿孔治疗的临床效果。方法:对临床选取的120例急性胃穿孔患者的住院病历资料进行分析分组,将行单纯修补术的60例患者定为实验组;将胃大部切除术60例患者定为对照组。分别对比两组患者的各项临床指标如治疗效果、溃疡复发Visick分级、并发症等,记录分析。结果:试验组患者的治疗效果、溃疡复发情况等临床指标与比较对照组,差异具有统计学意义(P<0.05)。结论:在治疗急性胃穿孔时采用单纯修补手术的方法优势比较明显。%Objective:To observe and analyze the different operation to the clinical effect of treatment of acute gastric perforation. Method:To clinical selected 120 acute hospital medical records patients with gastric perforation analysis grouping,who were divided into two groups,60 patients with simple repair for the experimental group;gastrectomy 60 patients were in the control group. Contrast the two groups of patients the clinical indicators such as the treatment effect,ulcer recurrence Visick grading,complications recorded. Result:The different groups of patients were compared we can see that the treatment of patients of the control group,ulcer recurrence and clinical parameters of the were significantly less than the experimental group,and statistical analysis(P<0.05),the difference was statistically significant. Conclusion:The more obvious in the treatment of acute gastric perforation using method operation simple repair.

  4. Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer.

    Science.gov (United States)

    Inoue, Tadahisa; Okumura, Fumihiro; Mizushima, Takashi; Nishie, Hirotada; Iwasaki, Hiroyasu; Anbe, Kaiki; Ozeki, Takanori; Kachi, Kenta; Fukusada, Shigeki; Suzuki, Yuta; Watanabe, Kazuko; Sano, Hitoshi

    2015-01-01

    We encountered a case of localized IgG4-cholecystitis mimicking gallbladder cancer with focal/segmental type1 autoimmune pancreatitis (AIP). In this case, we were unable to exclude a diagnosis of gallbladder cancer and thus performed radical cholecystectomy. Type1 AIP is often associated with gallbladder lesions, accompanied by generally diffuse, circumferential thickening of the gallbladder wall. Although localized IgG4-related cholecystitis is extremely rare, differentiating this condition from gallbladder cancer is often very difficult.

  5. Intramural hypoattenuated nodules in thickened wall of the gallbladder; CT features according to their primary causes

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Hyung; Ha, Hyun Kwon; Lee, Jeong Hyun; Lee, Jean Hwa; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Myung-Jin [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-02-01

    According to published reports, a common feature of xanthogranulomatous cholecystitis is the presence of intramural hypoattenuated nodules in thickened gallbladder wall. These nodules can, however, also be seen in pathological conditions such as acute cholecystitis, hyperplastic cholecystoses (cholesterolosis and adenomyomatosis), gallbladder cancer, and other inflammatory diseases such as tuberculosis. Retrospective review of the abdominal CT findings in 622 patients who for various reasons underwent cholecystectomy during a one-year period showed that intramural nodules were present in 60. In this pictorial essay we illustrate the imaging features of the many different pathological conditions which give rise to intramural hypoattenuated nodules in thickened wall of the gallbladder, correlating these features with the histopathological findings.

  6. A rare case of ascariasis in the gallbladder, choledochus and pancreatic duct.

    Science.gov (United States)

    Gönen, Korcan Aysun; Mete, Rafet

    2010-12-01

    Due to the anatomical characteristics of the biliary tract, Ascaris lumbricoides rarely settles in the gallbladder, which makes biliary ascariasis a rare clinical condition. Ultrasonography plays a significant and practical role in the diagnosis and follow-up of suspected cases of biliary ascariasis. The 15-year-old case presented herein had been complaining of abdominal pain and dyspepsia for three months, and the clinical and laboratory findings for the patient indicated acute abdomen. Abdominal ultrasonography showed worms consistent with Ascaris inside a normal-sized gallbladder, dilated choledochus and the pancreatic duct. We started antiparasitic treatment in the patient, with cholangitis and pancreatitis diagnoses. Post-treatment follow-up ultrasonography showed a normal gallbladder, choledochus and pancreatic duct.

  7. The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal.

    Directory of Open Access Journals (Sweden)

    Sabina Dongol

    Full Text Available Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

  8. The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal.

    Science.gov (United States)

    Dongol, Sabina; Thompson, Corinne N; Clare, Simon; Nga, Tran Vu Thieu; Duy, Pham Thanh; Karkey, Abhilasha; Arjyal, Amit; Koirala, Samir; Khatri, Nely Shrestha; Maskey, Pukar; Poudel, Sanjay; Jaiswal, Vijay Kumar; Vaidya, Sujan; Dougan, Gordon; Farrar, Jeremy J; Dolecek, Christiane; Basnyat, Buddha; Baker, Stephen

    2012-01-01

    Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

  9. Sonographic Gallbladder Abnormality Is Associated with Intravenous Immunoglobulin Resistance in Kawasaki Disease

    Directory of Open Access Journals (Sweden)

    Chih-Jen Chen

    2012-01-01

    Full Text Available Objective. Kawasaki disease (KD is an acute systematic vasculitis in children which causes coronary arterial lesions and hydrops of gallbladder. Our objective is to correlate the clinical significance and influence on disease outcome of patients with gallbladder abnormalities in Kawasaki dissease. Methods. Children who met KD diagnosis criteria and were admitted for IVIG treatment were retrospectively enrolled for analysis. Patients with abdominal sonography were divided into 2 groups based on the absence (Group A, N=61 or presence (Group B, N=16 of gallbladder abnormalities (GBA, defined as hydrops or acalculous cholecystitis. Between the two groups, clinical features, demographic data (including admission days, coronary artery lesions, IVIG resistance, and laboratory data before/after IVIG treatment were collected for analysis. Results. The presence of sonographic gallbladder abnormalities is correlated with higher levels of serum CRP, GPT, and neutrophils. It also points to an increased number of IVIG resistance rates in group B. There was no significant statistical difference among clinical features, age, gender, admission days, or coronary artery lesions between the two groups. Conclusion. Sonographic gallbladder abnormalities are associated with higher CRP, GPT, neutrophil and IVIG resistance in KD. It can be used as a predictor of IVIG resistance in patients with KD.

  10. Resected Pleomorphic Carcinoma of the Gallbladder

    Directory of Open Access Journals (Sweden)

    Masanari Shimada

    2012-12-01

    Full Text Available Pleomorphic carcinoma is a rare lesion and the literature contains few reports of pleomorphic carcinoma of the gallbladder. The present study reports a rare case of primary pleomorphic carcinoma of the gallbladder for which we were able to perform curative surgery. A 77-year-old woman with dementia developed nausea and anorexia, and computed tomography demonstrated irregular thickening of the gallbladder wall. Drip infusion cholangiography and endoscopic retrograde cholangiopancreatography revealed no stenosis of the common and intrahepatic bile ducts. We suspected carcinoma of the gallbladder without lymph node metastasis and invasion to the common bile duct. We guessed it to be resectable and performed open laparotomy. At operation, the fundus of the gallbladder was adherent to the transverse colon, but no lymph node and distant metastases were detected. Therefore, we performed curative cholecystectomy with partial colectomy. Histopathology and immunostaining showed coexistence of an adenocarcinoma, squamous cell carcinoma and sarcomatous tumor of spindle-shaped cell, as well as transition zones between these tumors. We diagnosed stage I pleomorphic carcinoma of the gallbladder. No recurrence has been observed for one and a half years. The biological behavior of pleomorphic carcinoma of the gallbladder remains unknown. It will be necessary to accumulate more case reports of this tumor in order to define diagnostic criteria.

  11. Strategies in Perforated Diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jefrey)

    2010-01-01

    textabstractAlthough diverticulitis is a common disease affecting the gastrointestinal tract, few is known about the optimal surgical treatment of its most severe form: perforated diverticulitis. Regardless of the selected operation, perforated diverticulitis is associated with mortality rates up to

  12. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman;

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to recon......Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap...... more practical and creative to use a free-style manner during pedicled perforator flap surgery, instead of being obliged to predefined templates for this type of procedure....

  13. Pneumoperitoneum Secondary to Spontaneously Perforated Pyometra

    Directory of Open Access Journals (Sweden)

    Benjamin A. Raymond

    2017-01-01

    Full Text Available Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention.

  14. A phantom gallbladder on endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Various complications have been related to laparoscopic cholecystectomy but most occur shortly after the procedure. In this report, we present a case with very late complications in which an abscess developed within the gallbladder fossa 6 years after laparoscopic cholecystectomy. The abscess resolved after treatment with CT-guided extrahepatic aspiration. However, 4 years later, an endoscopic retrograde cholangiopancreatography (ERCP) performed for choledocholithiasis demonstrated a "gallbladder" which communicated with the common bile duct via a patent cystic duct. This unique case indicates that a cystic duct stump may communicate with the gallbladder fossa many years following cholecystectomy.

  15. Gallbladder Tuberculosis Mimicking Gallbladder Carcinoma: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Yao Liu

    2016-01-01

    Full Text Available Gallbladder tuberculosis (GT is extremely rare, and it is difficult to differentiate from other gallbladder diseases, such as gallbladder carcinoma and Xanthogranulomatous Cholecystitis. A correct preoperative diagnosis of GT is difficult. The final diagnosis is usually made postoperatively according to surgical biopsy. Here, we report a case of a patient who underwent surgery with the preoperative diagnosis of gallbladder carcinoma. We reviewed the literature and present the process of differential diagnosis between two or more conditions that share similar signs or symptoms.

  16. Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

    Science.gov (United States)

    Alpuerto, Aldrin C.; Mora, Maximo E.

    2017-01-01

    Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer. PMID:28251014

  17. Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aldrin C. Alpuerto

    2017-01-01

    Full Text Available Primary pure squamous cell carcinoma (SCC of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer.

  18. Heterotopic pancreatic tissue in gallbladder

    Directory of Open Access Journals (Sweden)

    Aylhin Joana Lopez Marcano

    2016-12-01

    Full Text Available The heterotopic pancreas (PH is the atypical presence of pancreatic tissue without any anatomic or vascular continuity with the pancreas. PH is a rare condition that can be observed at any level of the gastrointestinal tract and even in other organs. Histopathological characterization of PH allows surgeons to distinguish it from other lesions. Although it is usually a benign and asymptomatic disease, it can occasionally cause complications (obstruction, hemorrhage, inflammation, or malignant transformation. In conclusion, localization in the gallbladder in the few cases of PH is very rare. We present two cases in which, after cholecystectomy indicated by other causes, in the pathological study of the surgical specimen, type 2 pancreatic tissue was found according to the Heinrich classification. [Arch Clin Exp Surg 2016; 5(4.000: 250-253

  19. Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease

    Science.gov (United States)

    Colak, Yasar; Bozbey, Gulcin; Erim, Tolga; Caklili, Ozge Telci; Ulasoglu, Celal; Senates, Ebubekir; Mutlu, Hasan Huseyin; Mesci, Banu; Doğan, Mehmet Sait; Tasan, Guralp; Enc, Feruze Yilmaz; Tuncer, Ilyas

    2016-01-01

    Background/Aims Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. Methods An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. Results Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. Conclusions Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD. PMID:26932908

  20. Clinical analysis of subtotal gastrectomy in treatment of 40 cases of acute peptic ulcer perforation%胃大部切除术治疗消化性溃疡急性穿孔40例临床分析

    Institute of Scientific and Technical Information of China (English)

    金德华

    2013-01-01

    Objective To investigate the clinical efficacy and safety of subtotal gastrectomy in the treatment of acute gastric ulcer perforation. Methods Eighty patients with acute gastric ulcer perforation admitted to our hospital from February 2009 to April 2011 were analyzed retrospectively.The observation group, consisting of 40 patients,received subtotal gastrectomy;The control group,consisting of 40 patients, received simple neoplasty.The postoperative ulcer recurrence rate,complications,hospital stay,operative time and other indicators of the two groups were compared. Results The observation group had 4 patients with grade Ⅲ Visick and 3 patients with grade Ⅳ Visick,and the control group had 6 patients with grade Ⅲ Visick and 7 patients with grade Ⅳ Visick,with statistically significant difference between the two groups (P0.05).The observation group and the control group had statistically significant differences in the operative time and hospital stay [(2.3±0.5) and (1.2±0.3) hours,(7.3±2.4) and (5.1±1.7) days,t=34.617,30.019,P=0.032,0.041]. Conclusion Subtotal gastrectomy has better long-term efficacy than simple gastric perforation repair.Under permitting conditions and with informed consent of patients, subtotal gastrectomy should be adopted as far as possible for patients with acute gastric perforation.%目的探讨胃大部分切除术急性胃溃疡穿孔的临床疗效及安全性。方法回顾性分析我院2009年2月~2011年4月收治的急性胃溃疡胃穿孔患者40例作为观察组,采用选胃大部切除术;选取同期行单纯修补术治疗急性胃溃疡胃穿孔患者40例作为对照组,比较两组术后溃疡复发率、并发症、住院天数及手术时间等各指标情况。结果观察组患者VisickⅢ级4例,VisickⅣ3例,对照组患者VisickⅢ级6例,VisickⅣ7例,二者差异有统计学意义(P<0.05);两组患者术后并发症发生率(5%和7.5%)比较,差异无统计学意义(P>0.05

  1. Clinical analysis of subtotal gastrectomy for patients of acute gastroduodenal ulcer perforation%一期胃大部切除术治疗胃十二指肠溃疡急性穿孔临床分析

    Institute of Scientific and Technical Information of China (English)

    朱武东; 邓光华

    2014-01-01

    目的:观察一期胃大部切除术治疗胃十二指肠溃疡急性穿孔的临床疗效。方法:选取进行胃十二指肠溃疡急性穿孔手术治疗的178例患者为研究对象,随机分为对照组(单纯开腹修补术)89例和试验组(一期胃大部切除术)89例。术后分别观察两组患者的临床疗效并进行统计学分析。结果:术后1~3年,随访观察发现:①试验组的溃疡复发率为10.11%,二次穿孔复发率为6.74%,并发症发生率为8.99%,均低于手术对照组,两组比较差异具有统计学意义( P<0.05)。②试验组患者对于手术后治疗效果的满意率为94.38%,明显高于对照组的78.65%,两组比较差异有统计学意义( P<0.05)。结论:一期胃大部切除术治疗胃十二指肠溃疡急性穿孔长期疗效好,患者满意度高,术后溃疡复发率较低,并发症相对于保守治疗组较少,适用于长期急重症患者。%Objective To observe the clinical effects of subtotal gastrectomy for patients of acute gastroduodenal ulcer perforation. Methods 178 cases of acute gastroduodenal ulcer perforation treated by operation were divided into control group( operation on simple clo-sure with open)with 89 cases and treatment group( subtotal gastrectomy)with 89 cases. The clinical effects of two groups were observed and statistical analyzed. Results After 1~3 years follow-up observation:①The ulcer recurrence rate of treatment group was 10. 11%, the second gastric perforation was 6. 74%,the incidence of complication was 8. 99%,all these three data were lower than control group. The difference was statistical significance(P<0. 05). Conclusion The long-term results of subtotal gastrectomy for patients of acute gas-troduodenal ulcer perforation was good. The satisfactory was better. The ulcer recurrence rate and the incidence of complication were lower than traditional treatment. It′s fit for critical patients.

  2. Acute otitis externa.

    Science.gov (United States)

    Hui, Charles Ps

    2013-02-01

    Acute otitis externa, also known as 'swimmer's ear', is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  3. Acute otitis externa

    OpenAIRE

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  4. The systematic classification of gallbladder stones.

    Directory of Open Access Journals (Sweden)

    Tie Qiao

    Full Text Available BACKGROUND: To develop a method for systematic classification of gallbladder stones, analyze the clinical characteristics of each type of stone and provide a theoretical basis for the study of the formation mechanism of different types of gallbladder stones. METHODOLOGY: A total of 807 consecutive patients with gallbladder stones were enrolled and their gallstones were studied. The material composition of gallbladder stones was analyzed using Fourier Transform Infrared spectroscopy and the distribution and microstructure of material components was observed with Scanning Electron Microscopy. The composition and distribution of elements were analyzed by an X-ray energy spectrometer. Gallbladder stones were classified accordingly, and then, gender, age, medical history and BMI of patients with each type of stone were analyzed. PRINCIPAL FINDINGS: Gallbladder stones were classified into 8 types and more than ten subtypes, including cholesterol stones (297, pigment stones (217, calcium carbonate stones (139, phosphate stones (12, calcium stearate stones (9, protein stones (3, cystine stones (1 and mixed stones (129. Mixed stones were those stones with two or more than two kinds of material components and the content of each component was similar. A total of 11 subtypes of mixed stones were found in this study. Patients with cholesterol stones were mainly female between the ages of 30 and 50, with higher BMI and shorter medical history than patients with pigment stones (P<0.05, however, patients with pigment, calcium carbonate, phosphate stones were mainly male between the ages of 40 and 60. CONCLUSION: The systematic classification of gallbladder stones indicates that different types of stones have different characteristics in terms of the microstructure, elemental composition and distribution, providing an important basis for the mechanistic study of gallbladder stones.

  5. Acute acalculous cholecystitis due to an incarcerated epigastric hernia.

    OpenAIRE

    1985-01-01

    A case of a 96 year old woman with an incarcerated gallbladder in an epigastric hernia causing acute acalculous cholecystitis is described. At operation the gallbladder was replaced in its anatomical site and the hernia was repaired. This unique case of acute acalculous cholecystitis demonstrates cystic duct obstruction and cystic vessel compression as possible aetiologies for this pathology.

  6. 326例上消化道溃疡穿孔诊治体会%Clinical analysis of 326 cases with acute perforation of upper digestive tract

    Institute of Scientific and Technical Information of China (English)

    解传仁; 尹锡洲; 殷容暖; 谢健; 郝永钟; 丁胜文

    2011-01-01

    Objective To study the clinical characteristics and the methods of diagnosis and treatment for peptic ulcer perforation. Method The clinical data of patients with peptic ulcer perforation treated from January 1995 to December 2009 were analyzed. Results There were 326 cases. Subdiaphragmatic free-air was shown in 240 cases. After injected air through gastric tube, positive rate was increased to 81.29%. Simple suture closure of the perforation were performed in 269 cases, subtotal gastrectomy in 18 cases,6 patients with selective vagotomy plus suture closure,while 33 cases were treated by conservative therapy. Conclusions Diagnosis could be achieved according to history physical sign and abdominal X-rays. Due to the increased prescriptions for NSAIDs,percentages of old patients increased in the same period. Simple suture closure of the perforation is simple, safe with less complication, and remain to be a modus operation of peptic ulcer perforation.%目的 探讨胃十二指肠溃疡穿孔的特征和治疗方法.方法 回顾本院1995-2009年收治的胃十二指肠溃疡穿孔患者病例资料,对年龄、发病至就诊时间、治疗等进行分析.结果 共收治胃十二指肠溃疡穿孔患者共326人.有240例可见不同程度的隔下游离气体,其中25例经胃管注气后再行腹部立卧位X线检查发现隔下游离气体,阳性率为81.29%.消化性溃疡患者中,35岁以下所占比重逐渐下降,而55岁以上患者的比率逐渐增加,老年性患者使用非甾体类消炎药的比率随时间的推移逐渐增加.269例行单纯穿孔缝合术,18例行胃大部分切除术,穿孔缝合+高选迷走神经切断6例,保守治疗33例.结论 根据病史、体征和积极的腹部X线一般可诊断.消化性溃疡的患者中,老年人的比率呈现逐渐增高的趋势,可能与老年性患者非甾体类消炎药使用机率的增加有关.上消化道溃疡穿孔行单纯缝合修补操作简单、安全、并发症少,术后结

  7. Human gallbladder morphology after gallstone dissolution with methyl tert-butyl ether.

    Science.gov (United States)

    vanSonnenberg, E; Zakko, S; Hofmann, A F; D'Agostino, H B; Jinich, H; Hoyt, D B; Miyai, K; Ramsby, G; Moossa, A R

    1991-06-01

    The effects of methyl tert-butyl ether exposure on the human gallbladder in five patients who were treated for gallstones by contact dissolution is described. Two patients underwent cholecystectomy within 1 week of methyl tert-butyl ether treatment, one patient 2 weeks after, another 10 weeks after, and one 12 weeks after. Indications for cholecystectomy were bilirubinate stones (resistant to methyl tert-butyl ether), catheter dislodgement, bile leakage, and gallstone recurrence (2 patients). Gallstones were dissolved completely in three patients, there was approximately 50% stone reduction in one patient, and no dissolution occurred in the fifth patient. Each gallbladder was examined grossly and histologically. Electron microscopic evaluation was performed in one cases. Typical inflammatory findings of chronic cholecystitis were observed in each gallbladder and were most conspicuous in the submucosa; the mucosal and serosal surfaces were intact. Mild acute inflammatory changes were noted in the submucosa in the two patients with the shortest interval between methyl tert-butyl ether administration and cholecystectomy. There were no ulcerations in the mucosa and no unusual wall thickening or fibrosis in any patient. These observations support the safety of methyl tert-butyl ether perfusion in the human gallbladder; the mild acute changes may be a transient and reversible phenomenon.

  8. A new exploration for gallbladder polyps: gallbladder polypectomy by endolap technique.

    Science.gov (United States)

    Wang, JingMin; Tan, YuYan; Zhao, Gang; Wang, Dong; Ji, ZhenLing

    2014-12-01

    Abstract Gallbladder polyps are most commonly treated with cholecystectomy, which is associated with various complications. For benign disease, preserving the gallbladder is preferable. Since 1994, we have been exploring percutaneous polypectomy and have recently developed an improved new technique. This study reports a new endoscopic-laparoscopic (Endolap) technique for the removal of polyps and the preservation of the gallbladder. Nine Chinese mini-pigs were used to observe mucosal regeneration. Microwaves of 50-70 mA for 9 seconds were safe, and the gallbladder mucosa of pigs recovered to nearly normal 2 weeks later. In the clinical cases, 60 patients with gallbladder polyps were studied. With the patient under general anesthesia, each polyp stem was coagulated, and then the polyp was removed. All procedures were successful at between 60 and 135 minutes. The success rate was 93.33% (56/60). A retrospective analysis was conducted to assess the recovery of gallbladder function. All patients were followed up and symptom-free, without recurrence of the polyps; 3 months after the operation, the volume and contraction of the gallbladder recovered to preoperative levels. Thus the Endolap technique is reliable for removing benign gallbladder polyps and is applicable to a wider range of clinical situations than percutaneous polypectomy.

  9. Laparoscopic repair of acute perforation for gastroduodenal ulcer%腹腔镜胃十二指肠溃疡穿孔修补术13例临床体会

    Institute of Scientific and Technical Information of China (English)

    杨轶杰; 张宝勋; 吴尚德

    2009-01-01

    Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of pedorated peptic ulcers. Results Five patients were suffered from pedorated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gashie antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operafive time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all deers had healed well by Gastroscopy, we hadn't found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery.%目的 腹腔镜急性胃、十二指肠溃疡穿孔修补术的临床经验.方法 2003年6月~2007年12月,对13例急性胃、十二指肠溃疡穿孔患者施行腹腔镜溃疡穿孔修补术.结果 13例中十二指肠球部溃疡穿孔5例,幽门管溃疡1例,胃窦部溃疡穿孔7例,穿孔直径为0.3~0.7 cm,腹腔内积液600~1200 mL.手术时间80~180 min,除1例病检胃癌,改开放手术外,其余12例手术均获成功,术后恢复顺利,切口甲级愈合10例,乙级愈合2例.住院天数7~10 d.随访1年,胃镜检查溃疡均愈合,无再穿孔、腹腔感染、肠粘连、肠梗阻等并发症发生.结论 腹腔镜手术治疗急性胃、十二指肠溃疡穿孔,与开腹手术同样安全且有效.胃

  10. 腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎的疗效%Research on the curative effect of laparoscopic cholecystectomy in the treatment of calculi incarcerated in neck of gallbladder and acute suppurative cholecystitis

    Institute of Scientific and Technical Information of China (English)

    李文彬

    2015-01-01

    Objective:To observe the curative effect of laparoscopic cholecystectomy in the treatment of calculi incarcerated in necK of gallbladder and acute suppurative cholecystitis .Methods:80 cases of calculi incarcerated in necK of gallbladder and acute suppurative cho-lecystitis were divided into observation group and control group according to the difference in therapeutic methods ,40 cases in each group .The observation group received laparoscopic cholecystectomy ,and the control group accepted conventional open operation ,with the time of operation ,intraoperative blood loss ,the time of hospital stay and complication between the two groups compared .Results:There were significant differences in the time of operation ,intraoperative blood loss ,the time of hospitalization ,and the complication rate between the two groups .The time of operation and hospitalization in the observation group was shorter than those in the control group , and intraoperative blood loss in the former group was less than that in the latter group ( P <0 .05) .Conclusion:Laparoscopic cholecys-tectomy in the treatment of calculi incarcerated in necK of gallbladder and acute suppurative cholecystitis is of better clinical effect ,and higher treatment security ,which can help patients recover quicKly .%目的:观察腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿合并急性化脓性胆囊炎的疗效.方法:80 例胆囊颈部结石嵌顿并急性化脓性胆囊炎患者 ,按照治疗方法的差异分为观察组与对照组 ,每组各40例.其中观察组患者以腹腔镜胆囊切除术进行治疗 ,对照组患者以常规开腹手术进行治疗 ,对比两组患者的手术时间、术中出血量、住院时间及并发症等. 结果:两组患者在手术时间、术中出血量、住院时间、并发症发生率等指标上比较 ,差异有统计学意义 ,观察组患者的手术时间、住院时间均短于对照组 ,术中出血量也少于对照组( P <0 .05 ).结论:腹腔镜

  11. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case......, a massive constipation of the small bowel was most likely a contributing factor. In the second case, the cause was a kink of the entero-entero anastomosis leading to obstruction and finally perforation of the biliary limp. Late perforations are among the rarely reported complications associated with gastric...

  12. Acute Mesenteric Ischemia

    Science.gov (United States)

    ... Side Effects Additional Content Medical News Acute Mesenteric Ischemia By Parswa Ansari, MD, Department of Surgery, Lenox ... Abscesses Abdominal Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of ...

  13. Detecting gallbladders in chicken livers using spectral analysis

    DEFF Research Database (Denmark)

    Jørgensen, Anders; Mølvig Jensen, Eigil; Moeslund, Thomas B.

    2015-01-01

    This paper presents a method for detecting gallbladders attached to chicken livers using spectral imaging. Gallbladders can contaminate good livers, making them unfit for human consumption. A data set consisting of chicken livers with and without gallbladders, has been captured using 33 wavelengt...

  14. Gallbladder emptying in patients with primary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    Karouk Said; Nick Edsborg; Nils Albiin; Annika Bergquist

    2009-01-01

    AIM: To assess gallbladder emptying and its association with cholecystitis and abdominal pain in patients with primary sclerosing cholangitis (PSC). METHODS: Twenty patients with PSC and ten healthy subjects were investigated. Gallbladder fasting volume, ejection fraction and residual volume after ingestion of a test meal were compared in patients with PSC and healthy controls using magnetic resonance imaging. Symptoms, thickness and contrast enhancement of the gallbladder wall and the presence of cystic duct strictures were also assessed. RESULTS: Median fasting gallbladder volume in patients with PSC [67 (19-348) mL] was twice that in healthy controls [32 (16-55) mL] ( P < 0.05). The median postprandial gallbladder volume in patients with PSC was significantly larger than that in healthy controls ( P < 0.05). There was no difference in ejection fraction, gallbladder emptying volume or mean thickness of the gallbladder wall between PSC patients and controls. Contrast enhancement of the gallbladder wall in PSC patients was higher than that in controls; (69% ± 32%) and (42% ± 21%) ( P < 0.05). No significant association was found between the gallbladder volumes and occurrence of abdominal pain in patients and controls. CONCLUSION: Patients with PSC have increased fasting gallbladder volume. Gallbladder Mucosal dysfunction secondary to chronic cholecystitis, may be a possible mechanism for increased gallbladder.

  15. Is Routine Ultrasound Examination of the Gallbladder Justified in Critical Care Patients?

    Directory of Open Access Journals (Sweden)

    Pavlos Myrianthefs

    2012-01-01

    Full Text Available Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC in the intensive care unit (ICU. Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy’s sign, pericholecystic fluid and minor (gallbladder distention and sludge ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6±2.8 years; APACHE II score 21.3±0.9; mean ICU stay 35.9±4.8 days. Twenty-five patients (47.2% exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%, on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2% were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

  16. Gallbladder Hydrops Due to Viral Hepatitis A Infection: A Case Report

    OpenAIRE

    Aldaghi, Mitra; Haghighat, Mahmoud; Dehghani, Seyed Mohsen

    2014-01-01

    Introduction: Acute Hepatitis A Virus (HAV) infection is common in the developing countries among children, but hydrops of gallbladder due to hepatitis A infection is an uncommon presentation. Case Presentation: A five-year-old boy was admitted in Namazi Hospital, Shiraz, Iran due to jaundice and severe abdominal pain for 10 days. Physical examination revealed a mass in the right upper quadrant with severe tenderness. Liver function tests were abnormal while other laboratory data such as bloo...

  17. Arachidonate metabolism in bovine gallbladder muscle

    Energy Technology Data Exchange (ETDEWEB)

    Nakano, M.; Hidaka, T.; Ueta, T.; Ogura, R.

    1983-04-01

    Incubation of (1-/sup 14/C)arachidonic acid (AA) with homogenates of bovine gallbladder muscle generated a large amount of radioactive material having the chromatographic mobility of 6-keto-PGF1 alpha (stable product of PGI2) and smaller amounts of products that comigrated with PGF2 alpha PGE2. Formation of these products was inhibited by the cyclooxygenase inhibitor indomethacin. The major radioactive product identified by thin-layer chromatographic mobility and by gas chromatography - mass spectrometric analysis was found to be 6-keto-PGF1 alpha. The quantitative metabolic pattern of (1-/sup 14/C)PGH2 was virtually identical to that of (1-/sup 14/C)AA. Incubation of arachidonic acid with slices of bovine gallbladder muscle released labile anti-aggregatory material in the medium, which was inhibited by aspirin or 15-hydroperoxy-AA. These results indicate that bovine gallbladder muscle has a considerable enzymatic capacity to produce PGI2 from arachidonic acid.

  18. Septate gallbladder in the laparoscopic era

    Directory of Open Access Journals (Sweden)

    Patel Nitin

    2008-01-01

    Full Text Available The anatomy facing a surgeon during cholecystectomy is challenging as it involves complex relationship between the gallbladder, hepatic artery and extra-hepatic billiary tree. We report a case of septate gall bladder which was successfully treated with laparoscopic cholecystectomy. In this paper, we also discuss the embryology and characteristics of this rare anomaly. Lack of awareness, non-specific symptoms, signs and inadequacy of imaging methods are possible reasons for the reported problem of overlooking of this entity. Complete identification and removal of gallbladder is mandatory, as a remnant may result in recurrence of symptoms or stones.

  19. Acute cholecystitis: two-phase spiral CT finding

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Eung Young; Yoon, Myung Hwan; Yang, Dal Mo; Chun Seok; Bae, Jun Gi; Kim, Hak Soo; Kim, Hyung Sik [Chungang Ghil Hospital, Incheon (Korea, Republic of)

    1998-07-01

    To describe the two-phase spiral CT findings of acute cholecystitis. Materials and Methods : CT scans of nine patients with surgically-proven acute cholecystitis were retrospectively reviewed for wall thickening, enhancement pattern of the wall, attenuation of the liver adjacent to the gallbladder, gallstones,gallbladder distension, gas collection within the gallbladder, pericholecystic fluid and infiltration of pericholecystic fat. Results : In all cases, wall thickening of the gallbladder was seen, though this was more distinct on delayed images, Using high-low-high attenuation, one layer was seen in five cases, nd three layers in four. On arterial images, eight cases showed transient focal increased attenuation of the liver adjacent to the gall bladder;four of these showed curvilinear attenuation and four showed subsegmental attenuation. One case showed curvilinear decreased attenuation between increased attenuation of the liver and the gallbladder, and during surgery, severe adhesion between the liver and gallbladder was confirmed. Additional CT findings were infiltration of pericholecystic fat (n=9), gallstones (n=7), gallbladder distension (n=6), pericholecystic fluid(n=3), and gas collection within the gallbladder (n=2). Conclusion : In patients with acute cholecystitis,two-phase spiral CT revealed wall thickening in one or three layers ; on delayed images this was more distinct. In many cases, arterial images showed transient focal increased attenuation of the liver adjacent to the gallbladder.

  20. OVERVIEW FOR THE DIAGNOSIS AND TREATMENT OF GALLBLADDER CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    何小东; 肖毅; 郑朝纪; 张振寰; 张建希

    2000-01-01

    Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution. The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: ( 1 ) Age over 50 have recurrent eholecysfitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder,gall; (4) Polypoid lesion larger than lem inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.

  1. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-09-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  2. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacte...

  3. The Versatile Modiolus Perforator Flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    BACKGROUND: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our....... The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps...

  4. Meckels divertikel-perforation med intraabdominal blødning og periappendikulaer inflammation

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Zeb, Aurang; Mogensen, Anne Mellon;

    2009-01-01

    Perforation of Meckel's diverticulum (MD) is a rare and serious complication. The authors report a case of a 12-year-old girl who presented with acute abdominal pain and anaemia. Haemoperitoneum, perforated MD and peri-appendicular inflammation were found during laparotomy. The patient was treate...... with resection of a segment of ileum bearing the diverticulum and appendectomy. Postoperative recovery was uneventful. Pathological examination showed a perforated peptic ulcer with acute peritonitis and periappendicitis. Udgivelsesdato: 2009-Dec......Perforation of Meckel's diverticulum (MD) is a rare and serious complication. The authors report a case of a 12-year-old girl who presented with acute abdominal pain and anaemia. Haemoperitoneum, perforated MD and peri-appendicular inflammation were found during laparotomy. The patient was treated...

  5. The inflammatory inception of gallbladder cancer.

    Science.gov (United States)

    Espinoza, Jaime A; Bizama, Carolina; García, Patricia; Ferreccio, Catterina; Javle, Milind; Miquel, Juan F; Koshiol, Jill; Roa, Juan C

    2016-04-01

    Gallbladder cancer is a lethal disease with notable geographical variations worldwide and a predilection towards women. Its main risk factor is prolonged exposure to gallstones, although bacterial infections and other inflammatory conditions are also associated. The recurrent cycles of gallbladder epithelium damage and repair enable a chronic inflammatory environment that promotes progressive morphological impairment through a metaplasia-dysplasia-carcinoma, along with cumulative genome instability. Inactivation of TP53, which is mutated in over 50% of GBC cases, seems to be the earliest and one of the most important carcinogenic pathways involved. Increased cell turnover and oxidative stress promote early alteration of TP53, cell cycle deregulation, apoptosis and replicative senescence. In this review, we will discuss evidence for the role of inflammation in gallbladder carcinogenesis obtained through epidemiological studies, genome-wide association studies, experimental carcinogenesis, morphogenetic studies and comparative studies with other inflammation-driven malignancies. The evidence strongly supports chronic, unresolved inflammation as the main carcinogenic mechanism of gallbladder cancer, regardless of the initial etiologic trigger. Given this central role of inflammation, evaluation of the potential for GBC prevention removing causes of inflammation or using anti-inflammatory drugs in high-risk populations may be warranted.

  6. Multiseptate Gallbladder in an Asymptomatic Child

    Directory of Open Access Journals (Sweden)

    Dylan Wanaguru

    2011-01-01

    Full Text Available A one-year-old child being investigated for urinary tract infection was diagnosed with a multiseptate gallbladder. The patient remains asymptomatic, and investigations demonstrate no associated anomalies. Forty-three cases, including 13 cases in children were identified in the literature. Their presentation and management were reviewed.

  7. Effect of Nicotine on Gallbladder Bile

    Directory of Open Access Journals (Sweden)

    Anglo-Dutch Nicotine Intestinal Study Group

    1994-01-01

    Full Text Available Several studies have shown that symptomatic gallstones are largely a disease of nonsmokers, which raises the possibility that nicotine may protect against the formation of gallstones. To examine the effect of nicotine on the gallbladder, 32 rabbits were allocated to four groups: controls and three treatment groups in which nicotine tartarate at low, medium and high doses was administered subcutaneously via an osmotic minipump. After 14 days’ treatment the gallbladder was removed and measurements made of gallbladder mucin synthesis, bile mucin concentration, bile acid concentration and cholesterol saturation. Serum nicotine concentrations (ng/mL were (± SE 0.4±0.1, 3.5±0.4, 8.8±0.8 and 16.2±1.8 in the controls and three treatment groups, respectively. Total bile acid concentration increased significantly in all three treated groups with the greatest increase in the group given low dose nicotine (P<0.001. Cholesterol saturation did not differ significantly in any group but soluble mucin concentration in gallbladder bile was significantly reduced (P=0.013, 95% CI: 16 to 111 with high dose nicotine. Gallbladder mucin synthesis, measured by 3H-glucosamine incorporation, did not change significantly with nicotine treatment. Subcutaneous nicotine 2.0 mg/kg/day for 14 days significantly reduced the concentration of biliary mucin, which could potentially reduce cholesterol nucleation and subsequent gallstone formation. This may be one of the mechanisms responsible for the relative reduction in gallstone disease among smokers.

  8. Differential diagnosis of gallbladder wall thickening by two phase spiral CT : gallbladder carcinoma versus cholicystitis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sun; Cho, Soon Gu; Kim, Mi Young; Woo, Je Hong; Shin, Seok Hwan; Lee, Kykung Hee; Suh, Chang Hae [Inha Univ. College of Medicine, Inchon (Korea, Republic of)

    2001-04-01

    To determine whether an analysis of two-phase CT features provides a sound basis for differential diagnosis between gallbladder carcinoma and cholecystitis. We reviewed a total of 89 cases of gallbladder carcinoma (n=35) or cholecystitis (n=54) in patients who had undergone two-phase spiral CT. For this, a GE Highspeed Advantage scanner (GE Medical Systems, Milwaukee, U . S . A .) was used. A total of 120ml of contrast material was injected at a rate of 2-3 ml/sec. Arterial and venous phase scans were obtained 35 and 65 seconds, respectively, after the initiation of contrast infusion. All cases of gallbladder carcinoma and 468 of cholecystitis (of a total of 482) were confirmed by histopathology. We reviewed the two phase spiral CT features, analyzing and assessing thickness of the lesion, the enhancement pattern seen during the arterial and the venous phase, invasion of liver, pericholecystic fat infiltration, dilatation of intrahepatic ducts, and other associated findings. Mean wall thickness was 12.6 mm in the gallbladder carcinoma group, and 7.2 mm in the cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were 1) a highly enhanced thick inner wall layer during the arterial phase which became iso attenuated with adjacent liver parenchyma during the venous phase (16/35; 45.7%) and 2) highly enhanced thick inner wall layer during both the arterial and venous phase (8/35; 22.9%). The most common enhancement pattern in cholecystitis cases was an iso attenuated thin inner wall layer during both the arterial and the venous phase (44/54; 81.5%). Findings of intrahepatic mass formation by direct invasion (9/35), lymph node enlargement (12/35), and metastasis to other organs (7/35) occurred only in cases of gallbladder carcinoma (18/35, 51.4%) than of cholecystitis (10/54, 18.5%). The incidence of pericholecystic fat infiltration and fluid collection was not significantly different between the gallbladder cancer and cholecystitis groups

  9. Gallbladder motor function, plasma cholecystokinin and cholecystokinin receptor of gallbladder in cholesterol stone patients

    Institute of Scientific and Technical Information of China (English)

    Jian Zhu; Tian-Quan Han; Sheng Chen; Yu Jiang; Sheng-Dao Zhang

    2005-01-01

    AIM: To study the interactive relationship of gallbladder motor function, plasma cholecystokinin (CCK) and cholecystokinin A receptor (CCK-R) of gallbladder in patients with cholesterol stone disease.METHODS: Gallbladder motility was studied by ultrasonography in 33 patients with gallbladder stone and 10 health subjects as controls. Plasma CCK concentration was measured by radioimmunoassay in fasting status (CCK-f) and in 30 min after lipid test meal (CCK-30).Radioligand method was employed to analyze the amount and activity of CCK-R from 33 gallstone patients having cholecystectomy and 8 persons without gallstone died of severe trauma as controls.RESULTS: The percentage of cholesterol in the gallstone composition was more than 70%. The cholesterol stone type was indicated for the patients with gallbladder stone in this study. Based on the criterion of gallbladder residual fraction of the control group, 33 gallstone patients were divided into two subgroups, contractor group (14 cases)and non-contractor group (19 cases), The concentration of CCK-30 was significantly higher in non-contractor group than that in both contractor group and control group (55.86±3.86 pmol/l vs 37.85±0.88 pmol/l and 37.95±0.74 pmol/L, P<0.01), but there was no difference between contractor group and control group. Meanwhile no significant difference of the concentration of CCK-f could be observed among three groups. The amount of CCK-R was lower in non-contractor group than those in both control group and contractor group (10.27±0.94 fmol/mg vs24.59±2.39 fmol/mg and 22.66±0.55 fmol/mg, P<0.01).The activity of CCK-R shown as KD in non-contractor group decreased compared to that in control group and contractor group. Only was the activity of CCK-R lower in contractor group than that in control group. The ejection fraction correlated closely with the amount of CCK-R (r = 0.9683,P<0.01), and the concentration of CCK-30 correlated negatively with the amount of CCK-R closely (r = -0

  10. Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma

    Directory of Open Access Journals (Sweden)

    Giang Tran H

    2012-01-01

    Full Text Available Abstract Background Carcinoma of the gallbladder (GBC clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC. Methods We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5 with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC. Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract. Results These cases illustrate seven potential pitfalls which can be encountered. These include: 1 mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis, 2 misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis, 3 differentiating between primary NEC of gallbladder and metastasis, 4 confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5 confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6 undersampling early, grossly occult disease, and 7 misinterpreting extracellular mucin pools. Conclusions Clinical history and a high index of suspicion are

  11. Rapunzel syndrome resulting in gastric perforation.

    Science.gov (United States)

    Parakh, J S; McAvoy, A; Corless, D J

    2016-01-01

    We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.

  12. Avoiding or reversing Hartmann's procedure provides improved quality of life after perforated diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jefrey); M.P. Gosselink (Martijn Pieter); J.J. van Busschbach (Jan); J.F. Lange (Johan)

    2010-01-01

    textabstractINTRODUCTION: The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; long-term following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated di

  13. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Science.gov (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition. PMID:23833377

  14. Perforated duodenal ulcer: a rare complication of deferasirox in children.

    Science.gov (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  15. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Yadav

    2013-01-01

    Full Text Available Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  16. Single-organ gallbladder vasculitis: characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 61 patients.

    Science.gov (United States)

    Hernández-Rodríguez, José; Tan, Carmela D; Rodríguez, E René; Hoffman, Gary S

    2014-11-01

    higher than in GB-SOV (35.5% vs 10%; p = 0.05). Nongranulomatous inflammation with fibrinoid necrosis of medium-sized vessels occurred equally in both groups (>90%). Forms of SV affecting the gallbladder included polyarteritis nodosa (n = 10), hepatitis B virus-associated vasculitis (n = 8), cryoglobulinemic (essential or hepatitis C virus-associated) vasculitis (n = 6), vasculitis associated with autoimmune diseases (n = 6), microscopic polyangiitis (n = 4), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (n = 4), IgA vasculitis (Henoch-Schönlein) (n = 2), and giant cell arteritis (n = 1).GV is uncommon. Its histology most often consists of a nongranulomatous necrotizing vasculitis affecting medium-sized vessels. GB-SOV is usually discovered after routine cholecystectomy performed because of the presence of local symptoms, gallstone-associated cholecystitis, and contrary to GB-SV, GB-SOV is usually not associated with systemic symptoms. Acute phase reactants and surrogate markers of autoimmunity are usually normal or negative in GB-SOV. GB-SOV does not require systemic antiinflammatory or immunosuppressive therapy; surgery is adequate to achieve cure. GB-SV always warrants immunosuppressant therapy and is associated with high mortality. The finding of GV may precede the generalized manifestations of SV. Therefore, once GV is discovered, studies to determine disease extent and a vigilant follow-up are mandatory.

  17. Spontaneous Perforation of Pyometra

    OpenAIRE

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-01-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perfor...

  18. Gastric conduit perforation.

    Science.gov (United States)

    Patil, Nilesh; Kaushal, Arvind; Jain, Amit; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2014-08-16

    As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

  19. Gallbladder polyps: ultrasonographic and histopathological findings correlation

    Directory of Open Access Journals (Sweden)

    F. Rodriguez

    2014-11-01

    Full Text Available Gallbladder polyp is an increasingly common diagnosis, primarily as an abdominal ultrasound finding requested by another cause. Studies report a prevalence between 4% and 5.6%. The importance of an accurate diagnosis is related to the possibility of developing a malignancy desease. The objectvie is to correlate ultrasound and histopathologic findings in gallbladder polyp patients operated at the Hospital San Juan de Dios de La Serena. We reviewed retrospectively the medical records of patients undergoing cholecystectomy for gallbladder polyp from January 2000 to December 2010. a total of 40 patients underwent cholecystectomy for gallbladder polyp. 16 only had its tab clinic with abdominal ultrasonography report and the pathology report. 13 of them (81% were female. The mean age was 46 + / - 12 years. The reason for the ultrasonography was in 9 patients (56% abdominal pain in 3 patients (19%, a finding in asymptomatic patients, in one patient (6% biliary colic, none had jaundice, and in 3 patients (19% the cause was different. According to Abdominal ultrasound, the number of polyps was 1.1 + / - 0.3 per patient, and the average size was 5.8 + / - 1.8 mm. Histopathological examination showed the presence of polyps colesterolínicos in 11 of the 16 patients (69%. In the series described the abdominal ultrasonography showed a PPV = 0.68 for the diagnosis of gallbladder polyp. According to the report histopathological cholesterolosis diagnosed chronic cholecystitis in six cases (37.5%, chronic cholecystitis in six cases (37.5%, cholesterolosis in three cases (18.75% and cholelithiasis in one case (6 , 25%. Not demonstrated the presence of adenomas or foci of carcinoma in situ. In conclusion the described series does not allow to extrapolated or compare conclusions with other national and international series due to the small number of patients studied. There is a substantial sub-register of the pathology because the majority of patients undergoing

  20. Acute cholecystitis

    OpenAIRE

    Halpin, Valerie

    2014-01-01

    Acute cholecystitis causes unremitting right upper quadrant pain, anorexia, nausea, vomiting, and fever, and if untreated can lead to perforations, abscess formation, or fistulae. About 95% of people with acute cholecystitis have gallstones.It is thought that blockage of the cystic duct by a gallstone or local inflammation can lead to acute cholecystitis, but we don't know whether bacterial infection is also necessary.

  1. Cholecystitis of a duplicated gallbladder complicated by a cholecystoenteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Brady K. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Chess, Mitchell A. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Advanced Imaging, Batavia, NY (United States)

    2009-04-15

    Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder. (orig.)

  2. Residual gallbladder stones after cholecystectomy: A literature review

    OpenAIRE

    Pradeep Chowbey; Anil Sharma; Amit Goswami; Yusuf Afaque; Khoobsurat Najma; Manish Baijal; Vandana Soni; Rajesh Khullar

    2015-01-01

    Background: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. Materials And Methods: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-ch...

  3. Megalin and cubilin in the human gallbladder epithelium.

    Science.gov (United States)

    Tsaroucha, Alexandra K; Chatzaki, Ekaterini; Lambropoulou, Maria; Despoudi, Kaliopi; Laftsidis, Prodromos; Charsou, Chara; Polychronidis, Alexandros; Papadopoulos, Nikolaos; Simopoulos, Constantinos E

    2008-09-01

    Although the role of cholesterol absorption by the gallbladder epithelium in gallstone formation is well established, the exact process is poorly understood. Potential candidates for regulation of transepithelial cholesterol transport are suggested to be two large membrane multiple ligand receptors, megalin and cubilin. We studied the expression of these two proteins in both acalculous and calculous human gallbladder epithelia. Adult human gallbladder tissues were received from 21 patients (9 men, 12 women) who had undergone cholecystectomy. The patients were divided into two groups: group A (calculous gallbladder group; 5 men, 6 women; mean age 64.4 +/- 11.1 years) with cholelithiasis, and group B (acalculous gallbladder group; 4 men, 6 women; mean age 55.3 +/- 16.1 years). In the gallbladder tissues megalin and cubilin expression was studied by immunohistochemistry and conventional RT-PCR, and gene expression levels were estimated by real-time RT-PCR. Both megalin and cubilin gene transcripts were found in total RNA preparations from acalculous gallbladder. In contrast, in preparations from calculous gallbladder, none or only one of the proteins was detected. Immunoreactive proteins were detected in the simple columnar acalculous gallbladder epithelium but not in the calculous gallbladder epithelium. Our results show different expression patterns of the two proteins in calculous gallbladders and acalculous gallbladders. In the latter both proteins are expressed, suggesting an association with gallstone formation and implying a putative role of the two proteins in cholesterol endocytosis. In other words, the presence of both proteins may be essential for the prevention of stone formation.

  4. Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma

    Institute of Scientific and Technical Information of China (English)

    Hai-Xia Yuan; Jia-Ying Cao; Wen-Tao Kong; Han-Sheng Xia; Xi Wang; Wen-Ping Wang

    2015-01-01

    BACKGROUND:Gallbladder adenoma is a pre-cancerous neoplasm and needs surgical resection. It is dififcult to differ-entiate adenoma from other gallbladder polyps using imaging examinations. The study aimed to illustrate characteristics of contrast-enhanced ultrasound (CEUS) and its diagnostic value in gallbladder adenoma. METHODS:Thirty-seven patients with 39 gallbladder adenoma-toid lesions (maximal diameter≥10 mm and without metastasis) were enrolled in this study. Lesion appearances in conventional ultrasound and CEUS were documented. The imaging features were compared individually among gallbladder cholesterol polyp, gallbladder adenoma and malignant lesion. RESULTS:Adenoma lesions showed iso-echogenicity in ul-trasound, and an eccentric enhancement pattern, "fast-in and synchronous-out" contrast enhancement pattern and homo-geneous at peak-time enhancement in CEUS. The homogenic-ity at peak-time enhancement showed the highest diagnostic ability in differentiating gallbladder adenoma from cholesterol polyps. The sensitivity, speciifcity, positive predictive value, negative predictive value, accuracy and Youden index were 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The characteristic of continuous gallbladder wall shown by CEUS had the highest diagnostic ability in differentiating adenoma from malignant lesion (100%, 86.7%, 86.7%, 100%, 92.9% and 0.87, respectively). The characteristic of the eccentric enhance-ment pattern had the highest diagnostic ability in differenti-ating adenoma from cholesterol polyp and malignant lesion, with corresponding indices of 69.2%, 88.5%, 75.0%, 85.2%, 82.1% and 0.58, respectively. CONCLUSIONS:CEUS is valuable in differentiating gallbladder adenoma from other gallbladder polyps (≥10 mm in diameter). Homogeneous echogenicity on peak-time enhancement, a con-tinuous gallbladder wall, and the eccentric enhancement pat-tern are important indicators of gallbladder adenoma on CEUS.

  5. Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

    OpenAIRE

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-01-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  6. Jejunoileal diverticulosis, a rare cause of ileal perforation – Case report

    Directory of Open Access Journals (Sweden)

    Nádia Tenreiro

    2016-03-01

    Conclusion: JID remains under diagnosed. When it presents as an acute complication it may require immediate surgical intervention. In an elderly person, especially with known gastrointestinal diverticulosis, one must have a high index of suspicion for perforation.

  7. Duodenal perforation in childhood dermatomyositis

    Energy Technology Data Exchange (ETDEWEB)

    Magill, H.L.; Hixson, S.D.; Whitington, G.; Igarashi, M.; Hannissian, A.

    1984-01-01

    Perforation of the duodenum is an uncommon, but serious complication which may occur in children with dermatomyositis. In this disease vasculitis may involve the bowel to a variable extent and result in radiologic manifestations of intestinal injury ranging from benign pneumatosis intestinalis to signs of bowel perforation. We report two children with dermatomyositis in whom perforation of the second portion of the duodenum occurred. This serious complication should be considered in any child with dermatomyositis when extraluminal gas is suspected on abdominal radiographs.

  8. Outcome after emergency surgery in patients with a free perforation caused by gastric cancer.

    Science.gov (United States)

    Tsujimoto, Hironori; Hiraki, Shuichi; Sakamoto, Naoko; Yaguchi, Yoshihisa; Horio, Takuya; Kumano, Isao; Akase, Takayoshi; Sugasawa, Hidekazu; Aiko, Satoshi; Ono, Satoshi; Ichikura, Takashi; Kazuo, Hase

    2010-01-01

    Perforation of gastric cancer is rare and it accounts for less than 1% of the incidences of an acute abdomen. In this study, we reviewed cases of benign or malignant gastric perforation in terms of the accuracy of diagnosis and investigated the clinical outcome after emergency surgery in patients with a free perforation caused by gastric cancer. On the basis of pathological examination, gastric cancer was diagnosed in 8 patients and benign ulcer perforation in 32 patients. The sensitivity, specificity and accuracy of intraoperative diagnosis by pathological examination were 50, 93.8 and 85%, respectively. Except for age, there were no differences in the other demographic characteristics between patients with gastric cancer and benign ulcer perforation. The median survival time of patients with perforated gastric cancer was 195 days after surgery. Patients with gastric cancer perforation had a poorer overall survival rate than those who had T3 tumors without perforation. In addition, in patients with perforation, recurrence of peritoneum occurred more frequently. In conclusion, to improve the survival rate of patients with perforated gastric cancer and to improve the accuracy of intraoperative diagnosis, endoscopic examination and/or pathological examination of the frozen section should be performed, if possible. A balanced surgical strategy using laparoscopic local repair as the first-step of surgery, followed by radical open gastrectomy with lymphadenectomy may be considered.

  9. Residual gallbladder stones after cholecystectomy: A literature review

    Science.gov (United States)

    Chowbey, Pradeep; Sharma, Anil; Goswami, Amit; Afaque, Yusuf; Najma, Khoobsurat; Baijal, Manish; Soni, Vandana; Khullar, Rajesh

    2015-01-01

    BACKGROUND: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones. PMID:26622110

  10. Residual gallbladder stones after cholecystectomy: A literature review

    Directory of Open Access Journals (Sweden)

    Pradeep Chowbey

    2015-01-01

    Full Text Available Background: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. Materials And Methods: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. Results: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. Conclusion: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic is the most common treatment modality reported in the literature for the management of residual gallbladder

  11. Mechanisms of impaired gallbladder contractile response in chronic acalculous cholecystitis.

    Science.gov (United States)

    Merg, Anders R; Kalinowski, Scott E; Hinkhouse, Marilyn M; Mitros, Frank A; Ephgrave, Kimberly S; Cullen, Joseph J

    2002-01-01

    The mechanisms involved in the impaired gallbladder contractile response in chronic acalculous cholecystitis are unknown. To determine the mechanisms that may lead to impaired gallbladder emptying in chronic acalculous cholecystitis, gallbladder specimens removed during hepatic resection (controls) and after cholecystectomy for chronic acalculous cholecystitis were attached to force transducers and placed in tissue baths with oxygenated Krebs solution. Electrical field stimulation (EFS) (1 to 10 Hz, 0.1 msec, 70 V) or the contractile agonists, CCK-8 (10(-9) to 10(-5)) or K(+) (80 mmol/L), were placed separately in the tissue baths and changes in tension were determined. Patients with chronic acalculous cholecystitis had a mean gallbladder ejection fraction of 12% +/- 4%. Pathologic examination of all gallbladders removed for chronic acalculous cholecystitis revealed chronic cholecystitis. Spontaneous contractile activity was present in gallbladder strips in 83% of control specimens but only 29% of gallbladder strips from patients with chronic acalculous cholecystitis (P < 0.05 vs. controls). CCK-8 contractions were decreased by 54% and EFS-stimulated contractions were decreased by 50% in the presence of chronic acalculous cholecystitis (P < 0.05 vs. controls). K(+)-induced contractions were similar between control and chronic acalculous cholecystitis gallbladder strips. The impaired gallbladder emptying in chronic acalculous cholecystitis appears to be due to diminished spontaneous contractile activity and decreased contractile responsiveness to both CCK and EFS.

  12. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this pap...

  13. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case...... bypass but as our two cases illustrate they are important to keep in mind....

  14. Perforating disorders of the skin

    Directory of Open Access Journals (Sweden)

    Kalpana Arora

    2013-01-01

    Full Text Available Background: Perforating disorders of the skin, is an often overlooked entity characterized by transepidermal elimination of material from the upper dermis and are classified histopathologically according to the type of epidermal disruption and the nature of the eliminated material. They include Kyrle′s disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa. Aim: The aim of this study was to delineate the clinical and histopathological features of perforating disorders of the skin. Materials and Methods: In our study, we reviewed last 2 years skin biopsies received by us. Hematoxylin and eosin sections were re-examined and histochemical stainings (elastic van Gieson and Masson trichrome stains were also used for histopathological evaluation. Results: We reviewed five cases of perforating disorders of skin which included two cases of Kyrle′s disease, two cases of reactive perforating collagenosis and a single case of perforating folliculitis. Two patients had family history of perforating dermatosis in their siblings and three had associated systemic disease. Conclusion: Perforating disorders of the skin should be considered when ulcer with keratotic plugs is found.

  15. Perforated peptic ulcer following gastric bypass for obesity.

    Science.gov (United States)

    Macgregor, A M; Pickens, N E; Thoburn, E K

    1999-03-01

    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  16. CARCINOSARCOMA OF GALLBLADDER: A CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    WU Ai-wen; WANG Xiao-dong; JI Jia-fu

    2005-01-01

    Carcinosarcoma is a rare entity of neoplasm especially in gallbladder, withcollision elements of both adenocarcinomatous and sarcomatous component. Its clinical behavior is even worse than that of carcinoma, yet few cases have been reported to date. A male patient 75 years old admitted in our hospital was finally diagnosed as carcinosarcoma. He underwent surgical resection and adjuvant chemotherapy with oxaliplatin-containing regimen for six cycles. The patient achieved a long-time survival of 30 months.

  17. Perforated jejunal diverticula: a case report

    Directory of Open Access Journals (Sweden)

    Collins Christopher G

    2010-06-01

    Full Text Available Abstract Introduction Jejunal diverticula are rare and are usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation. Case presentation We report the case of an 82-year-old Caucasian woman presenting with a one-day history of generalized abdominal pain, with three episodes of vomiting. An abdominal X-ray displayed multiple dilated loops of the small bowel. A subsequent computed tomography scan of the abdomen and pelvis revealed a thickening of the duodenum and dilatation of the proximal jejunum. Multiple small bowel diverticula were identified with surrounding pockets of free air adjacent to the jejunal diverticula suggestive of a small bowel perforation. Our patient underwent a laparotomy, which identified multiple jejunal diverticula with two pinhole jejunal perforations and associated fecal contamination. The perforations were repaired with primary closure and extensive washout was performed. Conclusion Jejunal diverticulosis in the elderly can lead to significant morbidity and mortality and so should be suspected in those presenting with crampy abdominal pain and altered bowel habits.

  18. Tuberculous gastric perforation: report of a case.

    Science.gov (United States)

    Sharma, Deborshi; Gupta, Arun; Jain, Bhupendra Kumar; Agrawal, Vivek; Dargan, Puneet; Upreti, Lalendra; Arora, Vinod

    2004-01-01

    A 21-year-old woman presented with a 2-day history of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed a perforation in the lesser curve of the stomach. The patient suffered a bout of hematemesis, following which an endoscopy showed a bleeding blood vessel at the edge of the perforation. We performed an emergency distal gastrectomy, including the ulcer site. Histopathological examination revealed tuberculous granulation tissue and acid-fast bacilli in the ulcer. The patient was given antituberculosis therapy (ATT) postoperatively, and was well when last seen 1 year 5 months after surgery. We analyzed the clinical data of five cases of tuberculous gastric perforation (TGP), reported between 1948 and 2003, including our patient. The patients ranged in age from 21 to 45 years, with a mean age of 36.8 years (SD +/- 10.21), and a male to female ratio of 3 : 2. The diagnosis was confirmed by surgery or autopsy. Abdominal lymphadenopathy was present in all patients. Gastrectomy was performed in four patients, and two were given ATT. All four patients in the previous reports died of their disease.

  19. Gallbladder carcinoma associated with pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa; Bunsei Nobukawa

    2006-01-01

    AIM: To detect the patients with and without pancreaticobiliary maljunction who had pancreatobiliary reflux with extremely high biliary amylase levels.METHODS: Ninety-six patients, who had diffuse thickness (>3 mm) of the gallbladder wall and were suspected of having a pancreaticobiliary maljunction on ultrasonography, were prospectively subjected to endoscopic retrograde cholangiopancreatography, and bile in the common bile duct was sampled. Among them,patients, who had extremely high biliary amylase levels (>10000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients with and without pancreaticobiliary maljunction were examined.RESULTS: Seventeen patients had biliary amylase levels in the common bile duct above 10000 IU/L, including 11 with pancreaticobiliary maljunction and 6 without pancreaticobiliary maljunction. The occurrence of gallbladder carcinoma was 45.5% (5/11) in patients with pancreaticobiliary maljunction, and 50% (3/6) in those without pancreaticobiliary maljunction.CONCLUSION: Pancreatobiliary reflux with extremely high biliary amylase levels and associated gallbladder carcinoma could be identified in patients with and without pancreaticobiliary maljunction, and those patients might be detected by ultrasonography and bile sampling.

  20. Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

    Institute of Scientific and Technical Information of China (English)

    Haridimos Markogiannakis; Manousos Konstadoulakis; Dimitrios Tzertzemelis; Pantelis Antonakis; Ilias Gomatos; Constantinos Bramis; Andreas Manouras

    2008-01-01

    Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

  1. [Perforating necrobiosis lipoidica].

    Science.gov (United States)

    Peteiro, C; Zulaica, A; Toribio, J

    1986-01-01

    This is the case history of a woman with a 6 year history of insulin-dependent diabetes mellitus and a 5 year history of tuberous lesions on the dorsal aspect of the metacarpophalangeal joints. Histological examination revealed multiple necrobiotic foci throughout the dermis and subcutaneous tissue, with varying degrees of degeneration, alternating with fibrotic areas. This picture is compatible with lipoid necrobiosis. The existence of various foci of epithelial perforation, manifested clinically by a point hyperkeratosis similar in appearance to blackheads, suggests transfollicular elimination. This would explain the total absence of a pilosebaceous follicles in the lesion.

  2. Diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Yie, Miyeon [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Jang, Kyung Mi, E-mail: jkm7290@empal.com [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Kim, Min Jeong; Lee, Yul [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Choi, Dongil [Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of)

    2011-11-15

    Purpose: The aim of this retrospective study was to evaluate the diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis. Materials and methods: Eighty-six patients who underwent a diagnostic computed tomography (CT) scan for acute pancreatitis were included. The readers assessed the presence of pericholecystic increased attenuation of the liver parenchyma, enhancement of gallbladder (GB) and common bile duct (CBD) wall, pericholecystic fat strands, GB wall thickening, stone in the GB or CBD, and focal or diffuse manifestations of pancreatitis on abdominal CT scans. In addition, the maximal transverse luminal diameters of the GB and CBD were measured. Results: The presence of pericholecystic increased attenuation of the liver parenchyma, GB wall enhancement and thickening, pericholecystic fat strands, stone in the GB or CBD, and diffuse manifestations of pancreatitis achieved statistical significance for differentiation of gallstone induced pancreatitis from non-biliary pancreatitis (p < 0.05). The mean values of maximal transverse luminal diameter of GB and CBD were significantly higher in gallstone induced pancreatitis group (39.67 {+-} 7.26 mm, 10.20 {+-} 4.13 mm) than non-biliary pancreatitis group (27.01 {+-} 6.14 mm, 3.85 {+-} 2.51 mm, p < 0.0001). Conclusion: Gallbladder features of CT in patients with pancreatitis could be the valuable clues for the diagnosis of gallstone induced pancreatitis.

  3. Gastric Perforation and Phlegmon Formation by Foreign Body Ingestion

    Directory of Open Access Journals (Sweden)

    Albert Alejandro Avila Alvarez

    2014-08-01

    Full Text Available This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object  may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis.

  4. Identification of a candidate stem cell in human gallbladder.

    Science.gov (United States)

    Manohar, Rohan; Li, Yaming; Fohrer, Helene; Guzik, Lynda; Stolz, Donna Beer; Chandran, Uma R; LaFramboise, William A; Lagasse, Eric

    2015-05-01

    There are currently no reports of identification of stem cells in human gallbladder. The differences between human gallbladder and intrahepatic bile duct (IHBD) cells have also not been explored. The goals of this study were to evaluate if human fetal gallbladder contains a candidate stem cell population and if fetal gallbladder cells are distinct from fetal IHBD cells. We found that EpCAM+CD44+CD13+ cells represent the cell population most enriched for clonal self-renewal from primary gallbladder. Primary EpCAM+CD44+CD13+ cells gave rise to EpCAM+CD44+CD13+ and EpCAM+CD44+CD13- cells in vitro, and gallbladder cells expanded in vitro exhibited short-term engraftment in vivo. Last, we found that CD13, CD227, CD66, CD26 and CD49b were differentially expressed between gallbladder and IHBD cells cultured in vitro indicating clear phenotypic differences between the two cell populations. Microarray analyses of expanded cultures confirmed that both cell types have unique transcriptional profiles with predicted functional differences in lipid, carbohydrate, nucleic acid and drug metabolism. In conclusion, we have isolated a distinct clonogenic population of epithelial cells from primary human fetal gallbladder with stem cell characteristics and found it to be unique compared to IHBD cells.

  5. Novel Small Molecule Agonist of TGR5 Possesses Anti-Diabetic Effects but Causes Gallbladder Filling in Mice.

    Directory of Open Access Journals (Sweden)

    Daniel A Briere

    Full Text Available Activation of TGR5 via bile acids or bile acid analogs leads to the release of glucagon-like peptide-1 (GLP-1 from intestine, increases energy expenditure in brown adipose tissue, and increases gallbladder filling with bile. Here, we present compound 18, a non-bile acid agonist of TGR5 that demonstrates robust GLP-1 secretion in a mouse enteroendocrine cell line yet weak GLP-1 secretion in a human enteroendocrine cell line. Acute administration of compound 18 to mice increased GLP-1 and peptide YY (PYY secretion, leading to a lowering of the glucose excursion in an oral glucose tolerance test (OGTT, while chronic administration led to weight loss. In addition, compound 18 showed a dose-dependent increase in gallbladder filling. Lastly, compound 18 failed to show similar pharmacological effects on GLP-1, PYY, and gallbladder filling in Tgr5 knockout mice. Together, these results demonstrate that compound 18 is a mouse-selective TGR5 agonist that induces GLP-1 and PYY secretion, and lowers the glucose excursion in an OGTT, but only at doses that simultaneously induce gallbladder filling. Overall, these data highlight the benefits and potential risks of using TGR5 agonists to treat diabetes and metabolic diseases.

  6. Coexistence of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a fortuitous association?

    Science.gov (United States)

    Limaiem, F; Chelly, B; Hassan, F; Haddad, I; Ben Slama, S; Lahmar, A; Bouraoui, S; Mzabi-Regaya, S

    2013-08-01

    Xanthogranulomatous cholecystitis is a relatively uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. Not only does xanthogranulomatous cholecystitis mimic malignancy, it can also be infrequently associated with gallbladder carcinoma in 0.2% to 35.4% of cases. Herein, the authors report a new case of xanthogranulomatous cholecystitis concomitant with gallbladder adenocarcinoma in a 65-year-old female patient. Because of its overlapping clinical, radiological and macroscopic findings with gallbladder cancer, definitive diagnosis of xanthogranulomatous cholecystitis relies on extensive sampling and thorough microscopic examination of the surgical specimen to exclude the possibility of coexisting tumour. It is still a matter of debate whether xanthogranulomatous cholecystitis is truly a precursor of gallbladder carcinoma or if it is just an incidental finding. This aspect needs to be explored in the future with further studies.

  7. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Directory of Open Access Journals (Sweden)

    Olfa Kassar

    2015-01-01

    Full Text Available Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patient and conservative treatment was attempted in the other patient. None treatment measures were effective and two patients died. Acute acalculous cholecystitis is a serious complication in neutropenic patients. Earlier diagnosis could have expedited the management of these patients.

  8. Spontaneous Perforation of Pyometra

    Directory of Open Access Journals (Sweden)

    Begüm Yildizhan

    2006-01-01

    Full Text Available Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01–0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy. Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

  9. Familial reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Bhat Yasmeen

    2009-01-01

    Full Text Available Background: Reactive perforating collagenosis (RPC is one of the rare forms of transepidermal elimination in which genetically altered collagen is extruded from the epidermis. This disease usually starts in early childhood as asymptomatic umbilicated papules on extremities, and the lesions become more conspicuous with age. Aims: The objective of our study was to determine the clinico-pathological features of RPC and the response to various treatment modalities. Methods: Ten patients of RPC, belonging to five different families, were studied clinically. Various laboratory investigations were carried out and diagnosis was made by histopathology of the lesions. Patients were given various topical and oral treatments. Results: RPC is familial in most cases without any definite inheritance pattern. It begins in childhood and the lesions are usually recurrent and become profuse and large with age. Systemic diseases have no role in the onset of lesions. Conclusion: Oral and topical retinoids in combination with emollients is the best treatment option.

  10. A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma.

    Science.gov (United States)

    Sai, Jin-Kan; Suyama, Masafumi; Kubokawa, Yoshihiro

    2006-07-28

    A 62-year-old man with progressive thickening of the gallbladder wall visited our outpatient clinic. The biliary amylase level in the common bile duct was 19,900 IU/L and that of the gallbladder was 127,000 IU/L, although endoscopic retrograde cholangiopancreatography revealed no pancreaticobiliary maljunction. Histology demonstrated a moderately differentiated adenocarcinoma of the gallbladder. Pancreatobiliary reflux and associated gallbladder carcinoma were confirmed in the present case, in the absence of a pancreaticobiliary maljunction. Earlier detection of the pancreatobiliary reflux and progressive thickening of the gallbladder wall might have led to an earlier resection of the gallbladder and improved this patient's poor prognosis.

  11. A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa

    2006-01-01

    A 62-year-old man with progressive thickening of the gallbladder wall visited our outpatient clinic. The biliary amylase level in the common bile duct was 19900 IU/L and that of the gallbladder was 127000 IU/L, although endoscopic retrograde cholangiopancreatography revealed no pancreaticobiliary maljunction. Histology demonstrated a moderately differentiated adenocarcinoma of the gallbladder. Pancreatobiliary reflux and associated gallbladder carcinoma were confirmed in the present case, in the absence of a pancreaticobiliary maljunction. Earlier detection of the pancreatobiliary reflux and progressive thickening of the gallbladder wall might have led to an earlier resection of the gallbladder and improved this patient's poor prognosis.

  12. Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm.

    Science.gov (United States)

    Al-Abed, Yahya; Elsherif, Mohammed; Firth, John; Borgstein, Rudi; Myint, Fiona

    2012-09-01

    There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

  13. Case Report of Ectopic Liver on Gallbladder Serosa with a Brief Review of the Literature

    Science.gov (United States)

    Farooq, Mohammad S.; Soni, Utsav; Kalabin, Aleksandr; Rajabalan, Ajai S.; Ahmed, Leaque

    2016-01-01

    This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management. PMID:27803835

  14. Helicobacter species and common gut bacterial DNA in gallbladder with cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Peren; H; Karagin; Unne; Stenram; Torkel; Wadstrm; sa; Ljungh

    2010-01-01

    AIM:To analyze the association between Helicobacter spp. and some common gut bacteria in patients with cholecystitis. METHODS:A nested-polymerase chain reaction (PCR), specif ic to 16S rRNA of Helicobacter spp. was performed on paraff in-embedded gallbladder samples of 100 cholecystitis and 102 control cases. The samples were also analyzed for some common gut bacteria by PCR. Positive samples were sequenced for species identif ication. RESULTS: Helicobacter DNA was found in seven out of 100 cases of acute a...

  15. Expression of phenotypic markers of mast cells, macrophages and dendritic cells in gallbladder mucosa with calculous cholecystitis.

    Science.gov (United States)

    Kasprzak, A A; Szmyt, M; Malkowski, W; Surdyk-Zasada, J; Przybyszewska, W; Szmeja, J; Helak-Łapaj, C; Seraszek-Jaros, A; Kaczmarek, E

    2013-12-01

    The study aimed at quantitative analysis of expression involving markers of mast cells (tryptase), monocytes/macrophages (CD68 molecule) and dendritic cells (S100 protein) in gallbladder mucosa with acute and chronic calculous cholecystitis. Routinely prepared tissue material from the patients with acute (ACC) (n = 16) and chronic calculous cholecystitis (CCC) (n = 55) was evaluated. Three cellular markers were localized by immunocytochemistry. Their expression was quantified using spatial visualization technique. The expression of tryptase was similar in acute and chronic cholecystitis. CD68 expression in ACC was significantly higher than in the CCC group. Expression of S100 protein was significantly higher in CCC as compared to the ACC group. No significant correlations were disclosed between expression of studied markers and grading in the gallbladder wall. A weak negative correlation was noted between expression of CD68 and number of gallstones in the CCC group. The spatial visualization technique allowed for a credible quantitative evaluation of expression involving markers of mast cells (MCs), monocytes/macrophages (Mo/Ma) and dendritic cells (DCs) in gallbladder mucosa with ACC and CCC. For the first time mucosal expression of S100 protein-positive DCs was evaluated in calculous cholecystitis. The results point to distinct functions of studied cell types in the non-specific immune response in calculous cholecystitis.

  16. Rett syndrome and gastric perforation.

    Science.gov (United States)

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  17. Dumbbell Gallbladder Cholecystitis on Tc-99m Diisopropyliminodiacetic acid Hepatobiliary Imaging

    Science.gov (United States)

    Fakhri, Asif Ali; Rodrigue, Paul David; Hussain, Aun; Taiyebi, Abbas

    2017-01-01

    We present a case of a 79-year-old immunocompromised female admitted for abdominal pain and sepsis, who had an abdominal computed tomography (CT) showing distal gallbladder fundus wall thickening, pericholecystic edema, and a right posteroinferior hepatic abscess. Subsequent hepatobiliary scintigraphy with Tc-99m diisopropyliminodiacetic acid showed gallbladder filling of the proximal gallbladder fundus, yet no radiotracer filling of the distal gallbladder fundus. Further correlation with the initial CT showed a partial gallbladder stricture and a resultant altered morphology resembling a dumbbell-shaped gallbladder. Percutaneous cholangiogram also confirmed this dumbbell morphology. Nonfilling of radiotracer into the distal end of the dumbbell gallbladder correlating with CT findings of focal gallbladder inflammation indicated that there was a focal inflammation suggesting a distal dumbbell gallbladder cholecystitis. This case demonstrates a unique finding of focal inflammatory pathology involving an anatomic variant - the dumbbell-shaped gallbladder, and the challenges this anatomic variant presents in hepatobiliary scintigraphy image interpretation. PMID:28242983

  18. COMPARATIVE STUDY OF LAPAROSCOPIC CLOSURE OPEN PEPTIC PERFORATION CLOSURE

    Directory of Open Access Journals (Sweden)

    Vivek

    2015-10-01

    Full Text Available Laparoscopic closure of perforated duodenal ulcer was first performed in the year 1990 . Due to its advantage of better view of the peritoneal cavity an opportunity for thorough lavage and avoidance of upper abdominal incision, with its related complication, especially in high – ri sk patients, this procedure has gained popularity all over the world. Approximately 10 - 20% of patients suffering from peptic ulcer develop perforation of stomach or duodenum in which, chemical peritonitis develop initially from gastric secretion and duoden al secretion the condition is life threatening. Early diagnosis and treatment is extremely important. Mortality will increase up if perforation exists more than 24 to 48 hours. Usually surgical intervention of simple closure with omental patch of the perforation is required. this study aims at evaluating efficacy , safety and outcome of laparoscopic surgery for perforated duodenal ulcer patients admitted during period Jan 2009 to Dec 2012 at tertiary hospital in north Karnataka A total of 61cases diagnosed as peritonitis secondary to duodenal ulcer perforation were involved in the study 30underwent open perforation closure and 31 cases underwent lap closure. Peptic ulcers are focal defects in the gastric or duodenal mucosa which extend into the sub mucosa or deeper. they may be acute or chronic and ultimately are caused by on imbalance between the action of peptic acid and mucosal defenses peptic ulcer remains a common outpatient diagnosis, but the number of elective operations for peptic ul cer disease have decreased dramatically over the past 30 decades due to the advent of H2 blockers However the incidence of emergency surgeries, and death rate associated with peptic ulcer are same

  19. Perforated midgut diverticulitis: Revisited

    Institute of Scientific and Technical Information of China (English)

    Milan Spasojevic; Jens Marius Naesgaard; Dejan Ignjatovic

    2012-01-01

    AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis.METHODS:Three data sources were used:the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded)that were published after 1995.The inclusion criterion was sufficient individual patient data in the article.Both indexed and non-indexed journals were used.Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group.Data on symptoms,laboratory and radiology results,treatment modalities,surgical access,procedures,complications and outcomes were collected.The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007.The data collected were age,sex,mode of access,surgical procedure performed and number of patients per year.Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data.Statistical analysis was done with SPSS software.RESULTS:Group I:106 patients (48 men) were found.Mean age was 72.2 ± 13.1 years (mean ± SD).Age or sex had no impact on outcomes (P =0.057 and P =0.771,respectively).Preoperative assessment was plain radiography in 53.3% or computed tomography (CT)in 76.1%.Correct diagnosis was made in 77.1% with CT,5.6% without (P =0.001).Duration of symptoms before hospitalization was 3.6 d (range:1-35 d),but longer duration was not associated with poor outcome (P =0.748).Eighty-six point eight percent of patients underwent surgery,92.4% of these through open access where 90.1% had bowel resection.Complications occurred in 19.2% of patients and 16.3% underwent reoperation.Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm.At surgery,no peritonitis was found in 29.7% of patients,local peritonitis in 47.5%,and diffuse

  20. Percutaneous transhepatic gallbladder drainag sequential laparoscopic cholecystectomy in the treatment of acute cholecystitis in elderly patients with high risk%经皮经肝胆囊穿刺置管引流序贯手术治疗老年高危患者的临床研究

    Institute of Scientific and Technical Information of China (English)

    祁军安; 江奎; 王涛; 卢振华; 杨彦伟; 罗冬根; 郑又侨; 吴林; 马晓阳

    2016-01-01

    目的 探讨老年高危患者急性结石性胆囊炎行经皮经肝胆囊穿刺置管引流术(PTGD)的适应证,及其序贯腹腔镜胆囊切除术(LC)的临床优势、手术时机、临床意义.方法 分析440例老年高危患者急性结石性胆囊炎行PTGD的临床资料,其中395例择期序贯LC术,并与同期390例老年急诊行LC术患者对照分析;分析在PTGD术后2~4周、4~8周、8~12周三种不同时段序贯行LC术的临床资料.结果 440例患者PTGD术后1d,379例(86.1%)患者症状得到明显缓解,术后3d,体温、白细胞计数、C-反应蛋白、血清降钙素原均得到明显好转,术后7d,胆囊大小、胆囊壁厚度明显改善,差异有统计学意义.395例PTGD序贯LC组与同期390例急诊LC组对照,两组并发症发病率、中转开腹率、手术时间、手术出血量、术后腹腔引流总量及术后住院天数差异有统计学意义.395例PTGD术后2~4周、4~8周、8~12周三种不同时段序贯行LC术,三组随着时间段延长胆管感染次数增加,手术并发症、手术时间、中转开腹率、手术出血量、术后住院天数之间差异均无统计学意义.结论 对于老年高危急性结石性胆囊炎患者,通过先行PTGD,待炎症得到有效控制,经围手术期准备后,2~4周择期序贯行LC术,疗效显著.%Objective To study clinical advantages,operative opportunity and clinical significance in high-risk elderly patients with acute calculous cholecystitis underwent Percutaneous transhepatic gallbladder drainage (PTGD)sequential Laparoscopic cholecystectomy (LC).Methods Analysis of 440 cases of elderly and high risk patients with acute calculous cholecystitis underwent PTGD,including 395 patients underwent sequential LC clinical data,and compared with 390 cases of emergency LC in the same period.Comparative analysis in PTGD postoperative 2-4 weeks,4-8 weeks,8-12 weeks,three time sequential LC patient data.Results 440 cases of elderly patients with

  1. Clinical Relationship between Steatocholecystitis and Gallbladder Contractility Measured by Cholescintigraphy

    Directory of Open Access Journals (Sweden)

    Chang Seok Bang

    2015-01-01

    Full Text Available Objective. Contractility of gallbladder is known to be decreased in fatty gallbladder diseases. However, clinical estimation data about this relationship is still lacking. The aim of this study was to investigate the association between steatocholecystitis and contractility of gallbladder. Methods. Patients with cholecystitis (steatocholecystitis versus nonsteatocholecystitis who underwent cholescintigraphy before cholecystectomy were retrospectively evaluated in a single teaching hospital of Korea. The association of steatocholecystitis with contractility of gallbladder, measured by preoperative cholescintigraphy, was assessed by univariable and multivariable analysis. Results. A total of 432 patients were finally enrolled (steatocholecystitis versus nonsteatocholecystitis; 75 versus 357, calculous versus acalculous cholecystitis; 316 versus 116. In the multivariable analysis, age (OR: 0.94, 95% CI: 0.90–0.99, P=0.01 and total serum cholesterol (OR: 1.02, 95% CI: 1.01–1.04, P=0.04 were related to steatocholecystitis in patients with acalculous cholecystitis. Only age (OR: 0.97, 95% CI: 0.94–0.99, P=0.004 was significantly related to steatocholecystitis in patients with calculous cholecystitis. However, ejection fraction of gallbladder reflecting contractility measured by cholescintigraphy was not related to steatocholecystitis irrespective of presence of gallbladder stone in patients with cholecystitis. Conclusion. Ejection fraction of gallbladder measured by cholescintigraphy cannot be used for the detection or confirmation of steatocholecystitis.

  2. Perforation in a patient with stercoral colitis and diverticulosis: who did it?

    Directory of Open Access Journals (Sweden)

    Vijaya R. Bhatt

    2014-02-01

    Full Text Available Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment.

  3. Biliary Peritonitis due to Spontaneous Perforation of Choledochus: A Case Report.

    Science.gov (United States)

    Laway, Mushtaq A; Bakshi, Iftikhar H; Shah, Mubbashir; Paray, Showkat A; Malla, Mohd Sadiq

    2013-06-01

    Spontaneous perforation of common bile duct (CBD) in an adult is an exceedingly rare phenomenon. It is mostly seen in infants due to congenital anomalies. The diagnosis of biliary tract perforations is often delayed due to their nonspecific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences in terms of morbidity as well as mortality. We herein report spontaneous perforation of CBD in a middle-aged male who presented to our accident and emergency department with acute abdominal pain. Exploratory laparotomy revealed a small perforation with necrosed margins in the supraduodenal part of CBD, which was managed by a T-tube drain. However, no apparent cause for the perforation was found.

  4. Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

    Directory of Open Access Journals (Sweden)

    Aly Saber

    2012-01-01

    Full Text Available Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.

  5. Transverse colon perforation due to carcinoma rectum: an unusual presentation against Laplace's law.

    Science.gov (United States)

    Sahoo, Manash Ranjan; Kumar, Anil; Jaiswal, Sunil; C, Basavaraja

    2013-08-16

    We present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transverse colon (against Laplace's law). A 60-year-old women presented to the emergency department with acute abdominal pain. The pain was preceded by 3 days of intestinal obstruction. Clinically there was guarding and rigidity. Straight X-ray of the abdomen revealed free gas under diaphragm. Surgical exploration revealed transverse colon perforation with carcinoma of rectum. Loop transverse colostomy was performed as the patient was very sick. The patient improved slowly in the intensive care unit. To conclude, even though the caecum is the most common site for perforation in case of distal obstruction, perforation of transverse colon can occur otherwise as a unique presentation.

  6. Spontaneous Perforation of Rectosigmoid Colon

    Directory of Open Access Journals (Sweden)

    Farhad Haj Sheikholeslami

    2010-12-01

    Full Text Available Spontaneous perforation of the sigmoid colon or rectom is definedas a sudden perforation of the colon in the absence of diseasessuch as tumors, diverticulosis or external injury. It is avery rare finding, and if neglected, results in severe peritonitisand high mortality. The causes of this rare condition are numerous,and in this case it might be due to the chronic constipationinduced by an anticholinergic antipsychotic.Iran J Med Sci 2010; 35(4: 339-341.

  7. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    Science.gov (United States)

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  8. Synchronous gallbladder and pancreatic cancer associated with pancreaticobiliary maljunction.

    Science.gov (United States)

    Rungsakulkij, Narongsak; Boonsakan, Paisarn

    2014-10-21

    We report the case of a 46-year-old woman who presented with chronic intermittent abdominal pain without jaundice; abdominal ultrasonography showed thickening of the gallbladder wall and dilatation of the bile duct. Endoscopic retrograde cholangiopancreaticography showed pancreatobiliary maljunction with proximal common bile duct dilatation. Pancreatobiliary maljunction was diagnosed. A computed tomography scan of the abdomen showed suspected gallbladder cancer and distal common bile duct obstruction. A pancreatic head mass was incidentally found intraoperative. Radical cholecystectomy with pancreatoduodenectomy was performed. The pathological report showed gallbladder cancer that was synchronous with pancreatic head cancer. In the pancreatobiliary maljunction with pancreatobiliary reflux condition, double primary cancer of the pancreatobiliary system should be awared.

  9. Visualization of Gallbladder with In-111 Octreotide Scan

    Directory of Open Access Journals (Sweden)

    Filiz Özülker

    2015-06-01

    Full Text Available A 54-year-old woman underwent octreotide scintigraphy for evaluation of neuroendocrine tumor recurrence. The images demonstrated unusual uptake in gallbladder area in addition to physiologic uptake at other tissues. Whole-body planar and SPECT imaging were repeated after fatty meal ingestion at 28 hours in order to figure out whether this activity was physiologic or not. Since the unusual uptake in the gallbladder was still detected at these images, additional images were obtained 72 hours after radionuclide injection. The activity in the gallbladder disappeared at these images revealing the physiologic nature of this unusual accumulation.

  10. The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

    Energy Technology Data Exchange (ETDEWEB)

    Vyas, Rajashree C.; Sides, Corey; Klein, Deborah J. [University of Rochester Medical Center, Rochester, NY (United States); Reddy, Sireesha Y. [University of Rochester, Obstetrics and Gynecology, Rochester, NY (United States); Santos, Mary C. [University of Rochester, Pediatric Surgery, Rochester, NY (United States)

    2008-09-15

    Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis. (orig.)

  11. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka [Sendai City Medical Center (Japan)] [and others

    2000-12-01

    To clarify the significance of magnetic resonance cholangiopancreatography (MRCP) in the acute phase of acute cholecystitis, MRCP was carried out in forty-five patients with acute cholecystitis in their acute phase. The MR pericholecystic high signal was observed in 38 of the 45 patients (84%). Enlargement of the gallbladder, presence of gallstones, and impacted stones was seen in 71%, 53%, and 18%, respectively. The MR pericholecystic high signal was classified into four categories: type 0, not observed; type 1, a liner high signal; type 2, a band-like high signal; type 3, a radiating high signal. In patients who showed a type 3 MR pericholecystic high signal, 91% required percutaneous transhepatic gallbladder drainage, and most of the gallbladders were diagnosed as necrotic cholecystitis by histology. The accuracy of MRCP for the diagnosis of choledocholithiasis was 96%. It was suggested that MRCP for patients with acute cholecystitis in the acute phase provides useful information for planning the treatment. (author)

  12. Tracheal perforation managed by temporary tracheostomy in a horse : clinical communication

    Directory of Open Access Journals (Sweden)

    M.N. Saulez

    2005-06-01

    Full Text Available Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.

  13. Rare occurrence of simultaneous coronary artery perforation and intracoronary thrombus formation following angioplasty

    Institute of Scientific and Technical Information of China (English)

    Su-Yan Bian; Liu-Fa Duan

    2013-01-01

    Both coronary artery perforation and intracoronary thrombus formation are life-threatening complications of percutaneous coronary interventions, which rarely occur simultaneously during angioplasty. We herein report a case of stent-related, left circumflex artery perforation, and subsequently acute left main artery thrombosis after the leakage was embolized with 7 microcoils. Intracoronary thromboectomy and systemic anticoagulant therapy were carefully used with good results. This case also represents some of our uncertainties regarding the best management of the patient.

  14. Identification of a candidate stem cell in human gallbladder

    Directory of Open Access Journals (Sweden)

    Rohan Manohar

    2015-05-01

    In conclusion, we have isolated a distinct clonogenic population of epithelial cells from primary human fetal gallbladder with stem cell characteristics and found it to be unique compared to IHBD cells.

  15. Current Status on Cholangiocarcinoma and Gallbladder Cancer

    Science.gov (United States)

    Ebata, Tomoki; Ercolani, Giorgio; Alvaro, Domenico; Ribero, Dario; Di Tommaso, Luca; Valle, Juan W.

    2016-01-01

    Background Cholangiocarcinomas (CC) as well as gallbladder cancers are relatively rare and intractable diseases. Clinical, pathological, and epidemiological studies on these tumors have been under investigation. The current status and/or topics on biliary tract cancers have been reported in the East West Association of Liver Tumor (EWALT), held in Milano, Italy in 2015. Summary All the authors, herein, specifcally reported the current status and leading-edge findings on biliary tract cancers as the following sequence: epidemiology of CC, surgical therapy for intrahepatic CC, surgical therapy for perihilar CC, surgical therapy for gallblad der cancer, chemotherapy for biliary tract cancers, and new histological features in CC. Key Message The present review article will update the knowledge on biliary tract cancers, en hancing the quality of daily clinical practice. However, many features about these cancers remain unknown; further studies are required to establish disease-specific optimal treatment strategies. PMID:27995089

  16. Effects of growth hormone deficiency and recombinant growth hormone therapy on postprandial gallbladder motility and cholecystokinin release.

    NARCIS (Netherlands)

    Moschetta, A.; Twickler, M.; Rehfeld, J.F.; Ooteghem, N.A. van; Castro Cabezas, M.; Portincasa, P.; Berge-Henegouwen, G.P. van; Erpecum, K.J. van

    2004-01-01

    In addition to cholecystokinin, other hormones have been suggested to be involved in regulation of postprandial gallbladder contraction. We aimed to evaluate effects of growth hormone (GH) on gallbladder contractility and cholecystokinin release. Gallbladder and gastric emptying (by ultrasound) and

  17. Targeting the hedgehog pathway for gallbladder cancer therapy?

    Science.gov (United States)

    Mittal, Balraj; Yadav, Saurabh

    2016-02-01

    Gallbladder carcinoma is a fatal malignancy of hepatobiliary tract that is generally diagnosed at advanced stages of cancer because of its asymptomatic nature. Advanced GBC tumors are unresectable with poor prognosis. Improvement in GBC patient care requires better understanding of the biological signaling pathways and application of newly discovered drugs for cancer therapy. Herein, we discuss the possibilities and challenges in targeting the hedgehog pathway in gallbladder cancer therapy based on recent developments in the area.

  18. Mucinous adenocarcinoma originating in localized type adenomyomatosis of the gallbladder

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@ Adenomyomatosis of the gallbladder (GBA) has been defined as an acquired disease characterized by hyperplastic extension of the surface epithelium into, and often beyond, the thickened gallbladder muscular layer (Rokitansky-Aschoff's sinuses, or RA sinuses).1 It is reported as a lesion with no risk of malignant transformation.2 In recent years, however, a few cases of GBA associated with carcinoma have been reported.3-7 We present another case of mucinous adenocarcinoma arising from GBA.

  19. Unusual localization of hydatidosis: Hydatid cyst of gallbladder

    Directory of Open Access Journals (Sweden)

    K Rabbani

    2011-01-01

    Full Text Available The case of a 38-year-old man suffering from hydatid cyst located in the gallbladder is presented. Although Morocco remains an endemic area for echinococcosis, this presentation of the disease is rare. Pericyst was tightly attached to the liver. Complete pericystectomy followed by cholecystectomy was done. Histopathology confirmed the presence of calcified hydatid cyst of the gallbladder. Perioperative adjuvant medical therapy with albendazole was administered. In a 2-year follow-up, no recurrence has occurred.

  20. Polypoid Gallbladder Lesion in the Context of Renal Cell Carcinoma

    OpenAIRE

    Barbara Seeliger MD; Cosimo Callari MD; Michele Diana MD; Didier Mutter MD, PhD, FACS; Jacques Marescaux MD, FACS, HON FRCS, HON FJSES

    2013-01-01

    Introduction. The only curative therapeutic approach for renal cell carcinoma (RCC) is surgery. Laparoscopic surgery for RCC has become an established surgical procedure with equivalent cancer-free survival rate, following the same surgical oncological principles as open surgery. Metastatic RCC of the gallbladder is a rare phenomenon. Hence, there are few reports regarding their management. Case Presentation. We report 2 cases of gallbladder metastasis from clear cell RCC treated by laparosco...

  1. Gallbladder carcinoma in the "Hospital de Clinicas" of Uruguay: 1998-2002. A clinicopathologic study of five cases in 802 cholecystectomies.

    Science.gov (United States)

    Barcia, Juan José; Rodríguez, Ana; Siri, Leonardo; Masllorens, Ana; Szwebel, Patricia; Acosta, Gisĕle

    2004-02-01

    Five cases of primary carcinoma of the gallbladder are presented. The cases were identified after a study of 802 cholecystectomies in a period of 5 years. The patients are three women and two men between the ages of 43 and 60 years (mean, 55.8 years). In three cases the clinical diagnosis was that of carcinoma, while in two other patients the clinical diagnosis was that of acute cholecystitis. Grossly, all cases were characterized by a gray-white diffuse or focal plaque-like thickening of the gallbladder wall, with loss of the normal velvety mucosal surface and fibrosis of the organ. Histologically, four cases belong to moderately to poorly differentiated adenocarcinoma and were characterized by infiltrative, irregularly shaped and sized glands, islands, nests, and cords. The cells showed pleomorphic nuclei with clumped chromatin and frequent single nucleoli. One case was a mucinous adenocarcinoma characterized by large pools of mucoid material with neoplastic glands and cells "floating" within. Pathologic staging was pT3 in three cases; pT2 in one case; and pT2N1 in one other case. The present study highlights the importance of careful gross and histopathologic evaluation of gallbladders otherwise removed with the history of chronic or acute cholecystitis. In addition, it highlights the incidence of gallbladder carcinoma in a particular institution.

  2. Bovine gallbladder muscularis: Source of a myogenic receptor for cholecystokinin

    Energy Technology Data Exchange (ETDEWEB)

    Schjoldager, B.; Shaw, M.J.; Powers, S.P.; Schmalz, P.E.; Szurszewski, J.; Miller, L.J. (Mayo Clinic and Foundation, Rochester, MN (USA))

    1988-03-01

    Despite being a classic target for the gastrointestinal peptide hormone, cholecystokinin (CCK), the gallbladder CCK receptor is not well characterized. Pharmacological studies of small species suggest that CCK action can be mediated by direct myogenic or by both myogenic and neurogenic receptors. To prepare for the biochemical characterization of a gallbladder CCK receptor and to define the subtype of the receptor being studied. The authors have performed autoradiographic localization and pharmacological characterization of CCK receptors on bovine gallbladder. Autoradiography demonstrated high-affinity specific CCK-binding sites only on the muscularis. CCK-8 stimulated tonic contraction of longitudinal strips of gallbladder muscularis in a concentration-dependent manner. Antagonism at the cholinergic receptor with 1{mu}M atropine or axonal transmission with 1{mu}M tetrodotoxin did not modify CCK-induced contraction, supporting a direct myogenic effect of this hormone. Optimal electrical field stimulation to elicit a neuronal response resulted in muscle strip relaxation, which was abolished with adrenergic blockade. Although acetylcholine administration stimulated contraction, electrical field stimulation did not, even in the presence of phentolamine, propranolol, and/or CCK. Thus, in bovine gallbladder muscularis, there is evidence for a functional CCK receptor only on smooth muscle cells. Demonstration of a single, high-affinity specific CCK-binding site on an enriched plasma membrane preparation of bovine gallbladder muscularis is consistent with this representing a myogenic CCK receptor.

  3. Clinicopathologic characteristics of young patients with gallbladder cancer.

    Science.gov (United States)

    Do, Sung-Im; Lee, Hyoun Wook; Sohn, Jin Hee; Kim, Kyungeun

    2017-03-01

    Gallbladder cancer is the most common biliary tract cancer and the fifth most common cancer of the digestive system. However, the clinicopathologic features of gallbladder cancer in young Korean patients have not been studied. This study included 101 consecutive cases of gallbladder cancer that underwent cholecystectomy at Kangbuk Samsung Hospital from December 1990 to March 2011. The patients were divided into two groups by age at initial diagnosis of gallbladder cancer: a young patient group aged less than 45 years and an old patient group aged 45 or older. The young patient group included 10 patients with mean age of 38 (range, 29-44 years). Compared with the old patient group, the young patient group showed polypoid tumor appearance (p=0.014), lower pT stage (p=0.023), more frequent adenoma background (p=0.009), and less frequent dysplasia in remaining mucosa (p=0.001). The disease-related survival rate after 13.5 months was significantly more favorable for the young patients. Gallbladder cancers in young Korean patients have distinct clinicopathologic features of a high frequency of cancer arising in adenoma, rare association with intestinal metaplasia and dysplasia, and a favorable patient's prognosis. These findings suggest that the adenoma-carcinoma pathway could contribute more to gallbladder cancer carcinogenesis in young Korean patients than the metaplasia-dysplasia-carcinoma pathway.

  4. Intrathoracic caecal perforation presenting as dyspnea.

    Science.gov (United States)

    Granier, Vincent; Coche, Emmanuel; Hantson, Philippe; Thoma, Maximilien

    2010-01-01

    Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  5. Intrathoracic Caecal Perforation Presenting as Dyspnea

    Directory of Open Access Journals (Sweden)

    Vincent Granier

    2010-01-01

    Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  6. Posterior repair with perforated porcine dermal graft

    Directory of Open Access Journals (Sweden)

    G. Bernard Taylor

    2008-02-01

    Full Text Available OBJECTIVE: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. MATERIALS AND METHODS: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (PelvicolTM CR Bard Covington, GA USA. The incidence of postoperative vaginal incision separation (dehiscence was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. RESULTS: Seventeen percent of patients (21/127 who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71 of patients who received perforated grafts (p = 0.078. Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively. There was no difference in the flexibility of the two grafts (p = 0.20. CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  7. A Case of Hemorrhagic Necrosis of Ectopic Liver Tissue within the Gallbladder Wall.

    LENUS (Irish Health Repository)

    Nagar, Sapna

    2012-02-01

    Ectopic liver tissue is a rare clinical entity that is mostly asymptomatic and found incidentally. In certain situations, however, patients may present with symptoms of abdominal pain secondary to torsion, compression, obstruction of adjacent organs, or rupture secondary to malignant transformation. Herein, we report a case of a 25-year-old female that presented with acute onset of epigastric pain found to have ectopic liver tissue near the gallbladder complicated by acute hemorrhage necessitating operative intervention in the way of laparoscopic excision and cholecystectomy. The patient\\'s postoperative course was uneventful. Gross pathology demonstrated a 1.2 x 2.8 x 4.5 cm firm purple ovoid structure that histologically revealed extensive hemorrhagic necrosis of benign ectopic liver tissue.

  8. Postconditioning with isoflurane reduces acute lung injury induced by cecal ligation and perforation in rats%异氟烷后处理减轻大鼠盲肠结扎穿孔所致急性肺损伤

    Institute of Scientific and Technical Information of China (English)

    吕翔; 董翔; 李启芳; 姜虹; 朱也森

    2012-01-01

    Objective To study the protective effects of isoflurane postcondition on acute lung injury (ALI) induced by cecal ligation and perforation (CLP) in rats. Methods A total of 48 male Sprague-Dawley rats were randomly divided into 4 groups (n = 12): normal group, without any treatment; sham operation group, with incision and closure of abdomen; CLP group, the CLP model was used to induce ALI; and isoflurane group, rats were anesthetized with 1.4% isoflurane at 4 h after CLP modeling for 2 h. Then 6 rats in each group were randomly killed by decapitation 6 h and 24 h after pretreatment. Blood samples of abdominal aorta were taken for arterial blood gas analysis. The tissues of left lung were taken for the determination of lung wet/dry (W/D) ratio. Tumor necrosis factor-a (TNF-α) and interleukin-6 (IL-6) levels were measured with blood sample of heart. Histopathological changes of the right lung and the expression of nuclear factor (NF)-KB were observed by H-E staining and immunohistochemical staining, respectively. Results There were no significant differences in arterial oxygen partial pressure (paO2), the ratio of W/D or serum concentrations of TNF-α and IL-6 between sham operation group and normal group (P>0.05). The paO2 in CLP group and isoflurane group was significantly lower than that in the normal group, while the ratio of W/D and serum concentrations of TNF-a and IL-6 in CLP group and isoflurane group were significantly higher than those in the normal group (P<0. 05). There were significant differences in above mentioned parameters between isoflurane group and CLP group (P<0. 05). There was no obvious lung injury in normal group or sham operation group. The rats in CLP group suffered more serious lung injury as compared with isoflurane group, and the lung injury at 24 h after precondition was much severe than that at 6 h after precondition. The cells with NF-KB expression were occasionally seen in normal group and sham operation group, while a large number

  9. Control of gallbladder contractions by cholecystokinin through cholecystokinin-A receptors on gallbladder interstitial cells of cajal

    Institute of Scientific and Technical Information of China (English)

    Dan Xu; Bao-Ping Yu; He-Sheng Luo; Ling-Dan Chen

    2008-01-01

    AIM: To identify the cholecystokinin (CCK)-A receptors (CCK-AR) on the guniea pig gallbladder interstitial cells of cajal (ICC) and to study CCK-8 induced gallbladder muscle strip contractions through the CCK-AR.METHODS: The existence of CCK-AR was examined by immunohistofluorescence on sectioned tissue and cultured cells. In vitro contractile response of guinea pig gallbladder muscle strips and the strips with ICC removed were also studied with CCK-8 receptors added.RESULTS: In tissue sections, intensely CCKARimmunoreactive interstitial cells were found mainly in the muscular layers. In cultured cell sections, distinctive double staining of C-kit and CCK-AR ICCs were found.When we removed the ICC of the gallbladder, CCK-8induced muscle strip contraction dose response curve significantly shifted to the right.CONCLUSION: We proved that both the existence of CCK-AR on the guinea pig gallbladder ICC and CCK evoked contraction are mediated through direct action on CCK-AR on the gallbladder ICC.

  10. Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

    Directory of Open Access Journals (Sweden)

    Paula Lozanova

    2013-01-01

    Full Text Available Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica.

  11. Triple gastric peptic ulcer perforation.

    Science.gov (United States)

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  12. Primary appendiceal adenocarcinoma of colonic type with perforating peritonitis.

    Directory of Open Access Journals (Sweden)

    Noguch H

    2001-10-01

    Full Text Available Primary adenocarcinoma of the appendix is rare, especially the colonic type. We report a case of appendiceal adenocarcinoma of colonic type associated with perforating peritonitis after aorto-femoral artery bypass surgery. A 79-year-old woman presented with fever and pain in the right lower abdomen. She had undergone aorto-femoral artery bypass surgery due to arteriosclerosis obliterans 6 months earlier. Abdominal ultrasonography and computed tomography showed a suspected pool of fluid surrounding the artificial vessel and a mass lesion in the upper end of the fluid collection. These findings suggested localized peritonitis due to appendiceal perforation. Emergency laparotomy showed a pool of pus around the artificial vessel and inflamed appendix, which adhered to the surrounding tissue. The mass was excised in combination with an ileocaecal resection, followed by an ileocolic anastomosis. The histological diagnosis was moderately differentiated adenocarcinoma of the appendix, colonic type. The tumour had infiltrated and obstructed the lumen of the orifice of the appendix, which may have caused perforation of the appendix. She was examined at regular periodic follow-ups and no evidence of recurrence or metastasis was noted in the 12-month postoperative period. These findings indicate that, in cases of acute appendicitis, especially with perforation, the possibility of appendiceal adenocarcinoma should be considered.

  13. Intestinal perforation--a unique cause.

    Science.gov (United States)

    Kansal, G; Agrawal, V

    2000-04-01

    An illiterate, 65 years old, male attended surgery emergency with features of perforation peritonitis. Exploratory laparotomy revealed perforation in the terminal ileum and a sharp metallic object pointing at the perforation site. This, on removal, was found to be the sharp edge of a blister pack (with intact tablet within). The perforation was repaired. The abdomen was closed after leaving a drain. Postoperatively the patient had a morbid period and ultimately responded to management.

  14. Hyperbilirubinemia as a predictor for appendiceal perforation

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, Hans-Christian; Rosenberg, J;

    2013-01-01

    Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum...... bilirubin as a predictor for appendiceal perforation....

  15. Early Management Experience of Perforation after ERCP

    Directory of Open Access Journals (Sweden)

    Guohua Li

    2012-01-01

    Full Text Available Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations. Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45% were identified and retrospectively reviewed. Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD, endoscopic retrograde pancreatic duct drainage (ERPD, gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully. Conclusions. We found that: (1 the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2 Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3 Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

  16. Gallbladder Dynamics Before and After Extracorporeal Shock Wave Lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Hea; Suk, Jae Dong; Moon, Dae Hyuk; Kim, Myung Hwan; Min, Young Il [Asian Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Extracorporeal shock wave lithotripsy (ESWI.) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, {sup 99m}Tc-DISIDA hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7 mCi of {sup 99m}Tc-DISIDA, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (I frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated, ESWL group were studied before, l day after and 2 weeks after ESWL, and UDCA group were studied before and 2 weeks after starting oral medication Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESlVL group, mean EF and mean ER at 1 day after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recovered to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

  17. Perforated Closed-Loop Obstruction Secondary to Gallstone Ileus of the Transverse Colon: A Rare Entity

    Directory of Open Access Journals (Sweden)

    S. P. Carr

    2015-01-01

    Full Text Available Introduction. Gallstone ileus (GSI of the colon is an extremely rare entity with potentially serious complications including perforation. Case Presentation. An 88-year-old man presented to the emergency department with abdominal pain and distension. Clinical exam revealed signs of peritonism. Computed tomography (CT revealed GSI of the transverse colon with a closed-loop large bowel obstruction (LBO and caecal perforation. The patient underwent emergency laparotomy. A right hemicolectomy was performed, the gallstone was removed, and a primary bowel anastomosis was undertaken. A Foley catheter was sutured into the residual gallbladder bed to create a controlled biliary fistula. The patient recovered well postoperatively with no complications. He was discharged home with the Foley catheter in situ. Discussion. Gallstone ileus is a difficult diagnosis both clinically and radiologically with only 50% of cases being diagnosed preoperatively. Most commonly it is associated with impaction at the ileocaecal valve and small bowel obstruction. Gallstone ileus should also be considered as a rare but potential cause of LBO. This is the first reported case of caecal perforation secondary to gallstone ileus of the transverse colon. Successful operative management consisted of a one-stage procedure with right hemicolectomy and formation of a controlled biliary fistula.

  18. Perforated closed-loop obstruction secondary to gallstone ileus of the transverse colon: a rare entity.

    Science.gov (United States)

    Carr, S P; MacNamara, F T; Muhammed, K M; Boyle, E; McHugh, S M; Naughton, P; Leahy, A

    2015-01-01

    Introduction. Gallstone ileus (GSI) of the colon is an extremely rare entity with potentially serious complications including perforation. Case Presentation. An 88-year-old man presented to the emergency department with abdominal pain and distension. Clinical exam revealed signs of peritonism. Computed tomography (CT) revealed GSI of the transverse colon with a closed-loop large bowel obstruction (LBO) and caecal perforation. The patient underwent emergency laparotomy. A right hemicolectomy was performed, the gallstone was removed, and a primary bowel anastomosis was undertaken. A Foley catheter was sutured into the residual gallbladder bed to create a controlled biliary fistula. The patient recovered well postoperatively with no complications. He was discharged home with the Foley catheter in situ. Discussion. Gallstone ileus is a difficult diagnosis both clinically and radiologically with only 50% of cases being diagnosed preoperatively. Most commonly it is associated with impaction at the ileocaecal valve and small bowel obstruction. Gallstone ileus should also be considered as a rare but potential cause of LBO. This is the first reported case of caecal perforation secondary to gallstone ileus of the transverse colon. Successful operative management consisted of a one-stage procedure with right hemicolectomy and formation of a controlled biliary fistula.

  19. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S;

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...

  20. Non-traumatic abdominal emergencies: imaging and intervention in acute biliary conditions

    Energy Technology Data Exchange (ETDEWEB)

    Menu, Yves; Vuillerme, Marie-Pierre [Department of Radiology, Hopital Beaujon, 92118 Clichy Cedex (France)

    2002-10-01

    Imaging is the standard method for the evaluation of emergency bile ducts and gallbladder diseases. Imaging may help to treat the patient also. In acute cholecystitis, association of clinical and sonographic data is accurate for the diagnosis, even when the patient is examined by a junior radiologist. Computed tomography may be required for those patients with unusual presentation such as emphysematous cholecystitis, perforation, or abscess. Acalculous cholecystitis is a challenging problem. It sometimes requires percutaneous cholecystostomy for diagnosis or treatment purposes. In patients with acute cholangitis, sonography remains the first step for imaging, but its diagnostic accuracy is disappointing. This is related to low sensitivity, despite a high specificity. Computed tomography carries a slightly better sensitivity, and again a high specificity but overall accuracy is not sufficient. Magnetic resonance cholangiography and endosonography are the best methods for the detection. Both have advantages and limitations, including cost and availability, but endoscopic retrograde cholangiopancreatography remains necessary for therapeutic purposes, especially stone extraction. In conclusion, emergency radiologists should be able to put the patient through multiple imaging modalities in order to make a prompt diagnosis with no delay, and be aware of the therapeutic options, including cooperation between radiologist, endoscopist, and surgeon. (orig.)

  1. Adjuvant radiotherapy for gallbladder cancer: A dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy

    Institute of Scientific and Technical Information of China (English)

    Xiao-Nan Sun; Qi Wang; Ben-Xing Gu; Yan-Hong Zhu; Jian-Bin Hu; Guo-Zhi Shi; Shu Zheng

    2011-01-01

    AIM: To assess the efficacy and toxicity of conformal radiotherapy (CRT) and compare with intensity-modulated radiotherapy (IMRT) in the treatment of gallbladder cancer.METHODS: Between November 2003 and January 2010, 20 patients with gallbladder cancer were treated with CRT with or without chemotherapy after surgical resection. Preliminary survival data were collected and examined using both Kaplan-Meier and actuarial analysis. Demographic and treatment parameters were collected. All patients were planned to receive 46-56 Gy in 1.8 or 2.0 Gy per fraction. CRT planning was compared with IMRT.RESULTS: The most common reported acute toxicities requiring medication (Radiation Therapy Oncology Group, Radiation Therapy Oncology Group Grade2) were nausea (10/20 patients) and diarrhea (3/20).There were no treatment-related deaths. Compared with CRT planning, IMRT significantly reduced the volume of right kidney receiving > 20 Gy and the volume of liver receiving > 30 Gy. IMRT has a negligible impact on the volume of left kidney receiving > 20 Gy. The 95% of prescribed dose for a planning tumor volume using either 3D CRT or IMRT planning were 84.0% ±6.7%, 82.9% ± 6.1%, respectively (P > 0.05).CONCLUSION: IMRT achieves similar excellent target coverage as compared with CRT planning, while reducingthe mean liver dose and volume above threshold dose. IMRT offers better sparing of the right kidney compared with CRT planning, with a significantly lower mean dose and volume above threshold dose.

  2. Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Martin Kobborg

    2011-02-01

    Full Text Available Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP with endoscopic sphincterotomy (ES. Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP and Computerized Tomography (CT verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.

  3. Simultaneous breast and ovarian metastasis from gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Sanjay Singh; Puneet Gupta; Rahul Khanna; Ajay K Khanna

    2010-01-01

    BACKGROUND: Gallbladder carcinoma is a common malig-nancy in the Indian subcontinent. It commonly metastasizes through lymphatics, direct invasion, and hematogenous spread. A common extra-abdominal site of metastasis is the lungs. Simultaneous metastasis to breast and ovary is extremely rare. METHOD: This report describes an unusual case of carcinoma gallbladder metastasizing to the breast and ovary at the same time. RESULTS: A 45-year-old woman came to us with complaints of flatulent dyspepsia associated with weight loss and anorexia. Ultrasound of the abdomen revealed hepatomegaly with thick-walled gallbladder with multiple stones and a mass at the fundus, but normal uterus and ovary. Contrast-enhanced computer tomography of the abdomen showed a gallbladder mass infiltrating the liver parenchyma. The patient underwent radical cholecystectomy. Histopathological examination revealed a poorly-differentiated adenocarcinoma with mar-gins free from tumor infiltration. One month after surgery she developed a breast lump. Ultrasound of the abdomen for metastatic workup revealed an ovary mass. Simple mastectomy and salphingo-opherectomy were performed, and histopathological examination revealed a metastatic adenocarcinoma. The patient is now on chemotherapy with gemcitabin. CONCLUSION: This is an unusual case of carcinoma of the gallbladder with metastasis to the breast and ovary, which has not been documented before.

  4. APOPTOSIS OF HYPERPLASIA AND CANCER OF THE GALLBLADDER WITH CALCULAS

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To investigate the relation between different extent of proliferation caused by gallstone and gallbladder cancer by counting the proliferation and the apoptosis of the gallbladder cancer for the clinically prevention of the gallbladder carcinoma.Methods:The TUNEL method was used to detect the apoptosis of the specimens and the mean apoptosis indices obtained by quantification of apoptosis cells flurescence by laser scanning confocal microscope were compared among the varible pathological paterns,Results:The mean apoptosis indexed in the mormal and abnormal specimens with cholecystits,simple hyperplasia,low-grade dysplasia,mid-grade dysplasia,high-grade dysplasia and carcinoma were 5.11,5.49,6.32,8.65,12.27,25.24,39.62,119.8,respectively.There was significant difference among the variable pathological patterns and as the lesion progressing,the index went up gradually with the carcinoma had the highest index.Conclusion:the apoptosis indexes increase with the pathological progress during the carcinogenesis of gallbladder cancer caused by lithiasis,which stimulate the epithelium for long time and result in an increasing of the apoptosis;and it may play an important role in the carcinogenesis of gallbladder cancer.

  5. Left-sided gallbladder: Its clinical significance and imaging presentations

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To assess the importance of preoperative diagnosis and presentation of left-sided gallbladder using ultrasound (US), CT and angiography.METHODS: Retrospective review of 1482 patients who underwent enhanced CT scanning was performed. Left-sided gallbladder was diagnosed if a right-sided ligamentum teres was present. The image presentations on US, CT and angiography were also reviewed.RESULTS: Left-sided gallbladder was diagnosed in nine patients. The associated abnormalities on CT imaging included portal vein anomalies, absence of umbilical portion of the portal vein in the left lobe of the liver,club-shaped portal vein in the right lobe of the liver, and difficulty in identifying segment Ⅳ. Angiography in six of nine patients demonstrated abnormal portal venous system (trifurcation type in four of six patients). The main hepatic arteries followed the portal veins in all six patients. The segment Ⅳ artery was identified in four of six patients using angiography, although segment Ⅳ was difficult to define on CT imaging. Hepatectomy was performed in three patients with concomitant liver tumor and the diagnosis of left-sided gallbladder was confirmed intraoperatively.CONCLUSION: Left-sided gallbladder is an important clinical entity in hepatectomy due to its associated portal venous and biliary anomalies. It should be considered in US, CT and angiography images that demonstrate no definite segment IV, absence of umbilical portion of the portal vein in the left lobe, and club-shaped right anterior portal vein.

  6. Concomitant Small Cell Neuroendocrine Carcinoma of Gallbladder and Breast Cancer

    Directory of Open Access Journals (Sweden)

    Paolo Aiello

    2014-01-01

    Full Text Available The neuroendocrine carcinoma is defined as a high-grade malignant neuroendocrine neoplasm arising from enterochromaffin cells, usually disposed in the mucosa of gastric and respiratory tracts. The localization in the gallbladder is rare. Knowledge of these gallbladder tumors is limited and based on isolated case reports. We describe a case of an incidental finding of small cell neuroendocrine carcinoma of the gallbladder, observed after cholecystectomy for cholelithiasis, in a 55-year-old female, who already underwent quadrantectomy and sentinel lymph-node biopsy for breast cancer. The patient underwent radiotherapy for breast cancer and six cycles of chemotherapy with cisplatin and etoposide. Eighteen months after surgery, the patient was free from disease. Small cell neuroendocrine carcinoma of the gallbladder has poor prognosis. Because of the rarity of the reported cases, specific prognostic factors have not been identified. The coexistence of small cell neuroendocrine carcinoma of the gallbladder with another malignancy has been reported only once. The contemporary presence of the two neoplasms could reflect that bioactive agents secreted by carcinoid can promote phenotypic changes in susceptible cells and induce neoplastic transformation.

  7. Correlation of Mechanical Factors and Gallbladder Pain

    Directory of Open Access Journals (Sweden)

    W. G. Li

    2008-01-01

    Full Text Available Acalculous biliary pain occurs in patients with no gallstones, but is similar to that experienced by patients with gallstones. Surgical removal of the gallbladder (GB in these patients is only successful in providing relief of symptoms to about half of those operated on, so a reliable pain-prediction model is needed. In this paper, a mechanical model is developed for the human biliary system during the emptying phase, based on a clinical test in which GB volume changes are measured in response to a standard stimulus and a recorded pain profile. The model can describe the bile emptying behaviour, the flow resistance in the biliary ducts, the peak total stress, including the passive and active stresses experienced by the GB during emptying. This model is used to explore the potential link between GB pain and mechanical factors. It is found that the peak total normal stress may be used as an effective pain indicator for GB pain. When this model is applied to clinical data of volume changes due to Cholecystokinin stimulation and pain from 37 patients, it shows a promising success rate of 88.2% in positive pain prediction.

  8. Gut perforation after orthotopic liver transplantation in adults

    Institute of Scientific and Technical Information of China (English)

    Jun Xiong; Shen You; Xiao-Shun He

    2007-01-01

    AIM: To describe cases of gut perforation after orthotopic liver transplantation.METHODS: Data were colleted from our center database and medical records. Six of 187 patients (3.2%)who underwent orthotopic liver transplantation from January to December 2005 developed gut perforation.All patients were male with an average age of 46 years.Modified piggyback liver transplantation was performed at the Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University.RESULTS: Previous operation, steroid therapy, and prolonged portal venous cross clamp time, poor nutritional status and iatrogenic injury were found to be its ecological factors. The patients with gut perforation were found to have fever, increased leukocytes, mild abdominal pain and tenderness. The median portal venous clamp time was 63 min (range 45-72 min),median cold ischaemia time was 11.3 h (range 7-15 h).Median intraoperative blood loss was 500 mL (range 100-1200 mL) and median operation time was 8.8 h (range 6-12 h). None of the six patients developed acute cellular rejection. White cell count was above 18 × 109/L in five patients (neutrophilic leukocytes were above 90%) and 1.5 × 109/L in one patient. Bacterial culture in drainage liquid revealed enterococci in five patients. Of the 6 patients undergoing orthotopic liver transplantation, 3 survived and 3 died after modified piggyback liver transplantation.CONCLUSION: Gut perforation occurs after orthotopic liver transplantation in adults. A careful and minimal dissection during OLT, longer retention of the stomach tube, and reducing the portal clamp time and steroid dose should be taken into consideration. If gut perforation is not prevented, then early diagnosis,preferably through detection of enterococci may ensure better survival.

  9. Blind loop perforation after side-to-side ileocolonic anastomosis

    Institute of Scientific and Technical Information of China (English)

    Raffaele; Dalla; Valle; Roberto; Zinicola; Maurizio; Iaria

    2014-01-01

    Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  10. Blind loop perforation after side-to-side ileocolonic anastomosis.

    Science.gov (United States)

    Valle, Raffaele Dalla; Zinicola, Roberto; Iaria, Maurizio

    2014-08-27

    Blind loop syndrome after side-to-side ileocolonic anastomosis is a well-recognized entity even though its incidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perforation. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

  11. Stone ingestion causing obstructed inguinal hernia with perforation

    Directory of Open Access Journals (Sweden)

    Paiboon Sookpotarom

    2014-01-01

    Full Text Available We report a rare case of obstructed right inguinal hernia caused by ingested stones. A 2 year-old boy from Northern Thailand was transferred to our hospital with low-grade fever, vomiting, and acute painful swelling at his right hemiscrotum for one day. The physical examination revealed marked enlargement with inflammation in his right hemiscrotum. The radiological findings showed huge number of stones in the right hemiscrotum. At surgery, the content of hernia sac was ascending colon, which was full of hard masses. With the help of additional lower transverse abdominal incision, the obstructed segment was successfully reduced and revealed a perforation. Most of the stones were removed through the perforation. The colonic wound was primarily repaired and both incisions were primarily closed. Although he developed post-operative wound infection, the boy had uneventfully recovered. The psychological exploration in this "stone pica" revealed no other psychological disorders.

  12. Single metastatic renal cell carcinoma in gallbladder: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Young; Cho, Bum Sang; Kang, Min Ho; Lee, Seung Young; Yi, Kyung Sik; Park, Kil Sun; Sung, Ro Hyun [Chungbuk National Univ. Hospital, Cheongju (Korea, Republic of)

    2012-07-15

    Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancy. 25% to 57% of RCC patients exhibit overt evidence of metastatic disease at initial presentation. Metastases to the gallbladder is uncommon and usually detected in only 0.4-0.6% of autopsies. We report the case of a 58 year old man who presented with a metastasis in the gallbladder from RCC. He had undergone went a right nephrectomy four years ago. There was no evidence of metastasis. A follow up abdomen CT scan taken three years after operation showed a polypoid lesion within the gallbladder. The size of the polypoid lesion had increased at the follow up CT and the enhancement pattern of lesion became similar to that of RCC. A Cholecystectomy was performed. Histopathological examination revealed the polyp was clear cell carcinoma of metastatic origin from kidney.

  13. [Etiopathogenic hypothesis on carcinoma of the gallbladder: our study].

    Science.gov (United States)

    Rizzo, A G; Barbuscia, M; Sanò, M; Cancellieri, A; Nicotina, P; Stassi, G; Lemma, G; Lemma, F

    2005-01-01

    The authors are interested in determining causes of gallbladder cancer (GBC). By this intention, they theorize a correlation between genetic modifications (which are responsible of malignant transformation of biliary epithelium) and some intestinal infections. From 1999 to 2004 they observed 15 GBC and all 15 gallbladder have been analyzed histologically and from microbiological aspect; by these means from 1999 till 2004 they have studied also 30 persons with colelithiasis. The authors noticed that bile of both groups contained, in three cases in the first and in 8 cases in the second, a germ named Escherichia Coli which normally lives in intestine, while in 10 operated gallbladders of the first group and 12 of the second there was a positive for k-ras. They are studying to confirm their theories.

  14. Aging impairs Ca2+ sensitization pathways in gallbladder smooth muscle.

    Science.gov (United States)

    Macias, Beatriz; Gomez-Pinilla, Pedro J; Camello-Almaraz, Cristina; Pascua, Patricia; Tresguerres, Jesus Af; Camello, Pedro J; Pozo, Maria J

    2012-08-01

    Calcium sensitization is an important physiological process in agonist-induced contraction of smooth muscle. In brief, calcium sensitization is a pathway that leads to smooth muscle contraction independently of changes in [Ca(2+)](i) by mean of inhibition of myosin light chain phosphatase. Aging has negative impacts on gallbladder contractile response due to partial impairment in calcium signaling and alterations in the contractile machinery. However, information regarding aging-induced alterations in calcium sensitization is scanty. We hypothesized that the calcium sensitization system is negatively affected by age. To investigate this, gallbladders were collected from adult (4 months old) and aged (22-24 months old) guinea pigs. To evaluate the contribution of calcium sensitization pathways we assayed the effect of the specific inhibitors Y-27632 and GF109203X on the "in vitro" isometric gallbladder contractions induced by agonist challenges. In addition, expression and phosphorylation (as activation index) of proteins participating in the calcium sensitization pathways were quantified by Western blotting. Aging reduced bethanechol- and cholecystokinin-evoked contractions, an effect associated with a reduction in MLC20 phosphorylation and in the effects of both Y-27632 and GF109203X. In addition, there was a drop in ROCK I, ROCK II, MYPT-1 and PKC expression and in the activation/phosphorylation of MYPT-1, PKC and CPI-17 in response to agonists. Interestingly, melatonin treatment for 4 weeks restored gallbladder contractile responses due to re-establishment of calcium sensitization pathways. These results demonstrate that age-related gallbladder hypocontractility is associated to alterations of calcium sensitization pathways and that melatonin treatment exerts beneficial effects in the recovery of gallbladder contractility.

  15. A rare cause of gastric perforation-Candida infection: a case report and review of the literature.

    Science.gov (United States)

    Gupta, Nalini

    2012-11-01

    Fungal microorganisms as a cause of gastric perforation, is very rare. Most of the cases of gastric perforation are seen as the complications of peptic ulcer disease, the intake of NSAIDs (Non Steroidal Anti-Inflammatory Drugs), neoplastic diseases, etc. We are reporting a case of a 50 year old male who presented with a sudden onset of abdominal pain and shock and was diagnosed as acute peritonitis which was caused by a gastrointestinal perforation. An emergency exploratory laporotomy was performed and a gastric perforation repair with omentoplexy was done. However, the patient died in the post operative period due to a sudden cardiac arrest. A gastric perforation edge biopsy revealed the presence of fungal hyphae. The peritoneal fluid culture revealed Candida albicans colonies.

  16. Contrast material and gallbladder kinetics: implications for same day sonography after intravenous pyelography or CT scanning.

    Science.gov (United States)

    Khan, O; Naipaul, R; Rampaul, R S; Abhang, V; Archibald, A; Maharaj, P; Mohammed, S; Mohammed, L

    1999-11-01

    Sonographic examination of the gallbladder has allowed us to study the effects of various substances on this organ. A prospective study involving 77 patients was undertaken to evaluate the effects of intravenous or oral contrast agents on gallbladder volume changes in patients without known gallbladder disease. A mean volume after contraction of 24.8% was observed after administration of intravenous contrast agent (P < 0.01) and of 31.9% after oral administration (P < 0.01). This phenomenon of contraction of the gallbladder should therefore be recognized when sonographic or computed tomographic evaluation of the gallbladder is undertaken after imaging procedures that use radiographic contrast agents either intravenously or orally.

  17. Gallbladder endometriosis as a cause of occult bleeding

    Institute of Scientific and Technical Information of China (English)

    K Saadat-Gilani; L Bechmann; A Frilling; G Gerken; A Canbay

    2007-01-01

    A 17-year-old girl with colicky abdominal pain and chronic anemia presented to the gastrointestinal service of the University Hospital of Essen. In the routine workup, there were no pathological findings despite the anemia. Because of the fluctuation of symptoms with a climax at the time of menstruation, consecutive ultrasound studies were performed revealing a visible mass inside the gallbladder. This finding was confirmed by a magnetic resonance imaging (MRI) study performed at the same time. Because of the severe anemia by that time, a cholecystectomy was performed, and histology reconfirmed the diagnosis of isolated gallbladder endometriosis. The patient recovered well and has had no recurrence of the disease to date.

  18. [Cocaine-related gastric perforation].

    Science.gov (United States)

    Ring, A; Stein, E; Stern, J

    2010-06-01

    Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy.

  19. Combining rhinoplasty with septal perforation repair.

    Science.gov (United States)

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

  20. Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

    OpenAIRE

    Paula Lozanova; Lyubomir Dourmishev; Snejina Vassileva; Ljubka Miteva; Maria Balabanova

    2013-01-01

    Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and l...

  1. Intraperitoneal explosion following gastric perforation.

    Science.gov (United States)

    Mansfield, Scott K; Borrowdale, Roderick

    2014-04-01

    The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

  2. Freestyle Local Perforator Flaps for Facial Reconstruction

    Directory of Open Access Journals (Sweden)

    Jun Yong Lee

    2015-01-01

    Full Text Available For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  3. Freestyle Local Perforator Flaps for Facial Reconstruction.

    Science.gov (United States)

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  4. Dimensions of stabident intraosseous perforators and needles.

    Science.gov (United States)

    Ramlee, R A; Whitworth, J

    2001-09-01

    Problems can be encountered inserting intraosseous injection needles through perforation sites. This in vitro study examined the variability and size compatibility of Stabident intraosseous injection components. The diameters of 40 needles and perforators from a single Stabident kit were measured in triplicate with a toolmakers microscope. One-way ANOVA revealed that mean needle diameter (0.411 mm) was significantly narrower than mean perforator diameter (0.427 mm) (p < 0.001). A frequency distribution plot revealed that needle diameter followed a normal distribution, indicating tight quality control during manufacture. The diameter of perforators was haphazardly distributed, with a clustering of 15% at the lower limit of the size range. However on no occasion was the diameter of a perforator smaller than that of an injection needle. We conclude that components of the Stabident intraosseous anaesthetic system are size-compatible, but there is greater and more haphazard variability in the diameter of perforators than injection needles.

  5. Diagnosis of perforated gastric ulcers by ultrasound.

    Science.gov (United States)

    Wallstabe, L; Veitt, R; Körner, T

    2002-10-01

    Patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. Radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.

  6. Stercoral colonic diverticulum perforation with jejunal diverticulitis mimicking upper gastrointestinal perforation

    Institute of Scientific and Technical Information of China (English)

    BI Jing-tao; GUO Yan-tong; ZHAO Jing-ming; ZHANG Zhong-tao

    2012-01-01

    Stercoral perforation of the colon is an unusual pathological condition with fewer than 150 cases reported in the literature to date.We present a case of stercoral colonic perforation mimicking upper gastrointestinal perforation,which was diagnosed by computed tomography preoperatively.However,at laparotomy,stercoral colonic diverticulum perforation with jejunal diverticulitis became the most appropriate diagnosis.Colonic perforation is a severe complication in surgery.It is a rather uncommon event usually caused by malignancy,diverticular disease,trauma or ulcerative colitis.Stercoral perforation of the colon was reported by Berry1 in 1894.Fewer than 150 cases have been reported in the literature to date.2,3 We present a rare case of stercoral diverticulum colonic perforation with jejunal diverticulitis mimicking upper gastrointestinal (GI) perforation,which was correctly diagnosed at laparotomy.

  7. Spontaneous ileal perforation complicating low anorectal malformation

    Directory of Open Access Journals (Sweden)

    TiJesuni Olatunji

    2015-01-01

    Full Text Available Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.

  8. Lithium absorption by the rabbit gall-bladder

    DEFF Research Database (Denmark)

    Hansen, C P; Holstein-Rathlou, N H; Skøtt, O

    1991-01-01

    Lithium (Li+) absorption across the low-resistance epithelium of the rabbit gall-bladder was studied in order to elucidate possible routes and mechanisms of Li+ transfer. Li+ at a concentration of 0.4 mM in both mucosal and serosal media did not affect isosmotic mucosa-to-serosa fluid absorption...

  9. 胃大部切除术治疗急性胃溃疡穿孔的临床应用优势研究%Study on the Clinical Application Advantages of Subtotal Gastrectomy in the Treatment of Acute Gastric Ulcer Perforation

    Institute of Scientific and Technical Information of China (English)

    蒋波; 李金祥; 饶兰英

    2016-01-01

    目的:研究胃大部切除术治疗急性胃溃疡穿孔的临床应用优势。方法:选取笔者所在医院2014年1月-2016年1月收治的急性胃溃疡穿孔患者70例为研究对象,根据手术方法不同分为两组,即胃大部切除组和修补术组,每组35例。修补术组采取单纯修补手术治疗,胃大部切除组采取胃大部切除术治疗。就两组患者手术时间、恢复肠鸣音时间、恢复排气时间、住院天数和术后复发率、并发症发生率进行比较。结果:胃大部切除组术后复发率明显低于修补术组,并发症发生率高于修补术组,差异均有统计学意义(P0.05)。结论:胃大部切除术治疗急性胃溃疡穿孔的临床应用效果较好,虽然并发症较多,但可减少术后复发率,只要术中细心操作,可提高手术安全性。%Objective:To study the clinical application advantages of subtotal gastrectomy in the treatment of acute gastric ulcer perforation.Method:Seventy cases of acute gastric ulcer perforation in our hospital from January 2014 to January 2016 were selected as the objects and divided into two groups according to the operation methods,35 cases in each group.The repair group was treated with simple repair operation,and the subtotal gastrectomy group was treated with subtotal gastrectomy.The operation time,recovery of bowel sound,exhaust time,hospital stay and postoperative recurrence rate and complication rates between the two groups were compared.Result:The recurrence rate of subtotal gastrectomy group was significantly lower than that of the repair group,the complication rate was higher than the repair group,the differences were statistically significant(P0.05).Conclusion:The clinical effect of subtotal gastrectomy in the treatment of acute gastric ulcer perforation is better,although there are more complications,but it can reduce the recurrence rate,the safety of operation can be improved as long as paying more attention

  10. Changes in outcome and management of perforated diverticulitis over a 10 year period.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2013-03-04

    Aggressive non-operative intervention and evolving surgical strategies have altered the treatment of perforated diverticulitis in the acute setting. These strategies have predominantly been implemented over the last decade. The aim of this study was to assess the impact of this on patient outcome during their index admission and subsequently.

  11. A STUDY OF DUODENAL ULCER PERFORATION: RISK FACTORS AND PROGNOSTIC DETERMINANTS IN BTGH, GULBARGA

    Directory of Open Access Journals (Sweden)

    Rajshekhar

    2015-11-01

    Full Text Available : BACKGROUND AND OBJECTIVES: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in BTGH, Gulbarga. MATERIAL AND METHODS: The study was conducted in the Department of Surgery, Basaveshwara Teaching and General Hospital, Gulbarga Karnataka during the period of Nov. 2011 - Sep.2013. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confirm at operation. Surgery was defined as urgent less as 4 hours between admission and surgery, same day (4-24 hours and delayed at a later time during the same admission. This study comprises of 60 cases of duodenal ulcer perforation admitted in the Department of Surgery, Basaveshwar Teaching & General Hospital. Operative details included the site and nature of operation performed. Mortality was defined as death following surgical procedure. Post-operative morbidity was defined in terms of duration of hospital stay and associated complications following surgery. INCLUSION CRITERIA: All patients in whom a diagnosis of duodenal ulcer perforation was established on admission and confirmed by investigations between November 2011-September 2013 are included in this study. EXCLUSION CRITERIA: 1. Cases of gastric antral perforation. 2. Cases of traumatic duodenal perforation

  12. Evaluation of prognostic factors and scoring system in colonic perforation

    Institute of Scientific and Technical Information of China (English)

    Atsushi Horiuchi; Yuji Watanabe; Takashi Doi; Kouichi Sato; Syungo Yukumi; Motohira Yoshida; Yuji Yamamoto; Hiroki Sugishita; Kanji Kawachi

    2007-01-01

    AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation.METHODS: A total of 26 patients (9 men, 17 women;mean age 72.7±11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluationⅡ (APACHE Ⅱ),Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively.RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, nonsurvivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH,low PaO2/FiO2, and high serum creatinine postoperatively.APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4±3.84 vs19.3±2.87, P= 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no significant difference was identified.CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with significantly increased mortality rate.

  13. Trends in incidence of gallbladder cancer – Indian scenario

    Directory of Open Access Journals (Sweden)

    Nandagudi Srinivasa Murthy

    2011-01-01

    Full Text Available Nandagudi Srinivasa Murthy1, Dinesh Rajaram1, MS Gautham1, NS Shivraj1, Sreekantaiah Pruthvish1, Preethi Sara George2, Aleyamma Mathew21MS Ramaiah Medical College, Bangalore, Karnataka, India; 2Regional Cancer Centre, Thiruvananthapuram, Kerala, IndiaBackground: Reports of increasing incidence rates of gallbladder cancer in several areas in India prompted the analysis of time trends. The present communication reports its geographic and gender distribution and trends in occurrence of this disease over time.Materials and methods: The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registries served as the source material. Mean annual percentage change (MAPC in incidence rates was computed using relative difference between two time periods (earliest and latest, and estimation of annual percent change (EAPC was computed by log-linear regression model.Results: In 1998–2006, incidence rates of gallbladder cancer (age-standardized rate, ASR were high in Delhi and Kamrup ((3.6 and 7.4 and (5.3 and 14.3 per 105 person years in males and females, respectively and lowest in Aurangabad, 0.0 in both genders. The incidence rate revealed an increase in all registries. MAPC in ASR ranged from 1.0% to 8.10%. EAPC for Mumbai, Chennai, and Bangalore for the period 1983–2002 revealed statistically significant increase in crude, age-standardized, and truncated rate (TR (35–64 years incidence rates. The largest EAPC in ASR was in Chennai (almost 6.0% in both genders and smallest in Mumbai (3.5% and 2.1% in males and females, respectively.Conclusions: Statistically significant increase in gallbladder cancer incidence rates has been reported for Mumbai, Chennai, and Bangalore. Further studies are required in identifying factors that may be operative in etiology of cancer of gallbladder.Keywords: gallbladder cancer, trend, Indian scenario, calendar year

  14. Subacute Right Ventricle Perforation by Pacemaker Lead Presenting with Left Hemothorax and Shock

    Directory of Open Access Journals (Sweden)

    Julianne Nichols

    2015-01-01

    Full Text Available Cardiac perforation by pacemaker is a rare but potentially fatal complication. Acute perforations occurring within twenty-four hours of insertion of pacemaker can lead to hemopericardium, cardiac tamponade, and death. Hemothorax occurring as an acute complication of pacemaker insertion is reported but extremely rare. Previously, hemothorax and shock as a subacute complication following pacemaker insertion have not been reported. We report the case of an 85-year-old patient who presented with shock from hemothorax caused by pacemaker perforation, two weeks after insertion. Device interrogation showed normal function. Chest X-ray and echocardiogram missed lead dislocation and the diagnosis was made on computed tomogram (CT of the chest. Following surgical repair, a new ventricular pacemaker was placed transvenously in the right ventricular septum. This case illustrates that CT scan of the chest should be performed in all patients in whom cardiac perforation by pacemaker is suspected but not diagnosed on chest X-ray and echocardiogram. Normal functioning of pacemaker on device interrogation does not exclude perforation.

  15. Small bowel perforation due to CMV enteritis infection in an HIV-positive patient

    Directory of Open Access Journals (Sweden)

    Michalopoulos Nick

    2013-02-01

    Full Text Available Abstract Background Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS. Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. Case presentation This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum. The patient had poor prognosis and deceased despite the prompt surgical intervention and the antiviral therapy he received. At pathology a remarkable finding was the presence of viral inclusions in smooth muscle fibers. The destruction of muscle cells was the main cause of perforation. Conclusion Morbidity and mortality associated with perforation from CMV enteritis in AIDS patients are high and the life expectancy is short. Cytomegalovirus disease is multifocal; therefore, excision of one portion of the gastrointestinal tract may be followed by a complication elsewhere. Our case elucidate that muscle cell destruction by the virus is a significant cause leading to perforation.

  16. Iatrogenic esophageal perforation in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Yeon, Kyung Mo; Park, Won Soon; Choi, Jung Hwan [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1990-07-15

    Esophagus and pharyngeal structures of newborn are very week and so vulnerable. When a parallel longitudinal tubular structure around (especially behind) the esophagus is seen, traumatic esophageal perforation must be differentiated. We report a case of esophageal perforation in a premature twin baby by nasogastric tube insertion.

  17. [Methods for sealing of corneal perforations].

    Science.gov (United States)

    Samoilă, O; Totu, Lăcrămioara; Călugăru, M

    2012-01-01

    A variety of corneal pathology can lead to corneal ulcers and perforations. A deep corneal ulcer may need surgical treatment to allow good volume restoration and reepithelisation. Corneal perforation must be sealed and when the perforation is large, the task of repairing the defect can be underwhelming. The elegant solution is the corneal transplant, but this is not always readily available, especially in undeveloped countries. We present here two cases with different solutions to seal the perforated cornea: the first one has a large peripheral defect and it is successfully sealed with scleral patch and the second one is central with small perforation and is successfully sealed with multilayered amniotic membrane. Both cases are followed for over 12 months and demonstrate good corneal restoration (both on clinical examination and corneal topography). Sclera and amniotic membrane can be used to seal corneal defects when corneal transplant is not readily available.

  18. [Gastric perforation associated with Candida infection].

    Science.gov (United States)

    Bollo, Jesús; Carrilo, Elena; Lupu, Ion; Caballero, Ferran; Trias, Manel

    2009-01-01

    Notable causes of gastroduodenal ulcer are Helicobacter pylori infection, intake of non-steroidal anti-inflammatory agents, neoplastic disease, acid hypersecretory states and secondary peptic ulcer disease. There are case reports of healthy patients or those with risk factors for fungal infection who develop gastroduodenal ulcer perforation associated with the presence of fungi in ascitic fluid or gastroduodenal ulcer tissue but without the above-mentioned etiological factors. Thus, other factors and pathogens may be involved in the pathogenesis of perforation. The use of antifungal agents in patients following surgery for a perforated gastroduodenal ulcer is controversial. We report two cases of healthy patients who underwent surgery for perforated gastroduodenal ulcer, in whom the most frequent causes of perforation were excluded. Only the presence of Candida in the ulcer was found.

  19. Gallstone-Induced Perforation of the Common Bile Duct in Pregnancy

    Directory of Open Access Journals (Sweden)

    N. Dabbas

    2008-01-01

    Full Text Available Spontaneous perforation of the extrahepatic biliary system is a rare presentation of ductal stones. We report the case of a twenty-year-old woman presenting at term with biliary peritonitis caused by common bile duct (CBD perforation due to an impacted stone in the distal common bile duct. The patient had suffered a single herald episode of acute gallstone pancreatitis during the third trimester. The patient underwent an emergency laparotomy, bile duct exploration, and removal of the ductal stone. The postoperative course was uneventful.

  20. Chemotherapy-Induced Perforation of Gastric Burkitt Lymphoma; A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Shahram Bolandparvaz

    2014-07-01

    Full Text Available Burkitt lymphoma of stomach is among the most rapidly growing gastric cancersassociated with several gasterointestinal symptoms including hematemesis, anorexia, vomiting and etc. Gastric perforation in patients with Burkitt lymphoma of stomach is a very rare condition especially after chemotherapy. We herein present a 21-year old man who was kwon case of gastric Burkitt lymphoma who had undergone chemotherapy and presented with acute onset gastric pain and tenderness. He was diagnosed to suffer from perforated gastric lymphoma for which laparotomy and total gastrectomy was performed. Treatment was continued by chemotherapy. Closed observation is thus recommended for those patients with gastric Burkitt lymphoma undergoing chemotherapy.

  1. Measurement of Gallbladder Volume with Ultrasonography in Pregnant Women

    Directory of Open Access Journals (Sweden)

    Sait Kapicioglu

    2000-01-01

    Full Text Available Fasting and postprandial gallbladder volumes were investigated using ultrasonography in three groups (10 subjects in each of healthy women: third trimester pregnant women, postpartum women up to 10 days after giving birth and nonpregnant controls. The scans were performed at 09:00 after a 12 h fast. After the basal measurement was taken, gallbladder volumes were rescanned in 15 min intervals for 60 mins. At the end of this period, all volunteers received a standard liquid test meal, and scans were performed again for 1 h. The mean basal gallbladder volume was 22.2±4.2 mL in the nonpregnant (control group. In the third trimester group, the basal volume was 37.8±10.5 mL – 70.5% higher than in the nonpregnant group (P<0.001. In the postpartum group, the mean basal volume was 37.9% lower (27.4±6.5 mL than that of the third trimester group (P<0.02. This basal volume was 23.6% greater than that of the control group (P<0.05. After administration of a test meal, the postprandial gallbladder volumes decreased during the first few minutes compared with baseline values. The volumes decreased by 10.2% to 39.8% (23.5±7.3 to 34.0±10.2; P<0.01 in the third trimester group, by 14.9% to 43.2% (16.6±4.3 to 23.3±5.5; P<0.01, 0.001 in the postpartum group and by 19.2% to 51.6% (11.9±3.5 to 17.9±3.6; P<0.02, 0.05, 0.01, 0.001 in the control group. Postprandial mean gallbladder volumes of the third trimester (P<0.02 and postpartum groups (P<0.02 to 0.01 were significantly different from those of the control group. In conclusion, incomplete emptying of the gallbladder after eating during the third trimester of pregnancy may contribute to cholesterol-gallstone formation, and pregnancy may thus increase the risk of gallstones.

  2. EFFECT OF SOMATOSTATIN ON THE CELL CYCLE OF HUMAN GALLBLADDER CANCER CELL

    Institute of Scientific and Technical Information of China (English)

    李济宇; 全志伟; 张强; 刘建文

    2005-01-01

    Objective To explore the effect of somatostatin on the cell cycle of human gallbladder cancer cell. Methods Growth curve of gallbladder cancer cell was measured after somatostatin treated on gradient concentration. Simultaneously, the change of gallbladder cancer cell cycle was detected using flow cytometry.Results Concentration-dependent cell growth inhibition caused by somatostatin was detected in gallbladder cancer cell(P<0.05). Cell growth was arrested in S phase since 12h after somatostatin treated, which reached its peak at 24h, then fell down. The changes in apoptosis index of gallbladder cancer cell caused by somatostatin correlated with that's in cell cycle. Conclusion Somatostatin could inhibit the cell growth of human gallbladder cancer cell in vitro on higher concentration. It might result from inducing growth arrest in S phase in early stage and inducing apoptosis in the late stage.

  3. CHEMICAL CAUTERISATION OF TYMPANIC MEMBRANE PERFORATIONS

    Directory of Open Access Journals (Sweden)

    Vikramjit Singh

    2015-04-01

    Full Text Available Cauterisation of 144 ear perforations ( R ight and L eft with 20 percent TCA ( T richloracetic acid was tried in patients having 2 to 6mm perforations . Per forations were dry for 3 weeks - 3 months or more. 30 patients were having traumatic perforations such as slap on face, blast injuries or associated with head injuries. Most of the patients were having perforations due to inflammation. Few of them had recent attack of otitis media which were effectively treated by suitable antibiotics, anti - histamines and subs equently taken for cauterization of perforation. Site of perforation was mostly on the anteroinferior quadrant, next the inferior quadrants. Still less number in the entire four quadrant, least no. in P. S. quadrant. Traumatic perforations were irr egular i n shape varying from 2 - 6 mm in size and were elliptical in shape. Hearing loss ranged from 15dB - 45dB ( D epending upon size and site of perforation. Main presenting symptoms in inflammation cases were intermittent discharge as well as deafness. In traumatic case history of pain and deafness was the main symptom. We did wait for 1 month in traumatic cases to achieve spontaneous closure. In inflammatory cases cautery was considered first line of treatment. It has to be done several times at 10 days interval. Mo st of the times closure of perforation was achieved with 3 attempts, inflammatory cases 5 th or 6 th attempt. In one case as many as 23 attempts. In 6 cases of perforation after partial take of graft in myringoplasty occurred after 3 months cauterization was attempted and we got closure in 5 of them. In one case re myringoplasty had to be done.

  4. 大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系%Relationship between the patterns of acute middle cerebral artery deep perforator infarctions and arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    郑晋华; 邵蓓; 牛晓婷; 吕志坤

    2010-01-01

    目的 探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系.方法 回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料.依据磁共振弥散加权成像(DWI)分为大脑中动脉深穿支小梗死组(小PAI组,直径≤3.20 cm)、大脑中动脉深穿支大梗死组(大PAI组,直径>3.20 cm)、大脑中动脉深穿支+大脑中动脉皮质支梗死组(PAI+PI组)、大脑中动脉深穿支+分水岭梗死组(PAI+BZ组)、大脑中动脉深穿支+大脑中动脉皮质支+分水岭梗死组(PAI+PI+BZ组).比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率.结果 各组动脉狭窄检出率分别为16/87、9/11、17/17、11/12、23/25,小PAI组与其余4组相比差异有统计学意义(χ~2=21.780、48.065、30.567、55.523,P值均为0.000);各组动脉重度狭窄或闭塞检出率分别为1/87、2/11、12/17、9/12、21/25,小PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=56.505、55.465、79.283,P值均为0.000),大PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=7.337、7.425、11.633,P值分别为0.007、0.006、0.001);小PAI两亚组(2.00 cm<直径≤3.20 cm亚组与直径≤2.00 cm亚组)动脉狭窄检出率差异无统计学意义(χ~2=0.253,P=0.615).结论 小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低;大PAI组、PAI+PI组、PAI+BZ组及PAI+PI+BZ组动脉狭窄检出率均较高,且PAI+PI组、PAI+BZ组、PAI+PI+BZ组动脉苇度狭窄或闭塞检出率均较高.%Objective To explor the relationship between the different types of perforating artery fresh infarcts of the middle cerebral artery and related arterial stenosis.Methods All 152 acute ischemic stroke patients hospitalized in our hospital from February 2007 to April 2009 were retrospectively reviewed.Lesions of middle cerebral artery were classified on diffusion weighted imaging

  5. Multidetector CT diagnosis of massive hemobilia due to gallbladder polyposis in a child with metachromatic leukodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Wanner, Matthew R.; Karmazyn, Boaz [Indiana University School of Medicine, Riley Hospital for Children, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Fan, Rong [Indiana University School of Medicine, Riley Hospital for Children, Department of Pathology and Laboratory Medicine, Indianapolis, IN (United States)

    2015-12-15

    Hemobilia secondary to gallbladder polyposis is rare in children but has been reported in a few children with metachromatic leukodystrophy. We present a case with preoperative multidetector computed tomography (MDCT) diagnosis of massive hemobilia caused by gallbladder polyposis in a patient with metachromatic leukodystrophy. Our report highlights the importance of both awareness of the association of gallbladder polyposis with other syndromes such as metachromatic leukodystrophy as well as the possibility of this entity presenting with life-threatening bleeding. (orig.)

  6. Total laparoscopic removal of accessory gallbladder: A case report and review of literature

    OpenAIRE

    2015-01-01

    Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using th...

  7. Spontaneous Bladder Perforation in an Infant Neurogenic Bladder: Laparoscopic Management

    Directory of Open Access Journals (Sweden)

    Daniel Cabezalí Barbancho

    2013-01-01

    Full Text Available Spontaneous bladder perforation is an uncommon event in childhood. It is usually associated with bladder augmentation. We are presenting a case of bladder rupture in an infant with neurogenic bladder without prior bladder surgery. Three days after lipomyelomeningocele excision the patient showed signs and symptoms of acute abdomen. The ultrasound exploration revealed significant amount of intraperitoneal free fluid and therefore a laparoscopic exploration was performed. A posterior bladder rupture was diagnosed and repaired laparoscopically. Currently, being 3 years old, she keeps successfully dry with clean intermittent catheterization. Neurogenic bladder voiding function can change at any time of its evolution and lead to complications. Early diagnosis of spontaneous bladder rupture is of paramount importance, so it is essential to think about it in the differential diagnosis of acute abdomen.

  8. Postprandial gallbladder emptying in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Sonne, David P; Rehfeld, Jens F; Holst, Jens Juul;

    2014-01-01

    : In a randomised design, 15 patients with long-standing T2DM and 15 healthy age-, gender- and BMI-matched control subjects were studied during 75-g oral glucose tolerance test (OGTT) and three isocaloric (500 kcal) and isovolaemic (350 ml) liquid meals: i) 2.5 g fat, 107 g carbohydrate and 13 g protein; ii) 10 g...... secretion was similar after both OGTT and meals. CONCLUSIONS: In conclusion, patients with T2DM exhibited normal gallbladder emptying to meals with a wide range of fat content. Incretin responses were similar to that in controls, and an association with postprandial gallbladder contraction could...

  9. [Pancreatic choristoma in the gallbladder: report of two cases].

    Science.gov (United States)

    Beltrán, Marcelo A; Barría, Carlos; Naquira, Cecilia; Almonacid, Jorge; Cruces, Karina S

    2007-10-01

    Pancreatic choristoma is the occurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

  10. Evaluation of gallbladder volume and contraction index with three-dimensional ultrasonography in healthy dogs.

    Science.gov (United States)

    Rahmani, Vahideh; Molazem, Mohammad; Jamshidi, Shahram; Vali, Yasamin; Hanifeh, Mohsen

    2015-09-01

    Three-dimensional (3D) ultrasonography has been shown to be an accurate and appropriate tool for measurement of gallbladder volume in humans. Therefore, we applied this novel technique for the first time to study fasting and postprandial gallbladder volume in 10 healthy dogs and compared the results with those of 2-dimensional (2D) ultrasonography. Fasting gallbladder volumes determined by 3D ultrasonography were significantly higher than corresponding volumes determined by 2D ultrasonography (Pcompared with the fasting state using 3D ultrasonography (Pdogs in this study. It is suggested that 3D ultrasonography can be used to accurately estimate gallbladder volume and contractility.

  11. Pravastatin activates PPARα/PPARγ expression in the liver and gallbladder epithelium of hamsters

    Institute of Scientific and Technical Information of China (English)

    Seok Ho Dong; Jin Lee; Dong Hee Koh; Min Ho Choi; Hyun Joo Jang; Sea Hyub Kae

    2011-01-01

    BACKGROUND: Our earlier study with cultured gallbladder epithelial cells demonstrated that statins (HMG-CoA reductase inhibitors) activate the expression of PPARα and PPARγ, consequently blocking the production of pro-inflmmatory cytokines. The present study used hamsters to investigate the effects of pavastatin on PPARα/PPARγ expression in the liver and gallbladder epithelium, and to determine whether pravastatin suppresses cholesterol crystal formation in the gallbladder. METHODS: A total of 40 Golden Syrian male hamsters (4 weeks old) were randomly assigned to four groups (basal diet control;basal diet+pavastatin; high cholesterol diet; high cholesterol diet+pravastatin). All hamsters were 11 weeks old at the end of the experiment. The liver, gallbladder and bile were harvested. Immunohistochemical staining and Western blotting for PPARα and PPARγ were performed in the liver and gallbladder. A drop of fresh bile was examined for cholesterol crystals under a microscope. RESULTS: In the gallbladder and liver of the hamsters, pravastatin activated the PPARα and PPARγ expression of gallbladder epithelial cells and hepatocytes, and particularly the response of PPARγ was much stronger than that of PPARα. Pravastatin suppressed the formation of cholesterol gallstones or crystals in the gallbladder. CONCLUSION: Pravastatinisaneffectivemedicationtoactivate PPARs (especially PPARγ) in the liver and the gallbladder epithelium of hamsters, and contributes to the prevention of gallstoneformation.

  12. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; Pinto, Antonio; Romano, Luigia

    2004-04-01

    Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24

  13. Numerical Simulation on New Perforator

    Institute of Scientific and Technical Information of China (English)

    姚志华; 王志军; 李德战; 付盟

    2011-01-01

    To study a new shaped charge of perforator, the jet formation and penetration processes in concrete targets are simulated numerically by using LS-DYNA finite element analysis software. The results show that the cylindrical liner can form jet and most materials on top of liner form the tip of jet, while the others form the tail of jet. The jet has a better continuity, and the ratio of cumulative jet length to the liner diameter can reach to 7.56. Furthermore, the ratio of bore diameter to the liner diameter is from 0. 36 and 1, and the ratio of penetration depth to the liner diameter can be up to 5.5.

  14. Asymptomatic Cecal Perforation in a Renal Transplant Recipient After Sodium Polystyrene Sulfonate Administration.

    Science.gov (United States)

    Singla, Montish; Shikha, Deep; Lee, Sunggeun; Baumstein, Donald; Chaudhari, Ashok; Carbajal, Roger

    2016-01-01

    Sodium polystyrene sulfonate (SPS) is a medication commonly used for the treatment of hyperkalemia. There have been many cases of colonic necrosis and perforation associated with administration of SPS. There are very few such cases reported in renal transplant patients. We present a case of renal transplant recipient who developed cecal perforation after a single oral dose of SPS. She had no signs or symptoms suggestive of intestinal perforation and was incidentally diagnosed with it on abdominal imaging performed to find cause of acute blood loss anemia. This case underlines the importance of recognizing this severe and potentially life-threatening complication associated with SPS. The clinicians should also consider renal/solid organ transplant and immunosuppression as potential risk factors.

  15. Rare complication after totally extraperitoneal endoscopic inguinal hernia repair: Small bowel perforation without peritoneal disruption.

    Science.gov (United States)

    Kojima, Shigehiro; Sakamoto, Tsuguo; Honda, Masayuki; Nishiguchi, Ryohei; Ogawa, Fumihiro

    2016-11-01

    We report a rare case of visceral injury after totally extraperitoneal endoscopic inguinal hernia repair. A 48-year-old man underwent needlescopic totally extraperitoneal repair of a direct inguinal hernia. Bleeding from a branch of the inferior epigastric vessels occurred at the beginning of the extraperitoneal dissection with a monopolar electrosurgical device. Hemostasis was prolonged. However, herniorrhaphy and mesh repair were successfully performed, and no peritoneal disruption or pneumoperitoneum was visible. The patient was discharged home on the next day. However, 30 h after this operation, he underwent diagnostic and operative laparoscopy because of acute abdominal pain. Ileal perforation was found and repaired, and pathological examination indicated cautery artifact. Thus, thermal damage to the ileum during the initial operation may have caused the bowel perforation. To the best of our knowledge, no other cases of bowel perforation after totally extraperitoneal repair without peritoneal disruption have been reported.

  16. Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

    Directory of Open Access Journals (Sweden)

    Shahsanam Gheibi

    2016-10-01

    Full Text Available Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation  The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

  17. Gallbladder cancer with tumor thrombus in the superior vena cava

    Institute of Scientific and Technical Information of China (English)

    Sandeep Batra; Dinesh Chandra Doval; Ullas Batra; Pandalanghat Suresh; Amit Dhiman; Vineet Talwar

    2010-01-01

    BACKGROUND: Gastrointestinal cancers, especially pancreato-biliary cancers, are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage, especially of the abdomen and lower limbs. This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava (SVC) with resultant SVC obstruction, while on geiftinib-based anti-epidermal growth factor receptor (EGFR) therapy. METHODS: A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy. She had disease recurrence and received systemic chemotherapy followed by geiftinib-based anti-EGFR therapy. Subsequently, while on geiftinib-based therapy, she presented with clinical signs and symptoms suggestive of SVC thrombosis. RESULTS: A whole body PET scan revealed a metabolically active tumor thrombus in the SVC, besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen. She was treated with anti-thrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief. She continues to survive on the day of writing this report. CONCLUSIONS: This rare complication, though theoretically possible, is unreported because of the short overall survival of advanced gallbladder cancer patients. This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients, we may come across such cases more frequently in the future.

  18. Agenesis of the gallbladder: A dangerously misdiagnosed malformation

    Institute of Scientific and Technical Information of China (English)

    Nicolas Peloponissios; Michel Gillet; René Cavin; Nermin Halkic

    2005-01-01

    Isolated agenesis of the gallbladder is a rare anomaly,often asymptomatic. However, one patient out of four presented with right upper abdominal pain, nausea, and fatty food intolerance. The condition is frequently mistaken with an excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG often leads to unnecessary and potentially dangerous laparoscopic surgery as described in a few case reports over the last10 years. The aim of this study is to clarify the diagnostic and therapeutic approach of this unusual pathology. Two cases seen in our institutions were retrospectively reviewed, together with a review of the American and European literature. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to expose and dissect the triangle of Callot increases the risk of iatrogenic injury to biliary or portal structures. Depending on the experiment of the surgeon in laparoscopic procedure, this has to be taken into account to decide a conversion to laparotomy.A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRJ-cholangiography is mandatory. Because of possible inherited transmission,relatives with a history of biliary symptoms should be investigated.

  19. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

    Science.gov (United States)

    Zubair, M; Habib, L; Mirza, M R; Channa, M A; Yousuf, M

    2010-07-01

    This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in

  20. [Some aspects of the complex treatment of acute suppurative perionitis].

    Science.gov (United States)

    Kovalev, M M; Roĭ, V P; Zaritskiĭ, I; Konovalenko, V V; Mellin, V M

    1976-10-01

    The authors present an analysis of the results of complex treatment in 4318 patients operated upon for acute peritonitis, caused by acute appendicitis, perforating gastric and duodenal ulcers, acute cholecystitis, ruptures and perforations of the intestine and other surgical and gynecological diseases. Patients with diffuse purulent peritonitis showed marked disorders in protein-aminoacid, nitrogen, and water electrolyte metabolism, acid-base balance, a reduced nonspecific immune responsiveness of the organism. Therpeutic tactics was delineated taking into account the revealed changes.

  1. Nasal Septum Perforation due to Methamphetamine abuse

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhshaee

    2012-07-01

    Full Text Available Introduction: Spontaneous Perforation of the nasal septum is an uncommon condition. Nasal inhalation of substances such as cocaine has long been linked to this Perforation. Case Report: This report describes the case of a 46-year-old woman who was addicted to methamphetamine and who presented with perforation of the nasal septum.This is the first reported case of nasal septal necrosis linked to nasal inhalation of methamphetamine. Conclusions: Patient history and assurance regardingillegal drug consumption and abuse is a key point for fast and accurate diagnosis. The pathophysiology of drug-induced sinunasal disease and a review of the literature are also presented.

  2. Septum nasal perforation: treatments and literature' review

    Directory of Open Access Journals (Sweden)

    Martinez Neto, Eulógio Emílio

    2010-03-01

    Full Text Available Introduction: The present study consists in a bibliographical' review concerning the articles related to the different manifestations and forms of the septum nasal perforation, with a main emphasis in the description of its techniques of surgical correction. As the etiology, that is fundamentally iatrogenic, accordingly surgical trauma. Other causes include exhibition to chemical industrial reagents, cocaine use, intranasal steroidal therapeutic, neoplasia and, infectious conditions. There is a few data concerning the prevalence of septum perforation in the general population. The decision making about surgical correction or medical treatment depend on the anatomic characteristics and of the pathogenesis of the septal perforation.

  3. Modelling of acoustic transmission through perforated layer

    Directory of Open Access Journals (Sweden)

    Lukeš V.

    2007-10-01

    Full Text Available The paper deals with modeling the acoustic transmission through a perforated interface plane separating two halfspaces occupied by the acoustic medium. We considered the two-scale homogenization limit of the standard acoustic problem imposed in the layer with the perforated periodic structure embedded inside. The homogenized transmission conditions govern the interface discontinuity of the acoustic pressure associated with the two halfspaces and the magnitude of the fictitious transversal acoustic velocity. By numerical examples we illustrate this novel approach of modeling the acoustic impedance of perforated interfaces.

  4. Traumatic prenatal sigmoid perforation due to amniocentesis

    Energy Technology Data Exchange (ETDEWEB)

    Fines, B.; Ben-Ami, T.E.; Yousefzadeh, D.K. [Dept. of Radiology, Univ. of Chicago, IL (United States)

    2001-06-01

    A variety of fetal injuries, including those inflicted to the gastrointestinal tract by amniocentesis, have been reported before. This brief report describes the first documented case of sigmoid perforation owing to the common procedure of amniocentesis that manifested as abdominal distention at birth. A potential link between this complication and a recent increased incidence of ''intrauterine spontaneous perforation'' of the gastrointestinal tract has been mentioned. Practicing radiologists are encouraged to inquire directly about the history of amniocentesis in unexplained cases of intrauterine intestinal perforation. (orig.)

  5. Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

    Science.gov (United States)

    Abu-Zaid, Ahmed; AlOmar, Osama; Nazer, Ahmed; Azzam, Ayman; Abudan, Zainab; Al-Badawi, Ismail

    2013-01-01

    Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented. PMID:24073347

  6. Generalized Peritonitis Secondary to Spontaneous Perforation of Pyometra in a 63-Year-Old Patient

    Directory of Open Access Journals (Sweden)

    Ahmed Abu-Zaid

    2013-01-01

    Full Text Available Spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. Herein, we report the case of a 63-year-old woman who presented to emergency department with a 2-day history of severe diffuse abdominal pain, high-grade fever, nausea, and vomiting. Acute abdomen series was done, and upright plain chest radiograph showed free air under diaphragm. A noncontrast-enhanced computed tomography scan showed a significantly distended fluid-filled uterus measuring 10 × 7.8 × 10 cm, in addition to a single focus of perforation involving the uterine fundus and associated with presence of free air within the nondependant area. No evidence of ascites or pelvi-abdominal lymphadenopathy was identified. A preoperative diagnosis of generalized peritonitis secondary to spontaneous perforation of uterus was established. Subsequently, patient underwent urgent exploratory laparotomy which revealed pus-filled uterus with perforated fundus. Diagnosis of generalized peritonitis secondary to spontaneous perforation of pyometra was established. Consequently, patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, as well as thorough drainage and irrigation of pelvi-abdominal cavity. Postoperatively, patient was admitted to intensive care unit. Histopathological examination of uterus was negative for malignancy, and surgical culture grew Streptococcus constellatus. Patient had an uneventful recovery. Moreover, a brief literature review on pyometra is presented.

  7. Alteration in transforming growth factor-β receptor expression in gallbladder disease: implications of chronic cholelithiasis and chronic Salmonella typhi infection

    Directory of Open Access Journals (Sweden)

    Yogesh D. Walawalkar

    2016-08-01

    Full Text Available Gallbladder cancer prevalence is ever increasing with Salmonella typhi chronic infection being one of the predisposing factors. Altered ratios or expression of transforming growth factor-β (TGF-β receptors and changes in its function are associated with loss in anti-proliferative effects of TGF-β and cancer progression. Using reverse transcriptase polymerase chain reaction we monitor any changes in TGF-β receptor gene expression. We simultaneously screen for S. typhi within the samples. From 73 patients undergoing cholecystectomy 39-50% had significant expression (P<0.05 of TGF-β receptor (TβR- I and TβR-II during chronic cholelithiasis as compared to the remaining 19-23% with acute chronic cholelithiasis. There was no significant increase in TβR-III receptor expression. Patient’s positive for S. typhi (7/73 did not show any significant changes in expression of these receptors, thus indicating no direct relation in regulating the host TGFβ-signaling pathway. Further analysis on expression of downstream Smad components revealed that patients with up-regulated TGFβ receptor expression show >2-fold increase in the RSmads and Co-Smads with a >2-fold decrease in I-Smads. Thus gain of TβR-I and II expression in epithelial cells of the gallbladder was associated with chronic inflammatory stages of the gallbladder disease.

  8. Effect of Perforation Area and Arrangement Pattern on Structural Behaviour of Nature Inspired Perforated Hollow Structure

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    Woo Yian Peen

    2013-01-01

    Full Text Available The Cholla cactus skeleton has been the inspiration source for this study, in our effort to search forlight and more structural effective structures. This woody skeleton of Cholla with oval shaped perforationsarranged in spiral pattern is found strong enough to support the cactus self weight. This research has beencarried out to investigate the effects of percentage of perforations and perforations arrangements on structuralbehaviour of cylindrical hollow section. A total of eleven models consisting of one cylindrical hollow sectionwithout perforation as the control model and ten simplified perforated cylindrical hollow sections have beenconstructed using a finite element method software. The perforated models have been assigned with 10 to 50percent of perforations area by fixing the number of perforations to twenty and altering the perforation size toachieve the percentage variable. Computational analyses have been carried out for three loading conditions:compressive, flexural and torsional. Findings have shown that the increment in percentage of perforationsproduces higher stresses to the cylindrical hollow section. This has effects on the structural capacity of thecylindrical hollow section. Array arrangement of the perforations shows better structural performance incompression and flexural loading conditions while spiral arrangement exhibits better structural performanceunder torsional loading condition.

  9. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2009-04-02

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  10. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc

    2014-01-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that ea...

  11. Laparoscopic Repair for Perforated Duodenal Ulcer

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    A. Cotirleţ

    2015-01-01

    Full Text Available Perforated peptic ulcer (PPU, despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

  12. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2012-02-01

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  13. Perforated peptic ulcer: How to improve outcome?

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten;

    2008-01-01

    Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased...... with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published...... to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27...

  14. Diagnostic value of reflux sign in cholescintigraphy after administration of a gallbladder contracting agent. Comparison with X-ray cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao; Shimono, Reiko; Murase, Kenya; Koito, Hikaru; Iio, Atsushi; Hamamoto, Ken.

    1989-01-01

    This study explored the diagnostic value of cholescintigraphy in evaluating biliary passage, focusing on reflux sign in which radioactivity in the left hepatic duct or peripheral intrahepatic duct was increased after intramuscular injection of caerulein. Reflux sign was observed in 28 (12%) of 237 patients examined during the past four years from 1983 to 1987. Twenty five patients simultaneously undergoing X-ray cholangiography were eligible for this study, consisting of four each with common bile duct (CBD) stone, dilated CBD, biliary dyskinesia, and chronic pancreatitis, three with gallbladder stone, two with duodenal ulcer, and one each with adenoma of the CBD, pancreatic pseudocyst, duodenal diverticle, and acute cholangitis. The dilated CBD of 10 mm or more was seen in 13 patients (52%) and CBD stenosis was seen in 6 patients (24%). There was no correlation between reflux sign and gallbladder contraction. Prolonged RI gassage and pooling within the CBD were shown in 17 patients (68%) and 8 patients (28%), respectively. Major reflux sign was considered to reflect the CBD diameter increased by drip infusion of caerulein. It is useful in determining biliary passage in the lower end of the CBD and slight CBD dilatation. (Namekawa, K).

  15. The influence of gallbladder function on the symptomatology in gallstone patients, and the outcome after cholecystectomy or expectancy

    DEFF Research Database (Denmark)

    Larsen, Thomas Kjaergaard; Qvist, Niels

    2007-01-01

    gallstone disease. Fifty-six patients had a functioning gallbladder and 44 had a nonfunctioning gallbladder. Patients with a nonfunctioning gallbladder had significantly more vomiting and received more pain-killing injections during pain attacks. Otherwise, there were no differences in pain patterns...

  16. Freestyle Local Perforator Flaps for Facial Reconstruction

    OpenAIRE

    Jun Yong Lee; Ji Min Kim; Ho Kwon; Sung-No Jung; Hyung Sup Shim; Sang Wha Kim

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosi...

  17. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy.

    Science.gov (United States)

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2013-06-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  18. In vitro and in vivo accuracy of sonographic gallbladder volume determinations

    DEFF Research Database (Denmark)

    Andersen, I B; Monrad, H; Grønvall, S;

    1993-01-01

    being more precise. The absolute deviation was independent of the size of the volume and of the shape of the gallbladder. In vivo Simpson's method was validated on 11 patients with cholecystitis. The gallbladder volumes (mean 65 mL; Range 20 mL to 130 mL) measured by sonography differed from...

  19. Isolated IgG4-related cholecystitis mimicking gallbladder cancer: a case report.

    Science.gov (United States)

    Shin, Sang-Wook; Kim, Yongsoo; Jeong, Woo Kyoung; Kim, Jinoo; Kim, Min Yeong; Oh, Young Ha; Pyo, Ju Yeon

    2013-01-01

    A 58-year-old man with right upper quadrant pain was referred to the radiology department. The patient underwent computed tomography and magnetic resonance imaging, which suggested the diagnosis of gallbladder cancer invading the liver. After surgical removal of the gallbladder, and the adjacent liver parenchyma was performed, the histologic diagnosis of IgG4-related cholecystitis was made.

  20. The G protein-coupled bile acid receptor, TGR5, stimulates gallbladder filling.

    Science.gov (United States)

    Li, Tingting; Holmstrom, Sam R; Kir, Serkan; Umetani, Michihisa; Schmidt, Daniel R; Kliewer, Steven A; Mangelsdorf, David J

    2011-06-01

    TGR5 is a G protein-coupled bile acid receptor present in brown adipose tissue and intestine, where its agonism increases energy expenditure and lowers blood glucose. Thus, it is an attractive drug target for treating human metabolic disease. However, TGR5 is also highly expressed in gallbladder, where its functions are less well characterized. Here, we demonstrate that TGR5 stimulates the filling of the gallbladder with bile. Gallbladder volume was increased in wild-type but not Tgr5(-/-) mice by administration of either the naturally occurring TGR5 agonist, lithocholic acid, or the synthetic TGR5 agonist, INT-777. These effects were independent of fibroblast growth factor 15, an enteric hormone previously shown to stimulate gallbladder filling. Ex vivo analyses using gallbladder tissue showed that TGR5 activation increased cAMP concentrations and caused smooth muscle relaxation in a TGR5-dependent manner. These data reveal a novel, gallbladder-intrinsic mechanism for regulating gallbladder contractility. They further suggest that TGR5 agonists should be assessed for effects on human gallbladder as they are developed for treating metabolic disease.

  1. Total laparoscopic removal of accessory gallbladder: A case report and review of literature

    Science.gov (United States)

    Cozacov, Yaniv; Subhas, Gokulakkrishna; Jacobs, Michael; Parikh, Janak

    2015-01-01

    Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct (H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications. PMID:26730286

  2. Bile peritonitis after inadvertant puncture of the gallbladder as a rare complication of percutaneous transhepatic cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Farkas, I.; Marik, J.

    1983-01-01

    A report is given about a rare complication after percutaneous transhepatic cholangiography: after inadvertant puncture of the gallbladder, bile peritonitis developed. Surgery was done immediately and the gallbladder, which was filled with stones, as well as stones from the choledochus were removed. The literature dealing with complications of percutaneous cholangiography is reviewed.

  3. A case report of duplex gallbladder and review of the literature

    Directory of Open Access Journals (Sweden)

    Y.M. Goh

    2015-01-01

    Full Text Available Gallbladder duplication is a rare congenital abnormality first described by Boyden in 1926. Pre-operative diagnosis is essential in identifying anatomical abnormalities in order to avoid biliary injuries at the time of surgery or performance of an incomplete operation. We present a case of a duplex gallbladder and review of the literature.

  4. The relationship between gallbladder dynamics and the migrating motor complex in fasting healthy subjects

    DEFF Research Database (Denmark)

    Qvist, N; Oster-Jørgensen, E; Rasmussen, L

    1988-01-01

    The relationship between gallbladder dynamics and the interdigestive migrating motor complex (MMC) was investigated in 10 healthy male volunteers by a hepatobiliary scintigraphy and gastroduodenal pressure recordings. Filling of the gallbladder commenced in late phase II or in phase III of the MM...

  5. Hydropic Gallbladder in Three Patients with Poorly Controlled Diabetes Mellitus: What Constitutes Optimal Management?

    Directory of Open Access Journals (Sweden)

    Yezaz A Ghouri

    2015-05-01

    Full Text Available Context Long-standing diabetes mellitus results in autonomic nervous system dysfunction, leading to gastroparesis and cholecystoparesis. The latter can result in hydropic gallbladder, a condition that arises from the accumulation of mucinous secretions within the gallbladder, usually caused by obstruction of the cystic duct, but not in the case of the patients with diabetes that we have illustrated. Case report We describe three patients who presented with non-specific abdominal discomfort at the time of admission for complications of poorly controlled diabetes and were subsequently found to have hydropic gallbladder. We theorize that hydropic gallbladder may be a result of a natural progression of gallbladder dysfunction in poorly controlled diabetics with autonomic neuropathy. In our cases the risk of perioperative mortality was high at the time of presentation. No surgical intervention was performed except in one case with the most significant sized gallbladder, and underwent a temporizing cholescystostomy. Conclusions The development of hydropic gallbladder in patients with non-obstructed cystic ducts highlights the complexities of management of patients with functional biliary pain. The rome committee on functional biliary and pancreatic disorders has defined the characteristics of this pain. There is a need for guidelines to direct appropriate assessment of hydropic gallbladder in diabetics and also to determine the indications for cholecystectomy.

  6. Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

    Science.gov (United States)

    Thiong'o, Grace Muthoni; Luzzio, Christopher; Albright, A Leland

    2015-07-01

    OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending. Catheter frictional force was measured per unit length. RESULTS Six children were identified whose VP shunts had perforated the GI tract; 2 shunts subsequently protruded through the anal orifice, 1 protruded through the oral cavity, and 3 presented with subcutaneous abscesses that tracked upward from the intestine to the chest. All perforating shunts were Chhabra shunts. Catheter stiffness and resistance to bending were greatest with a Medtronic shunt catheter, intermediate with a Codman catheter, and least with a Chhabra catheter. Frictional force was greatest with a Chhabra catheter and least with a Medtronic catheter. CONCLUSIONS The frequency of perforations by Chhabra shunts appears to be higher than the frequency associated with other shunts. The increased frequency does not correlate with their stiffness but may reflect their greater frictional forces.

  7. Perforated duodenal ulcer in Asir central hospital

    Directory of Open Access Journals (Sweden)

    Jastaniah Suleiman

    1997-01-01

    Full Text Available In a study of 27 cases of perforated duodenal ulcer seen at Asir Central Hospital over a period of seven years, two patients were females and 25 males. The highest incidence was in the fourth decade and the average age was 36.3 years. The Saudi-foreigner ratio was 1:2.9 in an area where the Saudi-foreigner population ratio was 1:3. Nine patients (33.3% were previously diagnosed as having peptic ulcer and had received treatment at one time or the other before perforation. Eighteen patients (66.7% were first diagnosed to peptic ulcer after the perforation. All the identified perforations were located anteriorly and anterosuperiorly. Only one case occurred in the second part of duodenum. The rest occurred in the first part. Two patients were treated successfully conservatively. The month perforations occurred most was the month of Shaaban. The fasting period during the month of Ramadhan did not show any increase in the prevalence of perforation in this hospital.

  8. Surgical treatment of perforated gastric ulcer

    Directory of Open Access Journals (Sweden)

    Korica Milan

    2002-01-01

    Full Text Available Introduction Peptic ulcer perforation is a complication of ulcer disease which requires urgent surgical treatment. The aim of this paper was to point out our experience in surgical treatment of perforated peptic ulcer. Material and methods This retrospective study analyzes results of surgical treatment in 365 patients with perforated peptic ulcer during the period January 1996 to December 2000. Results During the last 5-year period 365 patients were treated following peptic ulcer perforation. The average age was 43.53±8.26, with the span from 18 to 86. The most frequent surgical procedures in treatment of peptic ulcer perforation were: simple closure with biopsy (55.88%, excision of the ulcer with a pyloroplasty and vagotomy (35.29% as nonresection surgical procedures and stomach resection after Billroth II (8.83%. The postoperative mortality was 4.41%. Conclusions The methods of choice in surgical treatment of gastric ulcer perforation are nonresection surgical procedures with drug therapy and eradication of Helicobacter pylori, if present.

  9. Fat graft myringoplasty in small central perforations

    Directory of Open Access Journals (Sweden)

    Chandni Sharma

    2014-01-01

    Full Text Available Background: Perforations of the tympanic membrane (TM are treated with various surgical techniques and materials. Although autologous temporalis fascia is the most common material used for the closure of TM perforations, however for a dry, small central perforation the fat graft myringoplasty (FM is a good alternative as it is a simple and cost-effective technique. Objectives: The aim of this study was to determine the efficacy of FM for repair of small central perforations. Suggestions for optimizing the outcome of FM are presented. Material and Methods: Twenty patients (10 males and 10 females who had uncomplicated dry small central perforation, which was confined to one quadrant of the pars tensa underwent FM. The outcome was evaluated after 1-week, 1-month, and 3 months. Results: After 3 months of follow-up, a closure rate of 80% was achieved. Mean preoperative air-bone (AB gap was 22.90 ± 6.54 dB and mean postoperative AB gap was 21.80 ± 6.28 dB. Mean improvement in AB gap postoperatively was 1.1 ± 2.63 dB. Conclusion: Fat graft myringoplasty, with its ease of technique and good graft uptake rate justifies its use in the closure of small dry central TM perforations.

  10. Clinical analysis of laparoscopic suture in the treatment of 40 cases of acute perforation of peptic ulcer%腹腔镜修补术治疗消化性溃疡急性穿孔40例临床分析

    Institute of Scientific and Technical Information of China (English)

    韩晓鹏; 柳万忠; 刘宏斌

    2012-01-01

    目的 探讨腹腔镜胃十二指肠溃疡修补术在消化性溃疡急性穿孔患者的临床应用价值.方法 回顾分析我科2010年3月-2011年5月使用腹腔镜行胃十二指肠溃疡修补手术治疗40例消化性溃疡穿孔患者的临床资料.结果 40例患者病理结果均为良性溃疡,手术时间为28 ~ 80 min,平均(40.1±17.8)min;术后下床活动时间为14~24 h,平均(16.8±4.7)h;去除胃肠减压时间为14 ~48 h,平均(19.7±3.5)h;术后镇痛药的使用率为12.5%(5/40);住院时间为4~7d,平均(5.1±1.4)d;术后均辅以内科抗溃疡药物治疗4~6周,随访6月,无溃疡复发.结论 应用腹腔镜胃十二指肠溃疡修补术治疗消化性溃疡穿孔具有安全可靠、疗效好、并发症少、恢复快等优点.%Objective To explore the clinical value of laparoscopic gastric ulcer suture in patients with acute perforation of peptic ulcer. Methods Clinical data of 40 patients with acute perforation of peptic ulcer underwent laparoscopic gastric ulcer suture in our department from March 2010 to May 2011 were retrospectively analyzed. Results Pathologic findings in 40 patients are benign ulcer, operation time is 28 -80 minutes, average operation time is (40 ?17.8) min; postoperative ambulation time is 14 -24h, (16.8?.7)hon average; removal of gastrointestinal decompression time is 14 -48h, (19.7 ?.5)h on average; the rate of postoperative analgesic use is 12.5% (5/40) ; hospitalization time is 4 -7d, (5. 1 ?1. 4)d on average; anti-ulcer drug for the treatment of 4 ~6 week, follow-up for 6 months, no ulcer recurrence. Conclusion Laparoscopic gastric ulcer suture has the features of safety, reliability, good curative effect, less complications and quick recovery.

  11. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    Directory of Open Access Journals (Sweden)

    Wever Jan

    2004-01-01

    Full Text Available Abstract Background Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. Case presentation A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Conclusion Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  12. Study on Salmonella Typhi occurrence in gallbladder of patients suffering from chronic cholelithiasis-a predisposing factor for carcinoma of gallbladder.

    Science.gov (United States)

    Walawalkar, Yogesh D; Gaind, Rajni; Nayak, Vijayashree

    2013-09-01

    Cholelithiasis is frequently associated with carcinoma of gallbladder, and the presence of Salmonella Typhi in gallbladder of patients suffering from cholelithiasis is implicated as a predisposing factor for carcinogenesis. This study was conducted on patients suffering from chronic cholelithiasis from a region in North India-endemic area for enteric fever with high incidence of gallstones and gallbladder cancer. Since culture studies rarely reveal the chronic Salmonella Typhi persistence, we use PCR assay to specifically amplify the H1-d flagellin gene sequence homologous with Salmonella Typhi. Seven cases (17.5%), none of which were positive for culture, showed positive PCR results for Salmonella Typhi, 4 (10%) of which were tissue, 2 bile (5%), and 1 gallstone (2.5%). The chronic existence of Salmonella Typhi in gallbladder disease was confirmed. Thus, the study would indicate the importance of vaccination so as to prevent chronic infection and need for early diagnostic tools to prevent any further complications.

  13. [A case of ascariasis in the gallbladder successfully treated with an anthelmintic injection into the gallbladder via a percutaneous transhepatic catheter].

    Science.gov (United States)

    Ikuta, Syuzo; Mizuguchi, Yasuhiro; Tsuji, Yuichiro; Tsukamoto, Sakiko; Oba, Nobuyuki; Nishinakagawa, Syuta; Kojima, Tatsuya

    2010-05-01

    A man in his 40s who had made frequent visits abroad was admitted to our hospital complaining of epigastric pain. Ultrasonography (US) revealed an "inner tube sign" in the gallbladder, which suggested a diagnosis of ascariasis in the gallbladder. Pyrantel pamoate was directly injected into the gallbladder via a percutaneous transhepatic catheter. The worm was dead 10 minutes after the injection. US revealed reduction of the worm's length and then the disappearance of the worm from the gallbladder at both 13 days and 2 months after the injection. This method is less invasive than operation and therefore is possibly more safe. It is known that the number of cases of ascariasis may increase in Japan due to increased organic vegetable consumption and foreign travel. We need to consider this disease in the differential diagnosis of epigastric pain.

  14. An unusual cause of cholecystitis: Heterotopic pancreatic tissue in the gallbladder

    Institute of Scientific and Technical Information of China (English)

    Gülsüm (O)zlem Elpek; Sevgi Bozova; G(o)kben Yildinm Küpesiz; Mehmet (O)(g)ü(s)

    2007-01-01

    Gallbladder localization of heterotopic pancreas (HP)is uncommon and very rarely gives rise to symptoms.Herein we report a case of HP found in the gallbladder neck presented with signs and symptoms of cholecystitis.The patient was a 40-year old male, suffering from epigastric pain, abdominal fullness and fever. On physical examination, the right upper abdomen was tender with a positive Murphy's sign. Ultrasonographic examination showed a hydropic gallbladder without stones and he underwent a cholecystectomy. Pathological examination revealed an intramural nodule (9 mm) in the neck region which is consisted of acini, ducts and islet cells of an aberrant pancreatic tissue. Although HP is encountered rarely in the gallbladder and is found incidentally durng pathological studies, this case emphasizes that HP might cause symptoms and present clinically as cholecystitis.For this reason, in patients presenting with symptomatic gallbladder diseases, including cholecystitis without any other pathology, HP should be taken into consideration before it is diagnosed as "idiopathic".

  15. Ascariasis of gallbladder: a rare case report and a review of the literature.

    Science.gov (United States)

    Khanduri, Sachin; Parashari, Umesh C; Agrawal, Deepak; Bhadury, Samarjit

    2014-01-01

    Ascariasis of the gallbladder is a very rare presentation. We report a case of a 15-year-old boy who presented with complaints of pain in the abdomen, vomiting, pruritus, and fever on-and-off for 10 days. On radiological examination, an ultrasonography of the abdomen showed a dilated gallbladder with multiple linear echogenic, tubular, parallel lines inside the lumen of the gallbladder, common bile duct and intrahepatic biliary radicles. The zigzag and coiling movement of a worm was noted in the lumen of the gallbladder on real time B-mode ultrasonography. The patient was successfully treated with an anthelminthic drug. On follow up no evidence of the worm was noted in the gallbladder or common bile duct lumen.

  16. H pylori exist in the gallbladder mucosa of patients with chronic cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Dong-Feng Chen; Lu Hu; Ping Yi; Wei-Wen Liu; Dian-Chun Fang; Hong Cao

    2007-01-01

    AIM: To study whether H pylori locate in the gallbladder mucosa of patients with chronic cholecystitis.METHODS: Using Warthy-Starry (W-S) silver stain and immunohistochemistry stain with anti-H pylori antibodies, we screened paraffin specimens in 524 cases of cholecystitis. H pylori urease gene A (HPUA) and H pylori urease gene B (HPUB) were analyzed by polymerase chain reaction (PCR) in the fresh tissue specimens from 81 cases of cholecystitis.RESULTS: H pylori-like bacteria were found in 13.55% of the gallbladders of the cholecystitis patients using W-S stain. Meanwhile, bacteria positive for H pylori antibodies were also found in 7.1% of the gallbladders of patients with cholecystitis by immunohistochemistry. Of 81 gallbladders, 11 were positive for both HPUA and HPUB, 4 were positive for HPUA only and 7 were positive for HPUB only.CONCLUSION: H pylori exist in the gallbladders of patients with chronic cholecystitis.

  17. Effect Observation and Systematic Evaluation on Two Different Surgical Methods Clinically Used to Treat Acute Gastric Perforation%2种不同手术方法用于治疗急性胃穿孔的效果观察与系统评价

    Institute of Scientific and Technical Information of China (English)

    陈龙

    2016-01-01

    Objective:This paper is to systematically evaluate the efficacy of two different surgical methods clinically used on the recovery of gastrointestinal functions of patients with acute gastric perforation in clinical treatment .Meth‐ods:Sixty patients with acute gastric perforation admitted by the In‐patient Department from January 1 ,2013 to De‐cember 1 ,2014 were selected as research subjects ,all of whom were treated with surgeries ,who were divided into the research group (30 cases ,subject to laparoscopic gastrorrhaphy) and the control group (30 cases ,subject to laparoto‐my gastrorrhaphy ) according to different operation methods ,details of clinical treatment ,gastric ulcer recovery and complications ,the level of serum and gastrin as well as the recovery of gastrointestinal function of patients in two groups were compared and analyzed .Results:The recovery of patients in the research group in indicators including the anus exhaust time ,recovery time of bowel sound ,hospital stay ,serum levels of serum gastrin were better ,and the in‐ter‐group statistics t test satisfied P<0 .05 ,the differences were obvious .Total recovery rate of patients with gastric ulcer (96 .67% ) in the research group were better than that of patients in the control group (86 .67% ) ,postoperative complications rate (6 .67% ) of patients in the research group were lower than that of patients in the control group (16.67% ) ,the inter‐group statistics χ2 test satisfied P<0 .05 ,and the differences were obvious .Conclusion:Laparo‐scopic gastrorrhaphy delivers more distinct efficacy in the treatment of clinically acute gastric perforation when com‐pared to that of laparotomy gastrorrhaphy ,and effectively recover gastrointestinal functions of patients ,generating the complication rate and high safety ,it is suggested to be preferentially selected and used in clinical services .%目的:系统评价2种不同手术方式治疗对急性胃穿孔患者胃肠功能恢

  18. Presence and distribution of leptin and leptin receptor in the canine gallbladder.

    Science.gov (United States)

    Lee, Sungin; Lee, Aeri; Kweon, Oh-Kyeong; Kim, Wan Hee

    2016-09-01

    The hormone leptin is produced by mature adipocytes and plays an important role in regulating food intake and energy metabolism through its interaction with the leptin receptor. In addition to roles in obesity and obesity-related diseases, leptin has been reported to affect the components and secretion of bile in leptin-deficient mice. Furthermore, gallbladder diseases such as cholelithiasis are known to be associated with serum leptin concentrations in humans. We hypothesized that the canine gallbladder is a source of leptin and that the leptin receptor may be localized in the gallbladder, where it plays a role in regulating the function of this organ. The aim of this study was to demonstrate the presence and expression patterns of leptin and its receptors in normal canine gallbladders using reverse transcriptase-PCR (RT-PCR) and immunohistochemistry. Clinically normal gallbladder tissue samples were obtained from four healthy beagle dogs with similar body condition scores. RT-PCR and sequencing of the amplified PCR products revealed the presence of leptin mRNA and its receptors in the gallbladder. Immunohistochemical investigations demonstrated the expression of leptin and its receptors in the luminal single columnar and tubuloalveolar glandular epithelial cells. In conclusion, the results of this study demonstrated the presence of leptin and its receptors in the gallbladders of dogs. Leptin and its receptor were both localized throughout the cytoplasm of luminal and glandular epithelial cells. These results suggested that the gallbladder is not only a source of leptin, but also a target of leptin though autocrine/paracrine mechanisms. The results of this study could increase the understanding of both the normal physiological functions of the gallbladder and the pathophysiological mechanisms of gallbladder diseases characterized by leptin system dysfunction.

  19. Acute abdomen

    Directory of Open Access Journals (Sweden)

    Wig J

    1978-01-01

    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  20. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2014-06-15

    To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. (orig.)

  1. Coronary perforation and covered stents: An update and review

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Mukhaini

    2011-01-01

    Full Text Available Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater, II (myocardial or pericardial blushing, and III (contrast streaming or cavity spilling. Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention.

  2. Migration of Gelfoam to the gallbladder after liver biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Riddle, Chris [The Hospital for Sick Children, Image Guided Therapy, Department of Diagnostic Imaging, Toronto (Canada); Dalhousie University, School of Medicine, Halifax (Canada); Ahmed, Bilal [University of Toronto School of Medicine, Toronto (Canada); Doyle, John [The Hospital for Sick Children, Department of Hematology/Oncology, Toronto (Canada); Connolly, Bairbre L. [The Hospital for Sick Children, Image Guided Therapy, Department of Diagnostic Imaging, Toronto (Canada)

    2008-07-15

    Liver biopsy is a common procedure, with an inherent risk of bleeding. There are different ways to help avoid hemorrhage, including biopsy through a transjugular venous route or embolization of the tract with liquid or solid materials. We describe an image-guided percutaneous core needle liver biopsy with tract embolization using thick Gelfoam slurry in a pediatric oncology patient. Imaging studies acquired after the biopsy indicated that the Gelfoam mixture had likely migrated to the gallbladder and common bile duct. We report this rare occurrence with its striking imaging in order to make those performing biopsies aware of this possibility. (orig.)

  3. Case Report: Delayed Perforation after Definitive Treatment of Focal Intestinal Perforation with a Peritoneal Drain

    Directory of Open Access Journals (Sweden)

    Brian G. A. Dalton

    2012-01-01

    Full Text Available Focal intestinal perforation (FIP has long been described in the pediatric literature. Peritoneal drainage (PD is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.

  4. Colonic perforation resulting from ingested chicken bone revealing previously undiagnosed colonic adenocarcinoma: report of a case and review of literature.

    Science.gov (United States)

    McGregor, Douglas H; Liu, Xiaoying; Ulusarac, Ozlem; Ponnuru, Kimberly D; Schnepp, Stephanie L

    2011-02-18

    An 86 year old male with a four-day history of nonspecific gastrointestinal symptoms was found on colonoscopy to have evidence of sigmoid colon obstruction and possible perforation. Emergent operative exploration revealed diffuse peritonitis, sigmoid perforation, adjacent dense adhesions, and a foreign body protruding through the perforated area. Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type. There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension. This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma. The four previously reported cases were all deeply invasive adenocarcinoma of sigmoid colon, and the foreign bodies included three chicken/poultry bones and a metallic staple. These five cases are highly unusual examples of a potentially lethal malignant neoplasm being clinically revealed by a usually (but not always) innocuous event, the ingestion of a small foreign body.

  5. Colonic perforation resulting from ingested chicken bone revealing previously undiagnosed colonic adenocarcinoma: report of a case and review of literature

    Directory of Open Access Journals (Sweden)

    Ulusarac Ozlem

    2011-02-01

    Full Text Available Abstract An 86 year old male with a four-day history of nonspecific gastrointestinal symptoms was found on colonoscopy to have evidence of sigmoid colon obstruction and possible perforation. Emergent operative exploration revealed diffuse peritonitis, sigmoid perforation, adjacent dense adhesions, and a foreign body protruding through the perforated area. Pathologic examination showed the foreign body to be a sliver of bone consistent with chicken bone and the sigmoid subacute perforation to be associated distally with a circumferential ulcerated obstructing mass, microscopically seen to be transmurally infiltrating adenocarcinoma, signet-ring cell type. There was extensive acute and organizing peritonitis, 100% Escherichia coli was cultured from peritoneal fluid, and the patient died two days postoperatively with sepsis and hypotension. This appears to be the fifth reported case of colonic perforation resulting from foreign body perforation due to previously undiagnosed adenocarcinoma. The four previously reported cases were all deeply invasive adenocarcinoma of sigmoid colon, and the foreign bodies included three chicken/poultry bones and a metallic staple. These five cases are highly unusual examples of a potentially lethal malignant neoplasm being clinically revealed by a usually (but not always innocuous event, the ingestion of a small foreign body.

  6. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  7. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  8. Acquired perforating dermatosis in a patient with chronic renal failure*

    Science.gov (United States)

    Fernandes, Karen de Almeida Pinto; Lima, Lourenço de Azevedo; Guedes, Juliana Chaves Ruiz; Lima, Ricardo Barbosa; D'Acri, Antônio Macedo; Martins, Carlos José

    2016-01-01

    Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

  9. Elevation of Pancreatic Enzymes in Gallbladder Bile Associated with Heterotopic Pancreas. A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Asahi Sato

    2012-03-01

    Full Text Available Context This is the first report associating heterotopic pancreas in the gallbladder and elevated pancreatic enzymes in bile. Case report A 60-year-old woman underwent abdominal ultrasonography at a medical check-up, revealing a nodular protrusion at the neck of the gallbladder. It seemed likely to be a lymph node, but we could not exclude the possibility of gallbladder cancer. In order to make a correct diagnosis, laparoscopic cholecystectomy was successfully performed. Pathological examination revealed heterotopic pancreatic tissue in the gallbladder wall. In addition, we detected elevated levels of amylase and lipase in gallbladder bile. Conclusions Preoperative diagnosis of heterotopic pancreas in the gallbladder is difficult. However, an increase of pancreatic enzymes in gallbladder bile may potentially play an important role in the occurrence of acalculous cholecystitis and biliary cancer. We need more accumulation of cases to know the true significance of this anomaly.

  10. Surgical Treatment of Perforation Esophageal Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Depu Duan; Jihua Zou; Zhigang Cai; Shengyong Wu; Haibo Xiao; Yiyong Zhou; Xiang Liang; Dekui Sun; Songchang Wu

    2006-01-01

    OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3~72months.Of these cases 15 wree alive at 7~12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.

  11. Contact lens rehabilitation following repaired corneal perforations

    Directory of Open Access Journals (Sweden)

    Sreenivas V

    2006-03-01

    Full Text Available Abstract Background Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. Method Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. Results Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60% required aphakic contact lenses. The best corrected visual acuity (BCVA of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25% eyes with spectacle correction and 37 (92.5% eyes with the use of contact lens (p Conclusion Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries.

  12. Small-bowel perforation caused by fish bone

    Institute of Scientific and Technical Information of China (English)

    Sheng-Der Hsu; De-Chuan Chan; Yao-Chi Liu

    2005-01-01

    A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

  13. Metastatic clostridial myonecrosis secondary to perforated metastatic bowel cancer

    Institute of Scientific and Technical Information of China (English)

    Nasser Mohammed Amer; John Karayanis

    2016-01-01

    Spontaneous metastatic clostridial myonecrosis is a rare condition caused byClostridium septicum. The underlying lesion is usually either a colonic neoplasm or leukemia. The authors reported a 67-year-old female who presented with acute abdomen secondary to a perforated sigmoid cancer and who developed gas gangrene in her right leg. Unfortunately, despite all resuscitative measures, she died. The authors reviewed the literature; the diagnosis of metastatic myonecrosis was based on a high index of suspicion, development of bullae containing gram-positive rods, and subcutaneous crepitus (although this was a late sign). Treatment involves aggressive lfuid replacement, high doses of intravenous penicillin, high concentration of oxygen, and surgical debridement, and/or amputation. The mortality remains very high, despite all the above measures.

  14. Establishment the infant mouse model of acute peritonitis caused by cecal ligation perforation%盲肠穿孔所致幼鼠急性腹膜炎模型的建立

    Institute of Scientific and Technical Information of China (English)

    黄薇; 李毅平; 汪健

    2012-01-01

    目的 建立一种稳定、符合临床小儿消化道穿孔所致多种细菌性急性腹膜炎的模型.方法 在3~4周龄BALB/c小鼠盲肠壁置入一个两端开放的18号无菌硅管,使得肠道内的细菌进入腹腔,观察实验小鼠每日情况,并记录体质量变化及死亡时间.1周后处死存活下来的小鼠,观察其腹腔内脏器外观改变情况,收集腹腔灌洗液做细菌培养,观察肝、脾、肾组织切片中炎症细胞的浸润情况.结果 实验组小鼠均表现出细菌性腹膜炎征象,48 h死亡率高达50%,未死亡小鼠的体质量进行性下降,腹腔灌洗液细菌培养呈现阳性,病理切片显示肝实质、肾周围脂肪组织内有不同程度的炎症细胞浸润.结论 幼鼠盲肠穿孔所致急性腹膜炎模型建立成功,这为探索小儿急性腹膜炎的发病机制和治疗方法奠定了基础.%Objective To establish an infant mouse model of polymicrobial acute peritonitis, which is similar to clinical syndrome. Methods we established a surgical connection between the cecum and the peritoneum (by placing a sterile 18-gauge silicon tube across the cecum) which allowed the exit of intestinal bacteria to the peritoneal cavity. The general situation and the time of death were recorded. One week later, the mice were killed and abdominal fluid was collected for bacteria culture in Luria-Bertani agar. The livers, spleens and kidneys were dissected and generated for pathological examination. Results The experiment groups showed typical clinical syndrome of peritonitis. The 48-hour mortality rate was 50% , the weight of mice decreased progressively. Abdominal fluid cultures were positive. Moreover, the pathological examination of liver and adipose tissue around the kidney revealed inflammatory cells infiltration. Conclusions The infant mouse model of polymicrobial peritonitis is constructed successfully, providing a useful tool to develop new diagnostic methods and therapeutic interventions.

  15. Helicobacter pylori damages human gallbladder epithelial cells in vitro

    Institute of Scientific and Technical Information of China (English)

    Dong-Feng Chen; Lu Hu; Ping Yi; Wei-Wen Liu; Dian-Chun Fang; Hong Cao

    2008-01-01

    AIM: To study the mechanism by which Helicobacter pylori (Hpy/orO damages human gallbladder epithelial cells (HGBEC).METHODS: H pylori isolated from gallbladder were cultured in a liquid medium. Different concentration supernatants and sonicated extracts of H pylori cells were then added to HGBEC in a primary culture. The morphological changes in HGBEC as well as changes in the levels of alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and glutamyltransferase (GGT)were measured.RESULTS: According to the culture curve of HGBEC,it was convenient to study the changes in HGBEC by adding H pylori sonicated extracts and H pylori culture supernatants. Both H pylori sonicated extracts and H pylori culture supernatants had a significant influence on HGBEC morphology, i.e. HGBEC grew more slowly, their viability decreased and their detachment increased. Furthermore, HGBEC ruptured and died. The levels of ALP (33.84 ± 6.00 vs 27.01± 4.67, P < 0.05), LDH (168.37 ± 20.84 vs 55.51 ±17.17, P < 0.01) and GGT (42.01 ± 6.18 vs 25.34 ±4.33, P < 0.01) significantly increased in the HGBEC culture supernatant in a time- and concentrationdependent. The damage to HGBEC in Hpylori culture liquid was more significant than that in H pylori sonicated extracts.CONCLUSION: H pylori induces no obvious damage to HGBEC.

  16. Gallbladder bile composition in patients with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Annika Lapidus; Jan-Erik (A)kerlund; Curt Einarsson

    2006-01-01

    AIM: To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn's disease.METHODS: Gallbladder bile was obtained from patients with Crohn's disease who were admitted for elective surgery (17 with ileallileocolonic disease and 7 with Crohn's colitis). Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids,bile acids, bilirubin, crystals, and crystal detection time (CDT). Cholesterol saturation index was calculated.RESULTS: The biliary concentration of bilirubin was about 50% higher in patients with Crohn's disease than in patients with cholesterol gallstones. Ten of the patients with Crohn's disease involving ileum and three of those with Crohn's colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn's disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn's disease,with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn's colitis probably not due to bile acid malabsorption.CONCLUSION: Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn's disease.

  17. The standardized surgical approach improves outcome of gallbladder cancer

    Directory of Open Access Journals (Sweden)

    Igna Dorian

    2007-05-01

    Full Text Available Abstract Background The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014. The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.

  18. Mutational profiling reveals PIK3CA mutations in gallbladder carcinoma

    Directory of Open Access Journals (Sweden)

    Bardeesy Nabeel

    2011-02-01

    Full Text Available Abstract Background The genetics of advanced biliary tract cancers (BTC, which encompass intra- and extra-hepatic cholangiocarcinomas as well as gallbladder carcinomas, are heterogeneous and remain to be fully defined. Methods To better characterize mutations in established known oncogenes and tumor suppressor genes we tested a mass spectrometric based platform to interrogate common cancer associated mutations across a panel of 77 formalin fixed paraffin embedded archived BTC cases. Results Mutations among three genes, KRAS, NRAS and PIK3CA were confirmed in this cohort. Activating mutations in PIK3CA were identified exclusively in GBC (4/32, 12.5%. KRAS mutations were identified in 3 (13% intra-hepatic cholangiocarcinomas and 1 (33% perihillar cholangiocarcinoma but were not identified in gallbladder carcinomas and extra-hepatic cholangiocarcinoma. Conclusions The presence of activating mutations in PIK3CA specifically in GBC has clinical implications in both the diagnosis of this cancer type, as well as the potential utility of targeted therapies such as PI3 kinase inhibitors.

  19. Glucose transporter-1 (GLUT-1) immunoreactivity in benign, premalignant and malignant lesions of the gallbladder.

    Science.gov (United States)

    Legan, Mateja; Tevžič, Spela; Tolar, Ana; Luzar, Boštjan; Marolt, Vera Ferlan

    2011-03-01

    GLUT-1 is a transmembrane glucose transport protein that allows the facilitated transport of glucose into cells, normally expressed in tissues which depend mainly on glucose metabolism. Enhanced expression of GLUT-1 can also be found in a large spectrum of carcinomas. This study aimed to investigate GLUT-1 expression in gallbladder tissue: from normal tissue samples, hyperplasias, low-grade and high-grade dysplasias to gallbladder carcinomas. In all, 115 archived samples of gallbladder tissue from 68 patients, presented after cholecystectomy, were immunohistochemically stained for GLUT-1. According to the intensity of GLUT-1 immunoreactivity, samples were divided into negative (stained 0-10% of cells stained), positive with weak to moderate (10-50%) and positive with strong (>50%) GLUT-1 expression. The GLUT-1 immunoreactivity of the samples showed a characteristic increase from premalignant lesions to carcinomas. Normal gallbladder tissue samples did not express GLUT-1 (100%). Weak expression was shown only focally in hyperplasias, but to a greater extent with low-grade dysplasias (20%), high-grade dysplasias (40%) and carcinomas (51.8%). Normal gallbladder tissue is GLUT-1 negative. GLUT-1 expression in carcinoma tissue is significantly higher than in dysplastic lesions. Strong GLUT-1 expression indicates 100% specificity for detecting gallbladder carcinomas. Therefore, GLUT-1 is a candidate as a diagnostic as well as a tissue prognostic marker in gallbladder carcinoma patients.

  20. Megalin and cubilin expression in gallbladder epithelium and regulation by bile acids.

    Science.gov (United States)

    Erranz, Benjamín; Miquel, Juan Francisco; Argraves, W Scott; Barth, Jeremy L; Pimentel, Fernando; Marzolo, María-Paz

    2004-12-01

    Cholesterol crystal formation in the gallbladder is a key step in gallstone pathogenesis. Gallbladder epithelial cells might prevent luminal gallstone formation through a poorly understood cholesterol absorption process. Genetic studies in mice have highlighted potential gallstone susceptibility alleles, Lith genes, which include the gene for megalin. Megalin, in conjunction with the large peripheral membrane protein cubilin, mediates the endocytosis of numerous ligands, including HDL/apolipoprotein A-I (apoA-I). Although the bile contains apoA-I and several cholesterol-binding megalin ligands, the expression of megalin and cubilin in the gallbladder has not been investigated. Here, we show that both proteins are expressed by human and mouse gallbladder epithelia. In vitro studies using a megalin-expressing cell line showed that lithocholic acid strongly inhibits and cholic and chenodeoxycholic acids increase megalin expression. The effects of bile acids (BAs) were also demonstrated in vivo, analyzing gallbladder levels of megalin and cubilin from mice fed with different BAs. The BA effects could be mediated by the farnesoid X receptor, expressed in the gallbladder. Megalin protein was also strongly increased after feeding a lithogenic diet. These results indicate a physiological role for megalin and cubilin in the gallbladder and provide support for a role for megalin in gallstone pathogenesis.

  1. 三孔法腹腔镜胆囊切除术治疗急性胆囊炎%Three Holes Method Laparoscopic Cholecystectomy for Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    赵言明; 李永明

    2012-01-01

      目的:探讨三孔法腹腔镜胆囊切除术治疗急性胆囊炎的应用价值。方法:2003年2月-2012年1月笔者所在医院对150例急性胆囊炎患者尝试三孔法腹腔镜胆囊切除,观察疗效。结果:145例患者顺利完成 LC,2例患者因胆囊周围严重粘连,肝外胆管难以辨认,1例患者胆囊横结肠瘘,2例术中快速病检提示胆囊癌中转开腹。术后住院3~5 d,无结肠,十二指肠及胃损伤,无胆管损伤及腹腔出血,剑突下切口感染5例,门诊换药治愈。结论:三孔法腹腔镜胆囊切除术治疗急性胆囊炎能迅速缓解患者剧烈腹痛及呕吐,终止患者痛苦,降低了发生胆囊穿孔、胆汁性腹膜炎及腹腔脓肿的风险,缩短了住院时间,降低了单病种的治疗费用,降低了并发症的发生及科室的医疗纠纷,减轻了医护人员的劳动强度及心理压力。%  Objective :To investigate three holes method laparoscopic cholecystectomy for acute cholecystitis in application value.Methods :In our hospital from Feb 2003 to Jan 2012150 cases of acute cholecystitis patients try three holes method laparoscopic cholecystectomy.Results :145 patients successfully completed LC,2 patients with gallbladder surrounding severe adhesions,extrahepatic bile duct illegible in 1 cases,gallbladder transverse colon fistula,2 cases of rapid intraoperative pathological examination revealed gallbladder carcinoma laparotomy.The postoperative hospital stay of 3-5 days,without colonic, duodenal and gastric injury,no bile duct injury and intraperitoneal hemorrhage,subxiphoid incision infection in 5 cases,clinic medicine changing cured. Conclusion :Three holes method laparoscopic cholecystectomy for acute cholecystitis can relieve the patient of severe abdominal pain and vomiting,termination of patient pain,reduces the incidence of perforation of the gallbladder,biliary peritonitis and peritoneal abscess risks,shorten hospitalization time,reduce the single disease

  2. Intestinal endometriosis-A rare cause of colonic perforation

    Institute of Scientific and Technical Information of China (English)

    Neeraj Kumar Garg; Nitin Babulal Bagul; Sam Doughan; Paul Harold Rowe

    2009-01-01

    Endomet r iosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and laparoscopy prior to formal laparotomy should be considered.Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.

  3. Two Anomalies in One: A Rare Case of an Intrahepatic Gallbladder with a Cholecystogastric Fistula

    Directory of Open Access Journals (Sweden)

    Mohammad F. Ali

    2017-03-01

    Full Text Available The gallbladder can be situated in a variety of anomalous positions. An intrahepatic gallbladder – the second most common ectopic location of the gallbladder – is one that is completely embedded within the liver parenchyma. Described in the literature as early as 1935, intrahepatic gallbladders predominantly result from a developmental anomaly but in some instances have been reported to be secondary to chronic inflammation. The significance of an intrahepatic gallbladder lies in the fact that 60% of the cases are associated with gallstones and may present a challenge for the general surgeon during cholecystectomy and other biliary operations in addition to causing misdiagnosis on imaging. Intrahepatic gallbladders are unusual, but the incidence of an intrahepatic gallbladder with a cholecystogastric fistula is rare. Cholecystogastric fistulas commonly are a complication of long-term cholelithiasis or chronic cholecystitis with subsequent gallstone ileus. Herein, we present the case of an 80-year-old man who presented with 2 months of progressive weakness, fatigue, decreased appetite, and intermittent right-sided abdominal pain, and was found to have a markedly distended and irregular intrahepatic gallbladder measuring 12.2 × 11.5 × 13.4 cm on CT, as well as a cholecystogastric fistula on esophagogastroduodenoscopy. During esophagogastroduodenoscopy, the gallbladder was entered directly via the fistulous tract. The patient was on i.v. antibiotics with tube feeds via a nasojejunal tube initially, followed by p.o. which he tolerated. He was eventually discharged with referral for surgical evaluation. Given the potential for cholelithiasis and fistulation, physicians should have a high index of suspicion and recommend timely endoscopic and/or surgical management to avoid future complications.

  4. Lymphangioma of the gallbladder in childhood: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    HAN Wei.; ZHANG Jin-zhe; WANG Huan-min

    2011-01-01

    Lymphangiomas are malformations of the lymphatic system,which is a common disease in children,usually superficial in body,but seldom seen in visceral organs.We present the case of a child with lymphangioma of the gallbladder.Also we reviewed the literatures.A 2-year-6-month-old boy complained of progressing difficulty in walking for 6 months.Cerebral MRI showed abnormal signals in the white matter suggesting leukodystrophy.Ultrasound of abdomen showed a mixed-echoic mass in the site of gallbladder.CT scan showed an enlarged gallbladder with increased density.Bloodcounting,liver function,and alpha fetal protein were within normal range.Exploratory laparotomy was done in order to rule out malignancy.The liver was found normal at surgery,and the gallbladder looked enlarged and deformed.The gallbladder wall was thick and edematous,and adherent with liver.The gallbladder was excised.Pathological examination gave the dia gnosis as lymphangioma of the gallbladder wall.The postoperative recovery was uneventful.There was no evidence of recurrence.Searching in literatures,three cases of lymphangioma of gallbladder in adults were found.According to the pathology of lymphangioma and the anatomy of gallbladder,the outcome of this disease should be benign and may be symptomless throughout the life.No death was reported due to lymphangioma of gall bladder,nor severe complications endangering life at any age.The only indication for surgery in the reported cases was to rule out the risk of being malignancy.If MRI or other means can make a definite preoperative diagnosis of lymphangioma,being a stable lesion,surgery would be unnecessary unless there is a progressive organic obstruction causing repeated infection or persistent abdominal pain.

  5. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    Science.gov (United States)

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  6. Traumatic oesophageal perforation due to haematoma

    DEFF Research Database (Denmark)

    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    INTRODUCTION: Traumatic oesophageal perforation is a rare, life-threatening emergency that requires early recognition and prompt surgical management. PRESENTATION OF CASE: We present an unusual case of a patient on warfarin treatment developed an intramural oesophageal haematoma following blunt......; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....... thoracic trauma leading to perforation on the 18th day. DISCUSSION: In treatment of oesophageal haematoma in patients on vitamin-K antagonists, strict control of the International Normalized Ratio (INR) is essential along with total parenteral nutrition therapy and refrainment through nasogastric tubes...

  7. Preoperative staging of perforated diverticulitis by computed tomography scanning

    NARCIS (Netherlands)

    M.P.M. Gielens; I.M. Mulder (Irene); E. van der Harst (Erwin); M.P. Gosselink (Martijn Pieter); K.J. Kraal; H.T. Teng; J.F. Lange (Johan); J. Vermeulen (Jefrey)

    2012-01-01

    textabstractBackground: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patie

  8. Pseudo-skin model for gravel-filled perforations

    Energy Technology Data Exchange (ETDEWEB)

    Onyekonwu, M.O. [Laser Engineering Consultants/Uniport, Port Harcourt (Nigeria); Okonkwo, F.C. [University of Port Harcourt Uniport, Port Harcourt (Nigeria)

    1997-11-05

    This paper discusses pressure losses due to flow in perforations filled with gravel or with formation material. These pressure losses are added to the pressure losses caused by convergence to perforations to obtain the pseudo-skin due to gravel-filled perforations. Calculation of the pressure loss due to convergence to perforation is discussed elsewhere. The flow in the perforation tunnel could be turbulent or laminar. Therefore, we calculated the pressure losses in a gravel-filled perforation using Forchheimer`s equation or Darcy`s law. However, we expect that the flow in such tunnels will be turbulent. Results from our model agree with experimental data published elsewhere. Also, our results show that pressure losses during flow through gravel-filled perforations could be substantial. Therefore, productivities of gravel pack completions may differ significantly from perforated completions in competent formation without gravel pack

  9. Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET

    Institute of Scientific and Technical Information of China (English)

    Isamu Makino; Takahiro Yamaguchi; Nariatsu Sato; Toshiaki Yasui; Ichiro Kita

    2009-01-01

    Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in differentiating between benign and mal ignant lesions in the gallbladder. However, there is a limitation in the ability of FDG-PET to differentiate between inflammatory and malignant lesions. We herein present a case of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma by ultrasonography and computed tomography. FDG-PET also showed increased activity. In this case, FDG-PET findings resulted in a false-positive for the diagnosis of gallbladder carcinoma.

  10. Cholecystocolic fistula caused by gallbladder carcinoma: preoperatively misdiagnosed as hepatic colon carcinoma.

    Science.gov (United States)

    Ha, Gi Won; Lee, Min Ro; Kim, Jong Hun

    2015-04-21

    Cholecystocolic fistula secondary to gallbladder carcinoma is extremely rare and has been reported in very few studies. Most cholecystocolic fistulae are late complications of gallstone disease, but can also develop following carcinoma of the gallbladder when the necrotic tumor penetrates into the adjacent colon. Although no currently available imaging technique has shown great accuracy in recognizing cholecystocolic fistula, abdominopelvic computed tomography may show fistulous communication and anatomical details. Herein we report an unusual case of cholecystocolic fistula caused by gallbladder carcinoma, which was preoperatively misdiagnosed as hepatic flexure colon carcinoma.

  11. Gallbladder ascariasis with uneventful worm migration back to the duodenum: A case report.

    Science.gov (United States)

    Mushtaque, Majid; Khan, Parwez Sajad; Mir, Mohammad Farooq; Khanday, Samina Ali

    2012-04-01

    Ascariasis, a worldwide parasitic disease, is regarded by some authorities as the most common parasitic infection in humans. The causative organism is Ascaris lumbricoides, which normally lives in the lumen of the small intestine. From the intestine, the worm can invade the bile duct or pancreatic duct, but invasion into the gallbladder is quite rare because of the anatomical features of the cystic duct, which is narrow and tortuous. Once it enters the gallbladder, it is exceedingly rare for the worm to migrate back to the intestine. We report a case of gallbladder ascariasis with worm migration back into the intestine, in view of its rare presentation.

  12. Right-Sided Sigmoid Diverticular Perforation

    Directory of Open Access Journals (Sweden)

    Andrew Little

    2012-04-01

    Full Text Available Diverticulosis is a common disorder among geriatric patients, of whom 10% to 25% go on to develop diverticulitis. Known complications of diverticulitis include formation of phlegmon, fistula, bowel obstruction, bleeding, perforation, and colonic abscess. A less common complication is perforation with formation of an extra-abdominal necrotizing abscess. This case is a report of an 83-year-old female who presented to the emergency department with a necrotizing abdominal wall abscess secondary to right-sided diverticular microperforation. [West J Emerg Med. 2012;13(1:103–105.

  13. Gall bladder perforation and biliary peritonitis in a young pregnant lady.

    Science.gov (United States)

    Sharma, D K; Panwar, R S; Kumari, K

    2001-11-01

    A rare event of acute free perforation of gall bladder with biliary peritonitis in a case of calculous cholecystitis in a 28 years old pregnant lady occurring in the absence of the usual factors associated with gall stone disease is reported. The clinical features resembled acute appendicitis and a pre-operative diagnosis could not be made. It is suggested that a thorough attempt should be made to exclude conditions mimicking appendicitis, including those of the biliary system, on finding a normal appendix at emergency appendicectomy without hesitating to convert to full laparotomy if required.

  14. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal\\/localised peritoneal irritation or when the patient\\'s premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV\\/V, mortality was 54.5% (6\\/11) following operative management and 52.9% (9\\/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV\\/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.

  15. Perforated Meckel’s diverticulum in an adult due to faecolith: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Sunny Modi

    2015-01-01

    Full Text Available Meckel’s diverticulum (MD is a persistent remnant of the vitelointestinal duct and is present in 2% of population [1]. It is the most common congenital malformation of the gastrointestinal tract. It can present clinically as haemorrhage, diverticulitis, intussusception, chronic ulceration, intestinal obstruction and perforation. Complicated presentation, especially bleeding, tends to be more common in the paediatric group, whereas intestinal obstruction is more common in adults [2]. Patients with a perforation of Meckel’s diverticulum by an enterolith are rare and may present with right iliac fossa pain, which mimics acute appendicitis.

  16. Perforated diverticulitis presenting as necrotising fasciitis of the leg

    Directory of Open Access Journals (Sweden)

    Talbot Robert

    2008-02-01

    Full Text Available Abstract Diverticulosis of the colon is a common condition of increasing age. Complications of diverticulitis including stricture, perforation and fistula formation often require surgery. Perforated diverticulitis may rarely present with spreading superficial sepsis. We describe for the first time, to our knowledge, a case of retroperitoneal diverticula perforation presenting as necrotising fasciitis of the leg necessitating hind-quarter amputation.

  17. Spontaneous perforation of a pyometra presenting as generalized peritonitis.

    Science.gov (United States)

    Hosking, S. W.

    1985-01-01

    Eleven cases of spontaneous perforation of a pyometra have previously been reported. All were associated with, and probably secondary to, cervical occlusion. A further case is described, but differs in that the cervical canal was patent. In the absence of other possible causes of uterine perforation, the aetiology of the perforation in this case remains uncertain. Images Figure 1 PMID:4040634

  18. Experience on acute cholecystitis in downlink LC operation%对急性胆囊炎患者行LC手术的心得体会

    Institute of Scientific and Technical Information of China (English)

    黄德波

    2015-01-01

    目的:探讨腹腔镜胆囊切除术(LC)治疗急性胆囊炎患者的效果。方法:2008年2月-2014年3月收治急性胆囊炎患者258例,给予LC进行治疗。结果:258例患者中顺利完成LC手术235例,手术时间45~135 min,平均(90±22.5)min。1例患者由于胆囊穿孔内瘘、坏疽症状而选择中转开腹,2例术中胆总管损伤而选择中转开腹,20例患者由于胆囊三角区域出现广泛粘连现象而选择中转开腹。结论:只有准确把握患者的手术特征、手术时机,并具有大量的临床经验与一定的手术技巧,才能够保证LC手术对急性胆囊炎患者的治疗效果。%Objective:To investigate the treatment effect of laparoscopic cholecystectomy in patients with acute cholecystitis. Methods:258 patients with acute cholecystitis were selected from February 2008 to March 2014.All of them were treated with laparoscopic cholecystectomy(LC).Results:In 258 patients,235 cases were completed LC operation successfully;the operation time were 45~135 min,averaged(90±22.5)min.There were 23 patients conversed to open surgery,in which 1 cases due to perforation of the gallbladder fistula and gangrene symptom,2 cases because of bile duct injury during the operation,and 20 cases due to adhesions phenomenon appears in the gallbladder triangle region.Conclusion:Only through accurately grasping the operation characteristics and operation time of patients,and with a large number of clinical experience and operation skill can ensure the curative effect of LC operation for acute cholecystitis patients.

  19. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

    LENUS (Irish Health Repository)

    Emmanuel, Andrew

    2011-04-01

    No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis.

  20. Radiofrequency Thermoablation of HCC Larger Than 3 cm and Less Than 5 cm Proximal to the Gallbladder without Gallbladder Isolation: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Antonio Orlacchio

    2014-01-01

    Full Text Available Radiofrequency ablation (RFA is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC, but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%. Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder.

  1. Determination of the Fundamental Frequency of Perforated Rectangular Plates: Concentrated Negative Mass Approach for the Perforation

    Directory of Open Access Journals (Sweden)

    Kiran D. Mali

    2013-01-01

    Full Text Available This paper is concerned with a vibration analysis of perforated rectangular plates with rectangular perforation pattern of circular holes. The study is particularly useful in the understanding of the vibration of sound absorbing screens, head plates, end covers, or supports for tube bundles typically including tube sheets and support plates used in the mechanical devices. An energy method is developed to obtain analytical frequencies of the perforated plates with clamped edge, support conditions. Perforated plate is considered as plate with uniformly distributed mass. Holes are considered as concentrated negative masses. The analytical procedure using the Galerkin method is adopted. The deflected surface of the plate is approximated by the cosine series which satisfies the boundary conditions. Finite element method (FEM results have been used to illustrate the validity of the analytical model. The comparisons show that the analytical model predicts natural frequencies reasonably well for holes of small size.

  2. Long-term survival after perforated diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jan); M.P. Gosselink (Martijn Pieter); W.C.J. Hop (Wim); E. van der Harst (Erwin); B.E. Hansen (Bettina); G.H.H. Mannaerts (Guido); P-P. Coene (Peter Paul); W.F. Weidema (Wibo); J.F. Lange (Johan)

    2011-01-01

    textabstractAim: Short-term survival after emergency surgery for perforated diverticulitis is poor. Less is known about long-term survival. The aims of this study were to evaluate long-term survival after discharge from hospital and to identify factors associated with prognosis. Method: All patients

  3. Jejunal Diverticular Perforation due to Enterolith

    Directory of Open Access Journals (Sweden)

    Ronaldo Nonose

    2011-08-01

    Full Text Available Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded.

  4. [Nineteenth century physicians against drum perforation].

    Science.gov (United States)

    Kierzek, A

    1995-01-01

    The trials of "organic" closure of drum perforation are described. The achievements of Adam Politzer, Hermann Schwartze, Joseph Gruber are presented. The first who used term "myringoplasty" was Emil Berthold. The "epochal" method of Wasilij Okuniew and achievements of Beniamin Gomperz are also depicted. The scientific activities of Polish otologists: Ludwik Guranowski and Rafai Spira were presented.

  5. Perforated stomach following the Heimlich maneuver.

    Science.gov (United States)

    Cowan, M; Bardole, J; Dlesk, A

    1987-03-01

    The use of infradiaphragmatic abdominal pressure for relief of airway obstruction caused by food was first described by Henry Heimlich in 1974. Since that time, several complications have been reported. We report a case of gastric perforation occurring in a choking victim following the application of the Heimlich maneuver.

  6. Spontaneous closure of traumatic tympanic membrane perforations

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K

    2015-01-01

    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  7. Advances in micro-perforated panel absorbers

    Institute of Scientific and Technical Information of China (English)

    LIU Ke; TIAN Jing; JIAO Fenglei; L(U) Yadong

    2006-01-01

    Theoretical and experimental investigations on the performance of micro-perforated-panel absorbers are reviewed in this paper. By reviewing recent research work, this paper reveals a relationship between the maximum absorption coefficient and the limit of the absorption frequency bandwidth. It has been demonstrated that the absorption frequency bandwidth can be extended up to 3 or 4 octaves as the diameters of the micro-holes decrease. This has become possible with the development of the technologies for manufacturing micro-perforated panels,such as laser drilling, powder metallurgy, welded meshing and electro-etching to form micrometer order holes. In this paper, absorption characteristics of such absorbers in random fields and in high sound intensity are discussed both theoretically and experimentally. A new absorbing structure based on micro-perforated-panel absorbers demonstrate experimentally high sound absorption capability. This review shows that the micro-perforated-panel absorber has potentials to be one of ideal absorbing materials in the 21st century.

  8. Intestinal perforation caused by multiple magnet ingestion

    Directory of Open Access Journals (Sweden)

    Nergul Corduk

    2014-01-01

    Full Text Available Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

  9. [Small bowel perforation caused by magnetic toys].

    Science.gov (United States)

    Schroepfer, E; Siauw, C; Hoecht, B; Meyer, T

    2010-06-01

    Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets.

  10. Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

    Directory of Open Access Journals (Sweden)

    Dirk J. Gouma

    1992-01-01

    Full Text Available The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

  11. Does Impaired Gallbladder Function Contribute to the Development of Barrett's Esophagus and Esophageal Adenocarcinoma?

    LENUS (Irish Health Repository)

    Nassr, Ayman O

    2011-06-01

    Esophageal adenocarcinoma is aetiologically associated with gastro-esophageal reflux, but the mechanisms responsible for the metaplasia-dysplasia sequence are unknown. Bile components are implicated. Impaired gallbladder function may contribute to duodenogastric reflux (DGR) and harmful GERD.

  12. Primary Gallbladder Lymphoma in a Male Patient with No Risk Factors Detected Incidentally by CT Colonography

    Science.gov (United States)

    Karia, Monil; Mitsopoulos, Grigorios; Patel, Ketan; Rafique, Akkib; Sheth, Hemant

    2015-01-01

    Primary gallbladder lymphoma, although rare, usually presents in females with symptoms mimicking cholecystitis. We present a rare case of primary gallbladder in an 81-year-old male with no risk factors whose only symptom was weight loss. Routine blood tests including liver function tests were unremarkable. A CT colonography was carried out to exclude colonic malignancy. Unilateral gallbladder wall thickening and lymphadenopathy were incidentally detected and confirmed by ultrasound and a decision for the patient to undergo laparoscopic cholecystectomy and intraoperative cholangiogram was made. Histology confirmed extranodal marginal zone lymphoma with follow-up staging and biopsy of the bone marrow not demonstrating spread. Cholecystectomy was therefore deemed curative and no adjuvant therapy was necessary. Thickening of the gallbladder wall on any imaging with or without symptoms should not be ignored or assumed to be cholecystitis, even in males with no risk factors. In these patients urgent cholecystectomy with intraoperative cholangiogram is indicated with histology and haematology follow-up. PMID:26587306

  13. Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Sang-Heum Park; Sang Pil Kim; Ji-Young Park; Chang Kyun Lee; Il-Kwun Chung; Hong Soo Kim; Sun-Joo Kim

    2009-01-01

    Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery.Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

  14. 急性胆囊炎及合并症的超声诊断分析

    Institute of Scientific and Technical Information of China (English)

    张元芬

    2004-01-01

    Objective To study the ultrasonic diagnosis value of acute cholecystitis and its complication. Methods The ultrasonic images of 148 cases with acute cholecystitis and its complication were retrospective analysised. Result Fifteen cases with simplicity acuteness cholecystitis, thirty-three cases with purulent acuteness cholecystitis, three cases with acuteness gangrenous cholecystits. Ninety- seven cases was chronic cholecystitis with acute attack merging gallbladder calculous. In them, four cases with biliary tract roundworm, nine cases with gallbladder polypus, two cases with perforation of gallbladder. Conclusion The ultrasonic has very high detectable rate and diagnose exactness rate in acute cholecystitis and its complication.

  15. Hepatitis, gallbladder hydrops, splenomegaly, and ascites in a child with scarlet fever.

    Science.gov (United States)

    Wang, Li Yueh; Young, Ton-Ho

    2012-11-01

    We report a case of scarlet fever associated with hepatitis, gallbladder hydrops, splenomegaly, and ascites in a 15-year-old girl. The girl presented with fever and skin rash. Leukocyte, liver enzyme, and serum C-reactive protein concentrations were elevated. Ultrasonography revealed marked gallbladder wall thickening, diffuse liver parenchymal disease with moderate splenomegaly, and moderate ascites throughout the abdominal and pelvic cavities. Blood cultures for group A β-hemolytic streptococci were negative. Complete recovery was facilitated with antibiotic treatment.

  16. Mucin and phospholipids determine viscosity of gallbladder bile in-patients with gallstones

    Institute of Scientific and Technical Information of China (English)

    Dieter Jungst; Anna Niemeyer; Iris Muller; Benedikta Zundt; Gunther Meyer; Martin Wilhelmi; Reginald del Pozo

    2001-01-01

    AIM An increased viscosity of gallbladder bile has been considered an important factor in the pathogenesis of gallstone disease. Besides lipids and proteins, mucin has been suggested to affect the viscosity of bile. To further clarify these issues we compared mucin, protein and the lipid components of hepatic and gallbladder bile and its viscosity in patients with gallstones.METHODS Viscosity of bile ( mpa. s ) wasmeasured using rotation viscosimetry in regard to the non-Newtonian property of bile at law shear rates.RESULTS Biliary viscosity was markedly higher in gallbladder bile of patients with cholesterol (5.00 ± 0.60 mpa. s, mean ± SEM, n --28) and mixed stones (3.50±0.68 mPa. s; n =8) compared to hepatic bile (0.92 ± 0.06 mpa. s,n -6). A positive correlation between mucin and viscosity was found in gallbladder biles (r=0.65; P<0.001) but not in hepatic biles. The addition of physiologic and supraphysiologic amounts of mucin to gallbladder bile resulted in a dose dependent non linear increase of its viscosity. A positive correlation was determined between phospholipid concentration and viscosity (r = 0.34, P<0.005) in gallbladder biles. However, no correlation was found between total protein or the other lipid concentrations and viscosity in both gallbladder and hepatic biles.CONCLUSION The viscosity of gallbladder bile is markedly higher than that of hepatic bile in patients with gallstones. The concentration of mucin is the major determinant of biliary viscosity and may contribute by this mechanism to the role of mucin in the pathogenesis of gallstones.

  17. Detection of nanobacteria in serum, bile and gallbladder mucosa of patients with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    WEN Yu; YANG Jing; E. Olavi Kajander; Neva Ciftcioglu; LI Yong-guo; YANG Zhu-lin; WANG Xue-jun; WEI Hong; LIU Wei; MIAO Xiong-ying; WANG Qun-wei; HUANG Sheng-fu

    2005-01-01

    @@ In 1990, nanobacterium was found and named by Kajander.1 With distinct mineralizing ability, nanobacteria are thought to play a role in extraskeletal calcifying diseases. It have been found in many human tissues, but whether they exist in the bile or gallbladder mucosa remains unclear. The present study was undertaken to investigate by ELISA, bacterial culturing, immunohistochemical staining and transmission electron microscopy (TEM), whether nanobacteria exist in serum, bile or gallbladder mucosa of healthy people and patients with cholecystolithiasis.

  18. Choledochoduodenal fistula presenting with pneumobilia in a patient with gallbladder cancer: a case report

    Directory of Open Access Journals (Sweden)

    Dadzan Elham

    2012-02-01

    Full Text Available Abstract Introduction Spontaneous biliary tract fistulas are rare entities. Most of them are associated with long-standing gallstones (especially common bile duct stones, or recurrent biliary tract infections, some with more uncommon diseases such as gallbladder cancer. Some authors believe that back flow from fistulas predisposes patients to gallbladder cancer and some believe that cancer causes necrosis and fistula formation. Gallbladder cancer has a dismal prognosis and 85% of patients are dead within a year of diagnosis. A common complication of gallbladder cancer is obstruction of the common bile duct, which may produce multiple intra-hepatic abscesses in or near the tumor-laden gallbladder. Fistula formation may further complicate the clinical picture. Case presentation We present a case of choledochoduodenal fistula in a 60-year-old diabetic African-American woman with gallbladder cancer. The initial clinical presentation was confusing and complex. Our patient was also found to have a gallbladder fossa abscess that was drained percutaneously as another complicating factor relating to her cancer. She developed myocardial infarction, massive upper gastrointestinal bleeding and respiratory arrest during her stay in hospital. Computed tomography was very helpful in assessing our patient and we discuss how, in a patient with pneumobilia, it can be helpful for detecting fistula, air in bile ducts or to show contractions of the gallbladder. Conclusions We believe this case merits reporting as it shows an entity that is not frequently thought of, is hard to diagnose and can be fatal, as in our patient. Careful evaluation, and computed tomography studies and endoscopic retrograde cholangio-pancreatography are helpful in early diagnosis and finding better management options for these patients.

  19. Uterine perforation with Lippes loop intrauterine device-associated actinomycosis: a case report and review of the literature.

    Science.gov (United States)

    Phupong, V; Sueblinvong, T; Pruksananonda, K; Taneepanichskul, S; Triratanachat, S

    2000-05-01

    A case of a 67-year-old postmenopausal woman, gravida 2, para 2, with an uterine perforation from actinomycotic infection with Lippes loop IUD is reported. She had the Lippes loop IUD inserted for 35 years, and had never had any pelvic examination nor Papanicolaou smear. She presented with acute abdominal pain. The clinical picture mimicked peptic ulcer perforation. The woman underwent laparotomy and exudative fluid was discovered in the abdominal cavity with the tip of the Lippes loop IUD at one of the two small holes of the uterine fundus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The postoperative microscopic pathological report demonstrated characteristics of actinomycosis. She was treated with parenteral high-dose penicillin for 4 weeks followed by oral penicillin for 6 months. The woman had an uneventful recovery. To our knowledge, this is the first case report of uterine perforation due to Lippes loop IUD-associated actinomycotic infection.

  20. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H. [School of Medicine, Jordan University of Science and Technology, Irbid (Jordan)

    2010-12-15

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean {+-} SD values for GBEF1 and GBEF2 were 52{+-}17% and 52{+-}16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible