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Sample records for cholecystitis

  1. Chronic cholecystitis

    Science.gov (United States)

    ... foods may relieve symptoms in people. However, the benefit of a low-fat diet has not been proven. Alternative Names Cholecystitis - chronic Images Cholecystitis, CT scan Cholecystitis, cholangiogram Cholecystolithiasis Gallstones, cholangiogram Cholecystogram References Wang ...

  2. Acute acalculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Fox, M.S.; Wilk, P.J.; Weissmann, H.S.; Freeman, L.M.; Gliedman, M.L.

    1984-07-01

    Sixty-eight patients with acute acalculous cholecystitis were reviewed. The results of history and physical examinations were usually nondiagnostic. IDA cholescintigraphy (93 per cent accuracy rate) was the only reliable diagnostic modality. The results of oral cholecystography, intravenous cholangiography and ultrasonography were considerably less reliable. One-half of the patients had gangrenous cholecystitis. Cholecystectomy was the preferred operation with an over-all mortality of 9 per cent. IDA cholescintigraphy is an important new modality for the diagnosis of acute acalculous cholecystitis which, in the past, has often been difficult to diagnose.

  3. Acute acalculous cholecystitis.

    Science.gov (United States)

    Barie, Philip S; Eachempati, Soumitra R

    2003-08-01

    Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered. PMID:12864960

  4. Cholecystitis occurring without stones

    International Nuclear Information System (INIS)

    A case of acalculous cholecystitis in a 65-year-old man with underlying diabetes mellitus, hypertension, and peripheral arteriosclerosis is presented here. His case remained diagnostically puzzling for some time until symptoms and signs became more severe and very suggestive of acute cholecystitis. The clinical impression was then supported by an abnormal radioisotope biliary scan. The scan has fairly good sensitivity in detecting this condition but may not be totally dependable. Acalculous cholecystitis is an unusual but serious variant of a common disorder in which treatable gallbladder disease may masquerade as a less treatable liver malady. A common denominator among this disorder's many etiologies may be impairment of the gallbladder microcirculation in the presence of one or more conditions that lower the gallbladder's resistance to bacterial invasion. Prompt detection and treatment are desirable to reduce morbidity and mortality. However, early diagnosis is not always possible, because the clinical picture often is unclear, clear, gallstones are absent, and laboratory test results may be normal or equivocal. As in the case reported here, the vague clinical picture may dictate following a patient until the illness reaches an intensity acute enough to permit identification. The greatest aid to earlier diagnosis for the physician faced with circumstances similar to those described here is to think of cholecystitis and then to give strong weight to that clinical suspicion. At times, a recommendation for cholecystectomy may have to be made mainly on clinical judgment

  5. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

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    María del Moral-Martínez

    2015-01-01

    Full Text Available Eosinophilic cholecystitis (EC is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  6. Emphysematous cholecystitis: a case report

    International Nuclear Information System (INIS)

    Emphysematous cholecystitis is an uncommon condition which may mimic acute cholecystitis. But it differs from acute cholecystitis in its relatively greater frequency in men and diabetics and has graver prognosis. The condition is diagnosed by demonstration of air in lumen, wall of gallbladder and/or pericholecystic space using a variety of radiographic techniques: simple abdominal radiography, ultrasonography and CT scanning. One illustrative case is presented herein and the pertinent literature is reviewed

  7. Omental Infarction Mimicking Cholecystitis

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    David Smolilo

    2015-01-01

    Full Text Available Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.

  8. Acute Cholecystitis in Patients with Scrub Typhus

    OpenAIRE

    Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop

    2015-01-01

    Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as ...

  9. Acute Cholecystitis in Patients with Scrub Typhus.

    Science.gov (United States)

    Lee, Hyun; Ji, Misuk; Hwang, Jeong-Hwan; Lee, Ja-Yeon; Lee, Ju-Hyung; Chung, Kyung Min; Lee, Chang-Seop

    2015-11-01

    Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of scrub typhus such as skin rash and eschar can present after the abdominal pain. PMID:26539017

  10. H pylori are associated 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 are associated with chronic cholecystitis.METHODS:The subjects were divided into three groups:H pylori-infected cholecystitis group,H pylorinegative cholecystitis group and control group.Pathologic changes of the gallbladder were observed by optic and electronic microscopes and the levels of interleukin-1,6 and 8(IL-1,6 and 8)were detected by radioimmunoassay.RESULTS:Histological evidence of chronic cholecystitis including degeneration,necrosis,inflammatory cell infiltration,were found in the region where H pylori-colonized.Levels of IL-1,6 and 8 in gallbladder mucosa homogenates were significantly higher in H pylori-infected cholecystitis group than those in H pylori-negative cholecystitis group and control group.CONCLUSION:H pylori infection may be related to cholecystitis.

  11. Emphysematous cholecystitis Colecistite enfisematosa

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    Renato Micelli Lupinacci

    2009-12-01

    Full Text Available BACKGROUND: Emphysematous cholecystitis is life-threatening condition characterized by gas-forming infection of the gallbladder. It is mostly seems in old male patients with systemic, specially diabetes and vascular diseases. CASE REPORT: - A 30-year-old man without previous diseases was admitted because of right upper quadrant pain and nausea. On admission the patient was febrile (38.7o with normal bilirubin levels. The white blood count was 26700/µl and reactive protein C was 470. Axial sections of single slice computed tomography imaging (section thickness 5 mm, revealed gallbladder wall enhancement after i.v. contrast, as well as dilatation of the gallbladder with intraluminal air. The patient underwent open cholecystectomy. The culture of the bile showed clostridium perfringes. The postoperative course of the patient was uneventful. CONCLUSION: This is a rare form of cholecystitis that carries a high mortality and usually present insidious clinical signs. CT is the most accurate imaging technique. Antibiotic therapy should begin quickly and include coverage of common pathogens, particularly Clostridia. Surgical intervention should take place as early as possible.INTRODUÇÃO: Colecistite enfisematosa é uma condição de risco de vida caracterizada por infecção da vesícula biliar por agentes produtores de gás. Na sua apresentação mais comum atinge preferencialmente homens idosos portadores de doenças sistêmicas em especial diabetes e vasculopatias. RELATO DO CASO: Paciente do sexo masculino, 30 anos de idade e sem co-morbidades que se apresenta ao pronto-socorro com história de dor abdominal em hipocôndrio direito há cinco dias, febre (38,7o e náuseas. Os exames laboratoriais mostravam leucocitose (26700/µl e elevação dos marcadores de inflamação (proteína C reativa, PCR 470. A tomografia computadorizada do abdome revelou realce da parede vesicular após injeção de contraste i.v., bem como dilatação da vesícula com a

  12. Oriental Medical Treatment of chronic Acalculous Cholecystitis

    OpenAIRE

    Hae-Yeon Lee; Jung-Han Park; Hyun-Seok Cho; Jung-Chul Kim; Tae-Hyun Baik; Jong-Seong Wi

    2004-01-01

    Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by...

  13. Ascariasis cholecystitis: An unusual cause

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    Shetty Balakrishna

    2008-01-01

    Full Text Available Ascariasis is the most common helminthic infection to infest man. Usually the adult worm lives in the small intestine. Rarely it migrates through the ampulla of vater and enters the common bile duct. We are reporting a case of gall bladder ascariasis causing acute cholecystitis treated by laparoscopic cholecystectomy. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to the narrow and tortuous cystic duct.

  14. Ascariasis cholecystitis: An unusual cause

    OpenAIRE

    Shetty Balakrishna; Shetty Prashanth; Sharma Pritam

    2008-01-01

    Ascariasis is the most common helminthic infection to infest man. Usually the adult worm lives in the small intestine. Rarely it migrates through the ampulla of vater and enters the common bile duct. We are reporting a case of gall bladder ascariasis causing acute cholecystitis treated by laparoscopic cholecystectomy. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to the narrow and tortuous cystic duct.

  15. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    Institute of Scientific and Technical Information of China (English)

    Montiel-Jarquín Alvaro

    2008-01-01

    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopahologic studies.The purpose of this paper is to comment on a case report published in Wodd J Gastroenterol 2007 luly;13 (27):3760-3762,about eosinophilic cholecystitis along with pericarditis without histopathological studies,which are considered necessary for its diagnosis.

  16. Oriental Medical Treatment of chronic Acalculous Cholecystitis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2004-12-01

    Full Text Available Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by Geonbihwan, acupuncture and herbal acupuncture. Satisfactory symptomatic improvement was achieved and findings of abdominal ultrasonogram came also normal.

  17. Acalculous cholecystitis due to Salmonella enteritidis

    Institute of Scientific and Technical Information of China (English)

    Maria Lourdes Ruiz-Rebollo; Gloria Sánchez-Antolín; Félix García-Pajares; Maria Antonia Vallecillo-Sande; Pilar Fernández-Orcajo; Rosario Velicia-Uames; Agustín Caro-Patón

    2008-01-01

    Acute acalculous cholecystitis (AAC) is defined as an acute inflammation of the gallbladder in the absence of stones. We herein report a case of a young man who developed AAC after a Salmonella enteritidis gastroin-testinal infection.

  18. 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.

  19. Candida famata-induced fulminating cholecystitis

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    Paulo Sergio Ramos de Araujo

    2013-12-01

    Full Text Available Lithiasic cholecystitis is classically associated with the presence of enterobacteria, such as Escherichia coli, Enterococcus, Klebsiella, and Enterobacter, in the gallbladder. Cholecystitis associated with fungal infections is a rare event related to underlying conditions such as diabetes mellitus, steroid use, and broad-spectrum antibiotic use for prolonged periods, as well as pancreatitis and surgery of the digestive tract. Here, we present the first reported case of a gallbladder infection caused by Candida famata.

  20. Acute cholecystitis from typhic origin in children

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    Komla Gnassingbé

    2013-01-01

    Full Text Available Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings, confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females. Their ages ranged from five to 13 years (median 8.8 years. The mean duration of symptoms was six to 21 days. The clinical signs were fever, abdominal pain, which predominated at the right upper abdominal quadrant, and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal′s test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3, perforation (2 and empyema (1. All the patients made an uneventful recovery, and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice.

  1. Tc-99m ciprofioxacin imaging in acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Yun-Mee Choe; Kee-Chun Hong; Seok-Hwan Shin; Kyung-Rae Kim; Ze-Hong Woo; Wonsick Choe; Keon-Young Lee; Seung-Ik Ahn; Kwang Kim; Young Up Cho; Sun Keun Choi; Yoon-Seok Hur; Sei-Joong Kim

    2007-01-01

    AIM: To evaluate the efficacy of a new nuclear imaging Infecton (Tc-99m ciprofioxacin) for the diagnosis of acute cholecystitis.METHODS: Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic findings.RESULTS: The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative.This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%,and a negative-predictive value of 75%.CONCLUSION: Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.

  2. Morphine-assisted cholescintigraphy in the diagnosis of acalculous cholecystitis

    International Nuclear Information System (INIS)

    Detecting acalculous cholecystitis still causes difficulties. The aim of the study was to assess the usefulness of morphine-assisted cholescintigraphy in the diagnosis of acute and chronic acalculous cholecystitis. Sixteen patients with suspicion of acute or chronic acalculous cholecystitis were examined. in the above mentioned patients choscintigraphy was performed by the intravenous administration of 5 mCi 99mTc-HIDA. None of the patients displayed the gallbladder within 60 min. The intravenous administration of 0.04 mg/kg b.w. morphine did not result in filling a tracer into the gallbladder in 10 patients, which allowed to confirm that acute acalculous cholecystitis. In the remaining 6 patients the morphine induction caused influx of radiotracer into the gallbladder, which allowed to diagnose the chronic acalculous cholecystitis. Morphine-assisted cholescintigraphy turned out to be useful in detecting acute and chronic cholecystitis. (author)

  3. Infusion cholecystography in the diagnosis of acute cholecystitis

    International Nuclear Information System (INIS)

    The use of infusion cholecystography as an aid in the diagnosis of acute cholecystitis was investigated in 21 patients. Seventeen of 18 patients (94%) with positive cholecyst-tomograms who underwent laparotomy had confirmation of acutely inflamed gallbladders both macroscopically and histologically. These findings suggest that infusion cholecystography can make a significant contribution in reducing the incidence of misdiagnosis in acute cholecystitis, and that the investigation should be part of the management of patients in whom early surgery is planned. (author)

  4. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis

    DEFF Research Database (Denmark)

    Gurusamy, Kurinchi Selvan; Davidson, Christopher; Gluud, Christian; Davidson, Brian R

    2013-01-01

    Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% of these adults become symptomatic in a year (the majority due to biliary colic but a significant proportion due to acute cholecystitis). Laparoscopic cholecystectomy for acute cholecystitis is mainly...... performed after the acute cholecystitis episode settles because of the fear of higher morbidity and of need for conversion from laparoscopic to open cholecystectomy. However, delaying surgery exposes the people to gallstone-related complications....

  5. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

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    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.

  6. Eosinophilic cholecystitis as a rare manifestation of visceral larva migrans

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Eosinophilic cholecystitis is an infrequent form of cholecystitis. The etiology of eosinophilic cholecystitis is still obscure, and it is sometimes accompanied with several complications, but a simultaneous onset with pericarditis is very rare. We would like to make an alternative interpretation of our recent report "Kaji K, Yoshiji H, Yoshikawa M, Yamazaki M, Ikenaka Y,Noguchi R, Sawai M, Ishikawa M, Mashitani T, Kitade M, Kawaratani H, Uemura M, Yamao J, Fujimoto M,Mitoro A,Toyohara M, Yoshida M, Fukui H. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report.World J Gastroenterol 2007;13: 3760-3762."

  7. Kocuria kristinae infection associated with acute cholecystitis

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    Chan Edmond CH

    2005-07-01

    Full Text Available Abstract Background Kocuria, previously classified into the genus of Micrococcus, is commonly found on human skin. Two species, K. rosea and K. kristinae, are etiologically associated with catheter-related bacteremia. Case presentation We describe the first case of K. kristinae infection associated with acute cholecystitis. The microorganism was isolated from the bile of a 56-year old Chinese man who underwent laparoscopic cholecystectomy. He developed post-operative fever that resolved readily after levofloxacin treatment. Conclusion Our report of K. kristinae infection associated with acute cholecystitis expands the clinical spectrum of infections caused by this group of bacteria. With increasing number of recent reports describing the association between Kocuria spp. and infectious diseases, the significance of their isolation from clinical specimens cannot be underestimated. A complete picture of infections related to Kocuria spp. will have to await the documentation of more clinical cases.

  8. [Laparascopic cholecystectomy in patients with acute cholecystitis].

    Science.gov (United States)

    Tokin, A N; Chistiakov, A A; Mamalygina, L A; Zheliabin, D G; Osokin, G Iu

    2008-01-01

    Experience of diagnostics and treatment of 758 patients with acute cholecystitis was summarized. Authors attach the main importance to evaluation of ultrasound data and functional condition of respiratory and cardio-vascular sistem choosing the method of surgical treatment. Sparse use of laparoscopic cholecystectomy in treatment of acute cholecystitis compared with chronic may be explouned by presence of complications in patients which make problems in differentiation of tubular structures during the operation. Authors offered to use ultrasound dissection for clear identification of tubular structures and argon coagulation for hemostasis and safe mobilization of gall bladder. Stick to suggested tactics authors practically doubled the amount of performed laparoscopic cholecystectomies reducing at the same time the frequency of complications. PMID:19301492

  9. Kocuria kristinae infection associated with acute cholecystitis

    OpenAIRE

    Chan Edmond CH; Lai Kristi TW; Wong Chris LP; Ma Edmond SK; Yam WC; Chan Angus CW

    2005-01-01

    Abstract Background Kocuria, previously classified into the genus of Micrococcus, is commonly found on human skin. Two species, K. rosea and K. kristinae, are etiologically associated with catheter-related bacteremia. Case presentation We describe the first case of K. kristinae infection associated with acute cholecystitis. The microorganism was isolated from the bile of a 56-year old Chinese man who underwent laparoscopic cholecystectomy. He developed post-operative fever that resolved readi...

  10. Acute acalculous cholecystitis secondary to dengue fever.

    OpenAIRE

    Farah HISAMONIE KOH; Hartini MISLI; Chong, Vui Heng

    2011-01-01

    Patients with dengue fever usually present with typical symptoms such as fever, frontal headache, retro-ocular pain, myalgia, arthralgia, nausea, vomiting, rash, leucopaenia and thrombocytopaenia. However, they can also manifest with atypical symptoms. Acute acalculous cholecystitis is an atypical manifestation of dengue fever. In dengue endemic areas such as Brunei Darussalam, it is imperative that typical and atypical presentations of dengue fever are recognised so that early diagnosis can ...

  11. Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa)

    DEFF Research Database (Denmark)

    Reurings, Jurrian C; Diaz, Ruben P D; Penninga, Luit;

    2014-01-01

    Acute acalculous cholecystitis (AAC) is a rare condition normally occurring in critically ill patients. Compared to acute calculous cholecystitis, AAC is associated with complications and has a worse outcome. Hence, knowledge of this condition is very important. We describe a case of a 31-year-ol...

  12. Use of morphine in cholescintigraphy for obstructive cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, E.E.; Nguyen, M.; Pjura, G.; Pollack, M.; Gobuty, A.

    1985-05-01

    Non-visualization of the gallbladder (GB) during the first hour of cholescintigraphy is observed in cystic duct obstruction (e.g. in acute cholecystitis) but may also occur in chronic cholecystitis, hepatocellular disease, alcoholism and prolonged total parenteral nutrition. Low dose morphine is shown to improve the specificity of the diagnosis of acute cholecystitis (from 85% to 100%) with no loss in sensitivity (98%) at a small cost in terms of additional study time. The authors reviewed 27 selected cholescintigraphic examinations augmented by intravenous (IV) morphine (0.04 mg/Kg). Of the 16 cases with persistent nonvisualization of the GB, ultrasound revealed gallstones in 5 cases, sludge in 4, acalculous cholecystitis in 3, one distended GB, one contracted GB and 2 normal GB's. Of the 4 patients taken to surgery, one with gallstones and one with acalculous cholecystitis were confirmed to have acute cholecystitis while another with gallstones had chronic cholecystitis and the final patient, who was sonographically normal, presented a single common duct stone. The authors conclude that the use of IV morphine is an effective adjunct to cholescintigraphy in the evaluation of gallbladder disease, especially when visualization post morphine rules out acute cholecystitis.

  13. Use of morphine in cholescintigraphy for obstructive cholecystitis

    International Nuclear Information System (INIS)

    Non-visualization of the gallbladder (GB) during the first hour of cholescintigraphy is observed in cystic duct obstruction (e.g. in acute cholecystitis) but may also occur in chronic cholecystitis, hepatocellular disease, alcoholism and prolonged total parenteral nutrition. Low dose morphine is shown to improve the specificity of the diagnosis of acute cholecystitis (from 85% to 100%) with no loss in sensitivity (98%) at a small cost in terms of additional study time. The authors reviewed 27 selected cholescintigraphic examinations augmented by intravenous (IV) morphine (0.04 mg/Kg). Of the 16 cases with persistent nonvisualization of the GB, ultrasound revealed gallstones in 5 cases, sludge in 4, acalculous cholecystitis in 3, one distended GB, one contracted GB and 2 normal GB's. Of the 4 patients taken to surgery, one with gallstones and one with acalculous cholecystitis were confirmed to have acute cholecystitis while another with gallstones had chronic cholecystitis and the final patient, who was sonographically normal, presented a single common duct stone. The authors conclude that the use of IV morphine is an effective adjunct to cholescintigraphy in the evaluation of gallbladder disease, especially when visualization post morphine rules out acute cholecystitis

  14. Xanthogranulomatous cholecystitis: a rare cause of digestive hemorrhage.

    Science.gov (United States)

    Scheiwe, C; Muller, A; Rocas, D; Cotte, E

    2014-02-01

    Xanthogranulomatous cholecystitis is a rare affection with non-specific symptoms. It is essential to differentiate it from gall bladder adenocarcinoma. Presentation signs include hemorrhage or fistula. This report concerns a patient with pseudotumoral xanthogranulomatous cholecystitis who presented with gastrointestinal hemorrhage. PMID:24411821

  15. Acute calculous cholecystitis with patent cystic duct

    Energy Technology Data Exchange (ETDEWEB)

    Massie, J.D.; Moinuddin, M.; Phillips, J.C.

    1983-07-01

    In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that wth unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.

  16. Cholescintigraphy and ultrasonography in patients suspected of having acute cholecystitis

    DEFF Research Database (Denmark)

    Lauritsen, K B; Sommer, W; Hahn, L; Henriksen, Jens Henrik Sahl

    1988-01-01

    The diagnostic power of combined cholescintigraphy and ultrasonography was tested in 67 patients suspected of having acute cholecystitis; of these, 42 (63%) had acute cholecystitis. The predictive value of a positive scintigraphy (PVpos) was 95% and that of a negative (PVneg) was 91% (n = 67). The...... patients suspected of having acute cholecystitis cholescintigraphy should be the first diagnostic procedure performed. If the scintigraphy is positive, additional ultrasonographic detection of gallstones makes the diagnosis almost certain. If one diagnostic modality is inconclusive, the other makes a fair...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. A Case Report of Typhoidal Acute Acalculous Cholecystitis

    Directory of Open Access Journals (Sweden)

    Neeha Rajan

    2014-01-01

    Full Text Available Introduction. Acalculous cholecystitis in the setting of typhoid fever in adults is an infrequent clinical encounter, reported sparsely in the literature. In this case report we review the presentation and management of enteric fever involving the biliary system and consider the literature surrounding this topic. The aim of this case report is to alert clinicians to the potential diagnosis of extraintestinal complications in the setting of typhoid fever in the returned traveller, requiring surgical intervention. Presentation of Case. We report the case of a 23-year-old woman with acalculous cholecystitis secondary to Salmonella Typhi. Discussion. There is scarce evidence surrounding the optimal treatment and prognosis of typhoidal acalculous cholecystitis. In the current case, surgical invention was favoured due to failure of medical management. Conclusion. Clinical judgement dictated surgical intervention in this case of typhoidal acute acalculous cholecystitis, and cholecystectomy was safely performed.

  19. 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)

  20. Acute Acalculous Cholecystitis due to Viral Hepatitis A

    OpenAIRE

    Safak Kaya; Ahmet Emre Eskazan; Nurettin Ay; Birol Baysal; Mehmet Veysi Bahadir; Arzu Onur; Recai Duymus

    2013-01-01

    Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with gangrene, perforation, and empyema. Due to these associated complications, AAC can be associated with high morbidity and mortality. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Particularly in acute acalculous cholecystitis cases, early diagnosis and early medical treatme...

  1. Gallstone spillage caused by spontaneously perforated hemorrhagic cholecystitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    There are occasional incidences of gallstone spillage during laparoscopic cholecystectomy, and there have been frequent reports on such a topic in the literature. To the best of our knowledge, however, there have been no reports about spilled stones caused by spontaneously perforated hemorrhagic cholecystitis. Here, we report the radiologic findings of spilled stones caused by spontaneously perforated hemorrhagic cholecystitis in a 55-year-old man.

  2. Gallbladder metastasis from renal cell carcinoma mimicking acute cholecystitis

    Directory of Open Access Journals (Sweden)

    Sand M

    2009-02-01

    Full Text Available Abstract Renal cell carcinoma constitutes about 3% of adult malignancies. It has a high metastatic potential associated with synchronous or metachronous metastatic disease. Further, it is known to metastasize mainly to the lung, bone, brain, liver, or adrenal glands. In very rare cases it can metastasize to the gallbladder mimicking acute cholecystitis on clinical exam. In this case we present a patient who developed a gallbladder metastasis five years after a renal cell carcinoma mimicking acute cholecystitis.

  3. Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

    OpenAIRE

    Tsuyuguchi, Toshio; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Wada, Keita; Nagino, Masato; Mayumi, Toshihiko; Yoshida, Masahiro; Miura, Fumihiko; Tanaka, Atsushi; Yamashita, Yuichi; Hirota, Masahiko; Hirata, Koichi; Yasuda, Hideki; Kimura, Yasutoshi

    2007-01-01

    The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspira...

  4. Synchronous presentation of acute acalculous cholecystitis and appendicitis: a case report

    LENUS (Irish Health Repository)

    Sahebally, Shaheel M

    2011-11-14

    Abstract Introduction Acute acalculous cholecystitis is traditionally associated with elderly or critically ill patients. Case presentation We present the case of an otherwise healthy 23-year-old Caucasian man who presented with acute right-sided abdominal pain. An ultrasound examination revealed evidence of acute acalculous cholecystitis. A laparoscopy was undertaken and the dual pathologies of acute acalculous cholecystitis and acute appendicitis were discovered and a laparoscopic cholecystectomy and appendectomy were performed. Conclusion Acute acalculous cholecystitis is a rare clinical entity in young, healthy patients and this report describes the unusual association of acute acalculous cholecystitis and appendicitis. A single stage combined laparoscopic appendectomy and cholecystectomy is an effective treatment modality.

  5. A focus on acute cholecystitis and acute cholangitis

    Institute of Scientific and Technical Information of China (English)

    Massimo Sartelli; Cristian Tranà

    2012-01-01

    Biliary infections are very common intra-abdominal infections. Laparoscopic cholecystectomy for acute cholecystitis and endoscopic retrograde management of acute cholangitis play important roles in the treatment of biliary infections. Also antimicrobial therapy is nevertheless important in the overall management of biliary infections. A multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists may improve outcomes of patients with biliary infections. This review focuses the clinical presentation, diagnosis, and state of the art management of acute cholecystitis and acute cholangitis.

  6. Cholescintigraphy in acute cholecystitis: use of intravenous morphine

    Energy Technology Data Exchange (ETDEWEB)

    Choy, D.; Shi, E.C.; McLean, R.G.; Hoschl, R.; Murray, I.P.C.; Ham, J.M.

    1984-04-01

    Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyroxylidene-glutamate. Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity. Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

  7. Cholescintigraphy in acute cholecystitis: use of intravenous morphine

    International Nuclear Information System (INIS)

    Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyroxylidene-glutamate. Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity. Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging

  8. Acalculous cholecystitis associated with hemorrhagic fever with renal syndrome.

    Science.gov (United States)

    Nicolas, J B

    2015-10-01

    Hantaviruses are responsible for various types of hemorrhagic fevers depending on the involved subtype. In Europe, Puumala virus is responsible for an epidemic nephropathy. This infection can be complicated by severe abdominal pain. A rarely reported cause of this presenting symptom is acalculous cholecystitis, which must be integrated in the clinicobiological spectrum and should not lead to a surgical sanction. Its presence seems to be correlated with the severity of the disease, whose main pathophysiological phenomenon is plasma leakage induced by a microvascular endothelial dysfunction. We report the case of a young male patient who presented with severe hantavirus infection complicated by acalculous cholecystitis. PMID:25982259

  9. Sclerosing cholecystitis associated with autoimmune pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Hitoshi Nakajima; Naoto Egawa; Kouji Tsuruta; Atsutake Okamoto; Shinichirou Horiguchi

    2006-01-01

    AIM: To evaluate the histopathological and radiological findings of the gallbladder in patients with autoimmune pancreatitis (AIP).METHODS: The radiological findings of the gallbladder of 19 AIP patients were retrospectively reviewed.Resected gallbladders of 8 AIP patients were examined histologically and were immunostained with antiIgG4 antibody. Controls consisted of gallbladders resected for symptomatic gallstones (n=10) and those removed during pancreatoduodenectomy for pancreatic carcinoma (n=10), as well as extrahepatic bile ducts and pancreases removed by pancreatoduodenectomy for pancreatic carcinoma (n=10).RESULTS: Thickening of the gallbladder wall was detected by ultrasound and/or computed tomography in 10 patients with AIP (3 severe and 7 moderate);in these patients severe stenosis of the extrahepatic bile duct was also noted. Histologically, thickening of the gallbladder was detected in 6 of 8 (75%) patients with AIP; 4 cases had transmural lymphoplasmacytic infiltration with fibrosis, and 2 cases had mucosal-based lymphoplasmacytic infiltration. Considerable transmural thickening of the extrahepatic bile duct wall with dense fibrosis and diffuse ly rnphoplasmacytic infiltration was detected in 7 patients. Immunohistochemically, severe or moderate infiltration of IgG4-positive plasma cells was detected in the gallbladder, bile duct, and pancreas of all 8 patients, but was not detected in controls.CONCLUSION: Gallbladder wall thickening with fibrosis and abundant infiltration of IgG4-positive plasma cells is frequently detected in patients with AIR We propose the use of a new term, sclerosing cholecystitis, for these cases that are induced by the same mechanism as sclerosing pancreatitis or sclerosing cholangitis in AIP.

  10. MR imaging finding of xanthogranulomatous cholecystitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Kang, Heoung Keun; Jeong, Yong Yeon; Cho, Yong Ho; Jang, Nam Kyu [Chonnam Univ. Medical School, Kwangju (Korea, Republic of)

    1999-07-01

    We describe a case of xanthogranulomatous cholecystitis in which there was close correlation between MR and histopathological finding and review the previous literature. On both T1- and T2-weighted MR images, multiple gallstones and diffuse wall thickening of the gallbladder were seen, with multiple hyperintense intramural nodules. The nodules were pathologically confirmed as xanthogranuloma.

  11. Nuclear medicine and ultrasonography in the acute cholecystitis diagnosis

    International Nuclear Information System (INIS)

    Newer modalities for the evaluation of gallbladder include cholescintigraphy and ultrasonography. The IDA-Tc 99m presents functional informations with regard to cystic duct patency. The ultrasonography demonstrates the topographic anatomy of gallbladder, and morfologic alterations. Both analysis are preconized in acute cholecystitis. (Author)

  12. Training vs practice: A tale of opposition in acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Purvi; P; Patel; Shaun; C; Daly; Jose; M; Velasco

    2015-01-01

    Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons.Despite its high incidence there remains a range of treatment of approaches.Current practices in biliary surgery vary as to timing,intraoperative utilization of biliaryimaging,and management of bile duct stones despite growing evidence in the literature defining best practice.Management of patients with acute cholecystitis with early laparoscopic cholecystectomy(LC)results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy.Regardless of this data,many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis.The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy,minimizing the risk for inadvertent injury to surrounding structures,and lowering conversion rates,however it is rarely utilized.Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal.Yet,there is evidence that intraoperative laparoscopic stone extraction is safe,feasible and may have added advantages.This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

  13. Characteristics of inflammation mediators changes at calculous cholecystitis

    OpenAIRE

    MAGRUPOV BOKHODIR ASADULLAEVICH; VERVEKINA TATYANA ANATOLEVNA; UBAYDULLAEVA VLADLENA ULUGBEKOVNA

    2015-01-01

    Investigation results of anti-inflammatory mediators levels in patients with different types of calculous cholecystitis in compare with blood indexes investigation results in healthy people have been presented in the paper. Comparison of cytokines level ratio in blood and immunocompetent cells in gallbladder tissue has been performed.

  14. Torsion of Pedunculated Accessory Liver Lobe with Acute Acalculous Cholecystitis

    OpenAIRE

    Khandelwal, Kamlesh K.; Gomes, Rachel M.; Bhagvat, Vikrant

    2012-01-01

    Accessory lobes of the liver are very uncommon and rarely symptomatic. We report the occurrence of torsion and infarction of a pedunculated accessory lobe of the liver with acute cholecystitis. The speculated possibilities of the coexistent pathologies and its management are discussed.

  15. Acalculous Cholecystitis : Is There Any Sonographic Finding to Indicate Cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyun Chul; Lee, Hak Soo; Lee, Tae Hee; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1996-06-15

    To assess clinical courses in patient with acalculous cholecystitis and sonographic criteria to indicate surgical intervention. Authors retrospectively reviewed clinical records and sonograms of 35 patients (aged 26-80 years) who were diagnosed as acalculous cholecystitis. They were confirmed clinically (n = 21) and surgically (n = 14) as acalculous cholecystitis. The clinical courses were assessed in view of the interval of symptom improvement during non-surgical management and after surgical management. Sonographic follow-up in 10 patients of non-surgical group was performed. Comparative assessment of sonographic findings in non-surgical group with those in surgical group was performed in view of gallbladder distension [axial diameter, longitudinal diameter, and roundness index(axial diameter/longitudinal diameter)], gallbladder wall thickening, halo sign, bile sludge, pericholecystic fluid, and sonographic Murphy sign. Acalculous cholecystitis in surgical group showed a tendency to be operated if clinical symptom was not improved after conservative treatment over seven days. Follow-up sonographic findings were also improved in seven of 10non-surgical patients. Although one case showed development of gallstone after 5-years follow-up, no one has been operated due to recurrence of cholecystitis in non-surgical group. We found no significant sonographic criteria except for sonographic murphy sign (33% vs 66% , P<0.05) between non-surgical and surgical groups. No statistically significant differences in longitudinal diameter (6.9{+-}1.6cm vs 7.7{+-}1.9cm : p>0.05), axial diameter(3.2{+-}0.9cm vs 3.3{+-}1.1cm : p>0.05), roundness index (0.47{+-}0.08 vs 0.42{+-}0.9 : p>0.05), wall thickening(4.0{+-}1.9mm vs 4.6{+-}2.5mm : p>0.05), halo sign (95% vs 78% : p>0.05), bile sludge (38% vs 21% : p>0.05),perichole cystic fluid (5% vs 7% :p>0.05) were found between non-surgical and surgical groups. Except for sonographic Murphy sign, any sonographic criteria in acalculous

  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. How to image the gallbladder in suspected cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Marton, K.I.; Doubilet, P.

    1988-11-01

    As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty. 103 references.

  18. How to image the gallbladder in suspected cholecystitis

    International Nuclear Information System (INIS)

    As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty. 103 references

  19. Omental infarction presenting as abdominal pain typical for cholecystitis

    Directory of Open Access Journals (Sweden)

    Pawel Dutkiewicz

    2016-01-01

    Full Text Available To describe a patient who presented to a family medicine clinic with symptoms typical for cholecystitis, but eventually was diagnosed with omental infarction. A 37-year-old Caucasian man reported with right upper quadrant pain suspicious for cholecystitis. In light of negative abdominal ultrasound, computed tomography scan was performed, and omental infarction was identified. The patient was treated conservatively with a good outcome. Omental infarction is rarely described in medical literature, and it is often missed or misdiagnosed. There are increasing numbers of reports that describe omental infarction being diagnosed as various types of acute abdomen. With increased utilization of advanced imaging, omental infarction is being found to be responsible for presentations of the acute abdomen that were misdiagnosed. Proper diagnosis prevents invasive mismanagement and an unnecessarily prolonged hospital stay.

  20. A rare case of listeriosis, acute cholecystitis and multiple myeloma.

    Science.gov (United States)

    Polanco, Thais O; Alothman, Sara; Depaz, Hector; Ramcharan, Alexius

    2016-01-01

    Listeria monocytogenes (LM) is an aerobic, motile, intracellular gram-positive bacterium. Most invasive systemic infections caused by LM are commonly seen in patients at both extremes of age, during pregnancy or in immunocompromised hosts. Common clinical manifestations of LM infection in immunocompromised adults are bacteremia, infections of central nervous system, such as meningitis, and self-limiting febrile gastroenteritis. Focal infections of listeria are rare, especially cholecystitis, with only few cases reported in the last 33 years. A 62-year-old man presented with multiple myeloma, cholecystitis and LM bacteremia. Due to prompt surgical treatment and antibiotics (amoxicillin plus clavulanic acid and gentamycin), this high-risk patient recovered without any complications. PMID:27170703

  1. Acute Cholecystitis: The Diagnostic Role for Current Imaging Tests

    OpenAIRE

    Krishnamurthy, Gerbail T.

    1982-01-01

    Acute cholecystitis is a relatively common clinical entity characterized histopathologically by obstruction of the cystic duct due to either edema or stone or both. Thorough clinical assessment and selection of the appropriate diagnostic tests are crucial in making an early diagnosis before surgical treatment. Many diagnostic tests are available for imaging the gallbladder. Hepatobiliary imaging using technetium Tc 99m IDA is the test of choice to either exclude or confirm the diagnosis of ac...

  2. Concurrent emphysematous cholecystitis and emphysematous pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Yoon, Yup [Dongguk University International Hospital, Dongguk University College of Medicine, Goyang (Korea, Republic of); Park, Sung Bin [Ulsan University Hospital, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2008-01-15

    Emphysematous infections of the abdomen and pelvis are potentially life-threatening conditions which require aggressive medical and surgical management. Therefore, early radiographic detection is important in the management of these conditions. Concurrent emphysematous infections involving different organs have been rarely reported, and primarily occur in immunocompromised patients. Here, we report a rare case of concurrent emphysematous cholecystitis and emphysematous pancreatitis in a 97 year old male patient.

  3. 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.)

  4. Xanthogranulomatous cholecystitis: challenges in management & feasibility of laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Vikram Singh Chauhan

    2013-04-01

    Full Text Available Objective: Xanthogranulomatous cholecystitis (XGC is a rare, unusual and destructive form of chronic cholecystitis. It is clinically indistinguishable from other forms of cholecystitis and hence difficult to diagnose. Due to its propensity to form dense adhesions with stuctures surrounding the gall bladder and mimic malignancy of gall bladder intra-operatively, it’s difficult to manage. This retrospective study was conducted with the aim to review the clinico-pathologic presentation of XGC and the possibility of its laparoscopic management. Patient and methods: All cases of histo-pathologically diagnosed XGC from January 2008 to December 2012 at Sharda Hospital, School of Medical Sciences & Research, Greater Noida were analyzed retrospectively. Results: Sixty two cases of biopsy proved XGC were studied.The mean age at presentation was 56.4 ± 14.3 years (range 30 – 72 years, with a male: female ratio of 1.6:1. Gall bladder wall thickening on ultrasonography was seen in 91.9% cases and all (100% had cholelithiasis. Laparoscopic cholecystectomy was possible in 18 (29% cases, with a high conversion rate of 71% to open surgery. Two cases of carcinoma gall bladder accompanying XGC were documented. Both the mean operative time and hospital stay for laparoscopic surgery were longer for cases with XGC (105 minutes & 4.2 days respectively. No mortality occurred during the study period. Conclusion: XGC is difficult to diagnose preoperatively due to lack of distinguishing clinical features and imaging study results. Due to dense peri-cholecystic adhesions laparoscopic surgery though feasible in some cases is difficult to perform with a high conversion rate. Overall morbidity is also increased due to same reasons.

  5. 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.

  6. 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; Hamilton-Dutoit, Stephen J; Funch-Jensen, Peter

    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...

  7. US diagnosis of choledocholithiasis in patients with acute cholecystitis: Its clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Joon Bum; Kim, Young Hoon; Cho, Woo Ho; Kim, Joung Sook; Kim, Soung Hee; Kim, Jae Hyung; Bae, Sang Jin [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2002-12-15

    It is essential to identify the presence of choledocholithiasis in patients with acute cholecystitis for elucidating the cause of cholecystitis and deciding the surgical planning. In this study, we tried to evaluate the incidence of choledocholithiasis and its ultrasonographic (US) diagnostic values in patients with acute cholecystitis and to discuss its clinical significance. During a 17 months period, seventy six patients with surgically proven acute cholecystitis who underwent preoperative US and endoscopic retrograde cholangiopancreatography (ERCP) were included in this study. US, ERCP and surgical findings of these patients were compared by reviewing their medical records as well as the US and ERCP images. The incidence of choledocholithiasis in these patients and its US diagnostic values were assessed. Of all 76 patients with acute cholecystitis, 20 (26%) were proved to have choledocholithiasis by ERCP and surgery. Among them, 13 were correctly diagnosed to have choledocholithiasis by US. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of US for the detection of choledocholithiasis in these patients were 65%, 100%, 100%, 89%, and 91%, respectively. Our results indicated that on fourth of patients with acute cholecystitis had choledocholithiasis, and the US diagnostic accuracy in detecting choledocholithiasis proved to be 91%, higher than previously reported results. Therefore, it is essential to undergo US in patients with acute cholecystitis to identify the presence of choledocholithiasis.

  8. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Davis, G.B. (Univ. of California School of Medicine, San Diego); Berk, R.N.; Sheible, F.W.; Witztum, K.F.; Gilmore, I.T.; Strong, R.M.; Hofmann, A.F.

    1982-12-01

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedues was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

  9. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Davis, G.B.; Berk, R.N.; Scheible, F.W.; Witztum, K.F.; Gilmore, I.T.; Strong, R.M.; Hofmann, A.F.

    1982-12-01

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

  10. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    International Nuclear Information System (INIS)

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedues was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis

  11. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    International Nuclear Information System (INIS)

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis

  12. A complication of xanthogranulomatous cholecystitis with Mirizzi syndrome.

    Science.gov (United States)

    Zhang, H-Y; Cao, X-D; Chen, J-J; Luo, Y-Q; Wang, X-C

    2015-05-01

    A patient had right upper quadrant pain with sclera was transferred from emergency room to the hospital, she was proposed to have acute cholecystitis, gallstones, obstructive jaundice, and a four-year history of gallbladder stones. The NMR results showed that the gallbladder was significantly enlarged and the gallbladder wall was thickening irregularly. The liver morphology was not abnormal except with extensive intrahepatic bile duct dilatation. The MRCP results demonstrated that the intrahepatic bile ducts were significant expanded. The ERCP results showed that duodenal stenosis and extra-hepatic bile duct stenosis. We placed a plastic stent of 8.5Fr and 12 cm in length in the hepatic duct, and after biliary plastic stent placement, jaundice was rapidly reduced and liver function was improved significantly. A surgery was performed and the final pathologic diagnosis is a complication of Xanthogranulomatous cholecystitis with Mirizzi syndrome. After the surgery of cholecystectomy and a bile duct repair were performed, the patient was recovered well. Conclusively, if a patient was diagnosed as biliary stricture, a biliary metal stent should not be placed until pathological diagnosis of malignancy. PMID:26044215

  13. Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Yair Edden; Hugo St Hilaire; Keith Benkov; Michael T Harris

    2006-01-01

    Liver biopsy is generally considered a safe and highly useful procedure. It is frequently performed in an outpatient setting for diagnosis and follow-up in numerous liver disorders. Since its introduction at the end of the 19th century, broad experience, new imaging techniques and special needles have significantly reduced the rate of complications associated with liver biopsy. Known complications of percutaneous biopsy of the liver include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax and sepsis.Other intra-abdominal complications are less common.Hemobilia due to arterio-biliary duct fistula has been described, which has only rarely been clinically expressed as cholecystitis or pancreatitis. We report a case of a fifteen year-old boy who developed severe acute cholecystitis twelve days after a percutaneous liver biopsy performed in an outpatient setting. The etiology was clearly demonstrated to be hemobilia-associated,and the clinical course required the performance of a laparoscopic cholecystectomy. The post operative course was uneventful and the patient was discharged home. Percutaneous liver biopsy is a safe and commonly performed procedure. However, severe complications can occasionally occur. Both medical and surgical options should be evaluated while dealing with these rare incidents.

  14. MR imaging in clinically suspected acute cholecystitis: a comparison with ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Haakansson, K. [Kalmar Hospital (Sweden). Dept. of Radiology; Leander, P.; Ekberg, O. [Malmoe Univ. Hospital (Sweden). Dept. of Radiology; Haakansson, H.O. [Kalmar Hospital (Sweden). Dept. of Surgery

    2000-07-01

    Purpose: The diagnostic value of fast pulse sequences in MR imaging was compared with US in patients with clinically suspected acute cholecystitis. Material and Methods: In a prospective study of 94 patients, 35 were examined with both MR and US within 24 h. Results: MR diagnoses were acute cholecystitis in 23, gallbladder and common bile duct stones in 3, other pathologic conditions of the abdomen in 7 and normal in 2 patients. US diagnoses were acute cholecystitis in 17, gallbladder stones in 8, other pathologic conditions of the abdomen in 2, normal in 5 and non-conclusive in 3 patients. Conclusion: MR has a higher sensitivity than US for diagnosing acute cholecystitis and, with increased accessibility (may be the first imaging method)

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

    DEFF Research Database (Denmark)

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

    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...

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

    DEFF Research Database (Denmark)

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

    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: As...... 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...

  17. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition

    International Nuclear Information System (INIS)

    A review of gallbladder scintigraphy in patients with potentially compromised hepatobiliary function revealed two groups in whom cholecystitis might be mistakenly diagnosed. In 200 consecutive hospitalized patients studied with technetium-99m-PIPIDA for acute cholecystitis or cholestasis, there were 41 alcoholics and 17 patients on total parenteral nutrition. In 60% of the alcoholics and 92% of those on parenteral nutrition, absent or delayed visualization of the gallbladder occurred without physical or clinical evidence of cholecystitis. A cholecystagogue, sincalide, did not prevent the false-positive features which presumably are due to altered bile flow kinetics related to alcoholism and parenteral nutrition. Four patients on parenteral nutrition undergoing cholecystectomy for suspected cholecystitis had normal gallbladders filled with jellylike viscous thick bile. A positive (nonvisualized or delayed visualized) gallbladder PIPIDA scintigram in these two populations should not be interpreted as indicating a need for cholecystectomy

  18. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.

    Science.gov (United States)

    Agholi, Mahmoud; Heidarian, Hamid Reza; Moghadami, Mohsen; Hatam, Gholam Reza

    2014-06-01

    Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide. PMID:24827104

  19. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    International Nuclear Information System (INIS)

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  20. Imaging examination in the diagnosis of gall-stones and acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Loxton, A.J. (Stellenbosch Univ. (South Africa). Dept. of Radiology)

    1985-06-01

    X-ray radiography of the chest and abdomen can be of use when gall-stones or cholecystitis are suspected, but it is not always necessary. An ultrasonographic examination can also be very useful. If no gall-stones can be found, a cholecystogram must be done. Cholecystography also plays an important part in the tracing of gall-stones. The diagnosis of cholecystitis is best done by means of scintiscanning.

  1. Thickened wall-type GB cancer and complicated cholecystitis : comparison of CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seong Nim; Jung, Hae Jong; Kang, Sung Hag; Shin, Sung Ran; Lee, Min Jin; Lee, Kil Jun; Lee, Sang Chun [Seoul Red Cross Hospital, Seoul (Korea, Republic of)

    1996-11-01

    We compared CT findings of thickened wall-type gallbladder cancer with those of complicated cholecystitis. We retrospectively reviewed abdominal CT scans of ten patients with thickened wall-type gallbladder cancer and eight patients with complicated cholecystitis, from March 1991 to November 1995. CT findings of thickened wall-type gallbladder cancer showed diffuse or focal wall thickening. Wall thickness was 5.3-18.0mm (mean value, 12.2mm;n=10). Gallbladder wall thickness of complicated cholecystitis was 3.0-14.0mm (mean value, 6.6mm;n=8). Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecytitis(p<0.0029). Irregular wall thickening was noted in 7/10 cases of thickened wall-type gallbladder cancer(70%). Regular wall thickening was noted in 6/8 cases of complicated cholecystitis(75%). The luminal diameter of thickened wall-type gallbladder cancer was 3.3-5.4cm (mean value, 4.2cm; n=10). The luminal diameter of complicated cholecystitis was 5.2-8.0cm (mean value, 6.5cm; n=8). Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecystitis(p<0.0003). The halo sign was noted in only 3/8 cases of complicated cholecystitis(38%). Secondary findings of thickened wall-type gallbladder caner was lymphadenopathy in 3/10 cases(30%), and liver invasion in 2/10 cases(20%). Secondary findings of complicated cholecystitis were liver abscess in 2/8 cases(25%), and RLQ abdominal fluid collection and pleural effusion in 4/8 cases(50%). Differential factors of thickened wall-type gallbladder cancer from complicated cholecystits are gallbladder wall thickness, regularity of wall thickness, halo sign, secondary findings and luminal distention.

  2. The outcome of early laparoscopic surgery to treat acute cholecystitis: a single-center experience

    OpenAIRE

    Ciftci, Fatih; Abdurrahman, Ibrahim; Girgin, Sadullah

    2015-01-01

    Aim: The aim of this study was to prospectively assess the outcome of early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Materials and methods: Between July 2005 and December 2012, of 623 patients who had symptoms of acute cholecystitis during the first 72 h of hospital admission and who did not respond to non-operative treatment, 302 underwent surgical treatment. After initial treatment, all patients were followed up for 21 months on average (range: 5-27 months). T...

  3. Efficacy and Safety of Endoscopic Gallbladder Stenting for Acute Cholecystitis in Patients with Concomitant Unresectable Cancer.

    Science.gov (United States)

    Hatanaka, Takeshi; Itoi, Takao; Ijima, Masashi; Matsui, Ayako; Kurihara, Eishin; Okuno, Nozomi; Kobatake, Tsutomu; Kakizaki, Satoru; Yamada, Masanobu

    2016-01-01

    Objective Endoscopic gallbladder stenting (EGBS) is an alternative treatment option for high-risk surgical patients with acute cholecystitis. However, there are no reports focusing on EGBS in patients with concomitant unresectable cancer. The aim of this study was thus to evaluate EGBS in such patients. Methods Twenty-two consecutive patients with acute cholecystitis and unresectable cancer were enrolled between September 2010 and December 2014. Their median age was 74.5 years (range: 51-95). Thirteen patients were men and nine were women. The primary cancers of the patients were biliary tract cancer (9), pancreas cancer (9), lung cancer (2), gastric cancer (1), and colon cancer (1). The causes of cholecystitis were calculus cholecystitis (7), obstruction by malignant tumor (13), and obstruction by fully covered stent (2). Results EGBS was successfully performed in 17 patients (77.2%). The technical success rates for calculus cholecystitis, obstruction by malignant tumor, and obstruction by fully covered stent were 85.7% (6/7), 69.2% (9/13), and 100% (2/2), respectively. No complications were observed. Percutaneous transhepatic gallbladder drainage was conducted on two patients in whom EGBS had failed and then we performed EGBS by a rendezvous approach. Of the 19 patients in whom we finally deployed EGBS, the median follow-up period was 229 days (range: 14-880 days). A recurrence of acute cholecystitis occurred in three (15.7%) patients 14, 130, and 440 days after EGBS placement. The rates of recurrence of cholecystitis at one and two years were 10.5% and 18.7%, respectively. Conclusion Our study demonstrated that EGBS is a safe and effective method for acute cholecystitis in patients with concomitant unresectable cancer. PMID:27250045

  4. A Comparative Study of Clinicopathological Features between Chronic Cholecystitis Patients with and without Helicobacter pylori Infection in Gallbladder Mucosa

    OpenAIRE

    Zhou, Di; Guan, Wen-bin; Wang, Jian-Dong; Zhang, Yong; Gong, Wei; Quan, Zhi-wei

    2013-01-01

    Background Helicobacter pylori has been isolated from 10%–20% of human chronic cholecystitis specimens but the characteristics of “Helicobacter pylori positive cholecystitis” remains unclear. This study aims to compare the clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. Methods Three hundred and twenty-six chronic cholecystitis patients were divided into two groups according to whether Helicobacter pylor...

  5. Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Abdullah A. Albarrak

    2015-01-01

    Full Text Available Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.

  6. 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.

  7. Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, E.E.; Pjura, G.; Lowry, P.; Nguyen, M.; Pollack, M.

    1986-12-01

    Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

  8. Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis

    International Nuclear Information System (INIS)

    Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results

  9. Gallstone fistula with a gastric duplication cyst: an unusual complication of cholecystitis

    Directory of Open Access Journals (Sweden)

    Jasprit Bhamrah

    2010-11-01

    Full Text Available Cholecystitis can result in complications if not completely treated. These include gallbladder empyema, perforation and cholecystoenteric fistula.We report the first incidence of cholecystitis resulting in a gallstone fistula with a gastric duplication cyst. A 71 year old patient presented with generalised peritonism that was worst in the epigastric area. Computer tomography (CT revealed a perforated necrotic gallbladder. Emergency laparotomy, cholecystectomy, partial gastrectomy and Roux-en-Y reconstruction was required. The patient made a slow but full recovery.Pathology results revealed that chronic cholecystitis had resulted in a fistula with a duplication cyst overlying the greater curve of the stomach. Several one centimeter gallstones were found within the cyst cavity.

  10. 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".

  11. A rare case of primary EBV infection causing acute acalculous cholecystitis

    Directory of Open Access Journals (Sweden)

    Sonia Shah

    2015-07-01

    Full Text Available Primary Epstein–Barr Virus (EBV infection in children is common and frequently asymptomatic. While symptomatic patients typically present with features of infectious mononucleosis, a rare complication of primary EBV is acute acalculous cholecystitis. A 6 year old previously healthy boy presented with 6 days of low-grade fevers, non-bloody non-bilious vomiting, and periumbilical pain. Based on clinical, laboratory, and radiographic evidence, the patient was diagnosed with acute acalculous cholecystitis due to a primary EBV infection. The patient improved with supportive therapy and remained asymptomatic at follow-up. Overall, clinicians should consider EBV infection in the setting of multi-organ disease and blood dyscrasia. Furthermore, while the pathogenesis of EBV cholecystitis is still unclear, it is important to note that these patients may improve with supportive treatment and do not require surgical intervention.

  12. [The significance of morphologic changes in acute occlusive cholecystitis for determining the surgical approach].

    Science.gov (United States)

    Iukhtin, V I; Khripun, A I; Raksha, A P; Zhukotskiĭ, A V; Sergeeva, N A; Dorofeeva, I M; Belous, G G

    1996-01-01

    Specific morphological and functional changes in the liver in acute obturative cholecystitis have been experimentally studied in 30 dogs and clinically examined in 21 patients. No morphological substrate of liver insufficiency were found in early period of acute obturative cholecystitis. Early changes in the liver are of reactive nature and have the features of active nonspecific hepatitis. The reactions of compensation and decompensation are changing each other periodically. The intensive reactions of compensation take place in the first 2 or 3 days of disease. The reactions of compensation weaken gradually. There is no correlation between changes in the liver and in blood serum. The early surgery and laparoscopic procedures in acute obturative cholecystitis are advocated. PMID:8965448

  13. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report

    Institute of Scientific and Technical Information of China (English)

    Kosuke Kaji; Mitsuteru Kitade; Hideto Kawaratani; Masahito Uemura; Junichi Yamao; Masao Fujimoto; Akira Mitoro; Masahisa Toyohara; Motoyuki Yoshida; Hiroshi Fukui; Hitoshi Yoshiji; Masahide Yoshikawa; Masaharu Yamazaki; Yasuhide Ikenaka; Ryuichi Noguchi; Masayoshi Sawai; Masatoshi Ishikawa; Tsuyoshi Mashitani

    2007-01-01

    Although the etiology of eosinophilic cholecystitis is still obscure, the postulated causes include allergies,parasites, hypereosinophilic syndrome, and eosinophilic gastroenteritis. It is sometimes accompanied by several complications, but a simultaneous onset with pericarditis is very rares. A 28-year-old woman complained of acute right hypocondrial pain and dyspnea associated with systemic eruption. Several imaging modalities revealed acute cholecystitis and pericarditis with massive pericardial effusion. A marked peripheral blood eosinophilia was observed, and the eruption was diagnosed as urticaria. Her serum had a high titer of antibody against Ascaris lumbricoides. Treatment with albendazole drastically improved all clinical manifestations along with normalization of the imaging features and eosinophilia. We report herein a rare case of simultaneous onset of acute cholecystitis and pericarditis associated with a marked eosinophilia caused by parasitic infection.

  14. Clinical application of percutaneous cholecystostomy in the treatment of high-risk patients with acute cholecystitis

    International Nuclear Information System (INIS)

    Objective: To discuss the therapeutic strategy and the clinical efficacy of percutaneous cholecystostomy in treating high-risk patients with acute cholecystitis. Methods: During the period of Jan. 2006-June 2008, percutaneous cholecystostomy was performed in 27 high-risk patients with acute cholecystitis, consisting of lithic cholecystitis (n = 21) and non-lithic cholecystitis (n = 6). Of 27 patients, percutaneous cholecystostomy via transhepatic approach was performed in 22 and via transperitoneal approach in 5. The 7 F drainage catheter was used. Cholecystography was conducted before the drainage catheter was extracted. Results: Percutaneous cholecystostomy was successfully accomplished in all 27 cases, with a technical success rate of 100%. Postoperative patency of gallbladder drainage was obtained in 25 patients, with the relieving or subsiding of abdominal pain and the restoring of temperature and leukocyte account to normal range within 72 hours. In one patient, as the abdominal pain relief was not obvious 72 hours after the procedure, cholecystography was employed and it revealed the obstruction of the drainage catheter. After reopening of the drainage catheter, the abdominal pain was relieved. In another case, cholecystography was carried out because the abdominal pain became worse after the procedure, and minor bile leak was demonstrated. After powerful anti-infective and symptomatic medication, the abdominal pain was alleviated. The drainage catheter was extracted in 25 patients 6-7 weeks after the treatment. Of these 25 patients, 12 accepted selective cholecystectomy, 7 received percutaneous cholecystolithotomy and 6 with non-lithic cholecystitis did not get any additional surgery. The remaining two patients were living with long-term retention of the indwelling drainage-catheter. Conclusion: Percutaneous cholecystostomy is a simple, safe and effective treatment for acute cholecystitis in high-risk patients. This technique is of great value in clinical

  15. Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study

    International Nuclear Information System (INIS)

    Background: Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. Methods: This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. Result: Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +- 5.43 years in male and 48.76 +- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females (p=0.03, statistically significant). Majority of females (60%) had =40 U/ml antibody titre (p=0.917, non-significant). Conclusion: A possible relationship was identified between Helicobacter pylori and calcular

  16. Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

    Directory of Open Access Journals (Sweden)

    Cheema Muhammad

    2009-01-01

    Full Text Available Abstract Background Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka. Case presentation Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts. Conclusion Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.

  17. 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...

  18. Clinical Use of Cholescintigraphy in Acute Cholecystitis: A Comparative Study with Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwang Hee; Chung, Hye Kyeong; Kim, Myeong Gon; Chung, Duck Soo; Sung, Nak Kwan; Kim, Ok Dong [Taegu Catholic University School of Medicine, Taegu (Korea, Republic of)

    1993-03-15

    Retrospective analysis of cholescintigraphy and ultrasonography was done in 76 patients with clinically suspected acute cholecystitis to assess the relative value of the two modalities. Excluding the patients with obstructive jaundice, the overall results of cholescintigraphy(sensitivity 100%, specificity 95%, false positive rate 5%, false negative rate 0%, accuracy 97%) are nearly identical with or rather superior to those of the ultrasonography(sensitivity 94%, specificity 100%, false positive rate 0%, false negative rate 5%, accuracy 97%). We recommend the cholescintigraphy as the initial modality in patients with clinically suspected acute cholecystitis, and ultrasonography can be used in jaundiced patients to exclude the possibility of the false positive of cholescintigraphy.

  19. Acute cholecystitis associated with infection of Enterobacteriaceae from gut microbiota.

    Science.gov (United States)

    Liu, J; Yan, Q; Luo, F; Shang, D; Wu, D; Zhang, H; Shang, X; Kang, X; Abdo, M; Liu, B; Ma, Y; Xin, Y

    2015-09-01

    Acute cholecystitis (AC) is one of the most common surgical diseases. Bacterial infection accounts for 50% to 85% of the disease's onset. Since there is a close relationship between the biliary system and the gut, the aims of this study were to characterize and determine the influence of gut microbiota on AC, to detect the pathogenic microorganism in the biliary system, and to explore the relationship between the gut and bile microbiota of patients with AC. A total of 185 713 high-quality sequence reads were generated from the faecal samples of 15 patients and 13 healthy controls by 16S rRNA gene pyrosequencing. Patients' samples were significantly enriched in Akkermansia, Enterobacter and Escherichia/Shigella group. The healthy controls, however, showed significant enrichment of Clostridiales, Coprococcus, Coprobacillaceae, Paraprevotella, Turicibacter and TM7-3 in their faecal samples. Escherichia coli was the main biliary pathogenic microorganism, among others such as Klebsiella spp., Clostridium perfringens, Citrobacter freundii and Enterobacter cloacae in the bile of the patients. Additionally, the amount of bile endotoxin significantly correlated with the number of Enterobacteriaceae, especially E. coli. Our data indicate that Enterobacteriaceae might play essential role in the pathogenesis and/or progress of AC. This was verified in an in vivo model using a pathogenic E. coli isolated from one of the patients in guinea pigs and observed marked gallbladder inflammation and morphologic changes. This study thus provides insight which could be useful for the prevention, diagnosis and treatment of AC and related diseases by controlling the growth of Enterobacteriaceae to alleviate the infection. PMID:26025761

  20. Liver abscess in a female patient with chronic calculus cholecystitis and empyema of the gallbladder

    International Nuclear Information System (INIS)

    This is a report on a female patient aged 60 years of vague pain in the right lumbar region and heaviness in the right epigastrium, septic fever, accelerated ESR and leucocytosis. Diagnosis chronic calculus cholecystitis and liver abscess is made on the ground of conventional ultrasound and Doppler Ultrasound (Color - CFM), Pulse (PD) and power Doppler (PWD). In the differential diagnosis infected simple hydatid or parasitic cyst and liver carcinoma as well are considered. The absence of neoangiogenesis and vascularisation around the abscess formation direct the diagnostic discussion to pericholecystic liver abscess. The contrast CT study demonstrates chronic calculus cholecystitis and liver abscess involving IV and V hepatic segments. The diagnosis is confirmed intraoperatively. Historical diagnosis: gallbladder fibrosis, with heavily thickened wall, d choledochus narrowing, xantho-granulomatous cholecystitis and peri -cholecystitis. Description of the case reported on corroborates the differential diagnosis: difficulties faced inflammatory and neoplastic diseases of the gallbladder and surrounding hepatic structures, as well as the diagnosis relevance of the imaging methods of study. (authors)

  1. Acute intermittent porphyria caused by novel mutation in HMBS gene, misdiagnosed as cholecystitis

    Directory of Open Access Journals (Sweden)

    Alfadhel M

    2014-11-01

    Full Text Available Majid Alfadhel,1,3 Neam Saleh,2 Helal Alenazi,2 Henry Baffoe-Bonnie21Division of Genetics, Department of Pediatrics, 2Division of General Medicine, Department of Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi ArabiaBackground: Acute intermittent porphyria (AIP is an autosomal dominant neurovisceral inherited disorder due to a defect in the heme biosynthesis pathway. Misdiagnosis of the porphyrias is not uncommon.Case report: We present a case of a 26-year-old female with suspected acute cholecystitis, mental status changes, and seizures. Biochemical and molecular investigations confirmed the diagnosis of AIP by findings of elevated urinary porphobilinogen, 5-aminolevulinic acid, and total porphyrins. DNA molecular testing showed a novel heterozygous mutation (c. 760delC p.L254X in the exon11 of the HMBS gene. To the best of our knowledge, this is the first report of a misdiagnosis of AIP presenting with acute cholecystitis.Conclusion: Clinicians are alerted to consider the possibility of AIP in an adult presenting with an acute abdomen, features of cholecystitis, and neuropsychiatric manifestations.Keywords: porphyria, cholecystitis, acute abdomen, acute intermittent porphyria, HMBS gene, hydroxymethylbilane synthase

  2. Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: A Simple Score

    Directory of Open Access Journals (Sweden)

    Wael N. Yacoub

    2010-01-01

    Full Text Available The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point, heart rate > 90 beats/min (1 point, male (2 points, Leucocytosis > 13,000/mm3 (1.5 points, and ultrasound gallbladder wall thickness > 4.5 mm (1 point. The prevalence of gangrenous cholecystitis was 13% in the low-probability (0–2 points, 33% in the intermediate-probability (2–4.5 points, and 87% in the high probability category (>4.5 points. A cutoff score of 2 identified 31 (69% patients with no acute inflammation (PPV 90%. This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.

  3. Cholecystitis in a child with acquired immunodeficiency syndrome: ultrasonographic findings in a case of uncommon presentation during childhood

    International Nuclear Information System (INIS)

    We present the case of a boy with acquired immunodeficiency syndrome (AIDS) in whom ultrasound revealed the presence of a calculous cholecystitis. Abdominal ultrasound was essential in the initial diagnosis and the assessment of the response to treatment. This entity has rarely been reported in the pediatric radiology literature. In our patient, the cholecystitis may have been caused by infection, and the involvement of regional lymphatic obstruction in the pathogenesis is considered. (Author) 14 refs

  4. Comparison of operative time and length of hospital stay in laparoscopic cholecystectomy in acute verses chronic cholecystitis

    International Nuclear Information System (INIS)

    The laparoscopic surgery has opened a new era in the field of surgery. Currently, it is accepted as the gold standard in the treatment of symptomatic cholelithiasis. However, laparoscopic cholecystectomy (LC) performed for acute cholecystitis is technically difficult because of severe inflammatory adhesions and distortion of the biliary anatomy. The objective of this study was to compare the frequency, mean operative time and length of hospital stay in patients of acute and chronic cholecystitis undergoing laparoscopic cholecystectomy. Methods: This prospective comparative study was carried out in the department of General Surgery Jinnah Postgraduate Medical Centre (JPMC) Karachi, from March to September 2013. During this period 233 patients underwent laparoscopic cholecystectomy (54 cases of acute and 179 cases of chronic cholecystitis respectively). The patients who were pregnant, diagnosed with gall bladder mass on ultrasound, carcinoma gall bladder, acute pancreatitis, and those with co-morbid like diabetes mellitus/cardiovascular disorders were excluded. Result: A total of 233 patients were admitted for laparoscopic cholecystectomy. Fifty four (54) patients in Group A (acute cholecystitis) and 179 patients in Group B (chronic cholecystitis) with female: male 2.8:1 and 4:1 in Group A and B respectively. Operative time was longer for group A. Six cases of conversion to open procedure one (1) in Group A and 5 in Group B respectively. Conclusion: Laparoscopic cholecystectomy is safe and efficient for both acute and chronic cholecystitis. (author)

  5. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis

    Science.gov (United States)

    Nikfarjam, Mehrdad; Niumsawatt, Vachara; Sethu, Arun; Fink, Michael A; Muralidharan, Vijayaragavan; Starkey, Graham; Jones, Robert M; Christophi, Christopher

    2011-01-01

    Background: Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies. Methods: Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC. Results: A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P = 0.001), diabetes (19% vs. 10%; P = 0.049), temperature of >38 °C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P = 0.002), detection of muscle rigidity on examination (27% vs. 12%; P = 0.01) and greater elevations in white cell count (WCC) (13.4 × 109/l vs. 10.7 × 109/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P = 0.001), bilirubin (19 µmol/l vs. 17 µmol/l; P = 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P = 0.016) and creatinine (82 µmol/l vs. 74 µmol/l; P = 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0–14 days vs. median = 1 day, range: 0–10 days; P = 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P = 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P = 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P = 0.017), but this was not an independent risk factor on multivariate analysis. Conclusions: Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in

  6. Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

    Institute of Scientific and Technical Information of China (English)

    Chung-Hsu Lai; Hsin-Pai Chen; Te-Li Chen; Chang-Phone Fung; Cheng-Yi Liu; Shou-Dong Lee

    2005-01-01

    We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.

  7. Streptococcus agalactiae endocarditis presenting as acalculous cholecystitis in a previously well woman.

    LENUS (Irish Health Repository)

    Brewer, Linda

    2013-01-01

    This case report describes the unusual presentation of a previously very well woman with Streptococcus agalactiae endocarditis in the emergency department. History, examination and preliminary laboratory and radiological investigations supported a diagnosis of acalculous cholecystitis, for which she was given intravenous broad spectrum antimicrobial therapy. One day following admission, the patient deteriorated and became unresponsive. Subsequent MRI of the brain revealed multiple bihemispheric cerebral emboli and a large, mobile mitral valve thrombus was visualised on her transoesophageal echocardiogram. S agalactiae was cultured from venous blood samples and her antimicrobial cover was adjusted accordingly. Despite her presumed guarded prognosis, this patient made a remarkable recovery. To our knowledge, the association of S agalactiae endocarditis with acalculous cholecystitis has not been previously described.

  8. Pancreatic Heterotopia in the Gallbladder Associated with Chronic Cholecystitis: A Rare Combination

    Directory of Open Access Journals (Sweden)

    Mubarak Al-Shraim

    2010-09-01

    Full Text Available Context Pancreatic heterotopia is a rare pathologic entity, previously reported in the stomach, duodenum and jejunum. It is mostly asymptomatic and rarely gives rise to complications. Localization of pancreatic heterotopia in the gallbladder is extremely rare and can be associated with cholecystitis or cholecystolithiasis. Case report We herein describe a case of a 39-year-old man who presented with biliary type pain with ultrasonographic evidence of a gallbladder polyp. Laparoscopic cholecystectomy was performed with uneventful recovery. Pathologic examination of the gallbladder detected a heterotopic focus of pancreatic tissue in its wall, associated with chronic cholecystitis with no gallstones. Conclusion Pancreatic heterotopia of the gallbladder is a very rare entity with unknown clinical significance. Awareness of this condition may facilitate its recognition which may shed more light on its clinical significance

  9. Diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT

    International Nuclear Information System (INIS)

    The clinical and laboratory diagnosis of acute acalculous cholecystitis is difficult, and the reliability of various diagnostic imaging techniques has not been established. The results of several imaging procedures performed over a 6-year period on 56 patients with clinically suspected acute acalculous cholecystitis were evaluated retrospectively. Sonography and CT were both highly sensitive (92% and 100%, respectively) and specific (96% and 100%, respectively). Hepatobiliary scintigraphy was compromised by frequent false-positives; the result was a specificity of only 38%. Percutaneous bile aspiration was insufficiently sensitive (33%) for diagnosis. Sonography was as sensitive as hepatobiliary scintigraphy and was more specific in establishing the diagnosis. Because sonography is relatively inexpensive and can be performed at the bedside, it should be regarded as a satisfactory screening procedure. However, CT is a good alternative in an easily transported patient when other intraabdominal disease is suspected

  10. Churg-Strauss syndrome complicated by colon erosion,acalculous cholecystitis and liver abscesses

    Institute of Scientific and Technical Information of China (English)

    Msahiro Suzuki; Kazuo Nabeshima; Mitsukazu Miyazaki; Hitoshi Yoshimura; Shinsei Tagawa; Katsuya Shiraki

    2005-01-01

    We report on a case of Churg-Strauss syndrome (CSS)with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone,after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission.

  11. Membrane erythrocyte proteins changes under noncalculous cholecystitis and crohn’s disease

    OpenAIRE

    M. V. Gorelaya; Sergienko, T.I.; I. V. Klenina; O. M. Stadnik; N. I. Shtemenko

    2010-01-01

    The aim of the investigation was to reveal the changes in erythrocytes’ proteins from human blood under gastroenterological pathologies, namely noncalculous cholecystitis and Crohn’s disease. The erythrocyte was used as a model system. The PAAG electrophoresis with SDSNa method was used. Erythrocyte membrane proteins quantitative changes were observed in patient groups under liver and intestines diseases. High molecular weight proteins content (spectrines α and β) was reduced, but any changes...

  12. Transcatheter Arterial Embolization of Cystic Artery Pseudoaneurysm in Acalculous Cholecystitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyung Ook; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University College of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-04-15

    A pseudoaneurysm of the cystic artery is a rare complication of cholecystitis, and is manifested by hemobilia or hematemesis. An early diagnosis is required for the successful treatment by cholecystectomy and ligation of the cystic artery. Herein, we report a case of a pseudoaneurysm of the cystic artery diagnosed by color Doppler ultrasonography and CT, and successfully treated by transcatheter arterial embolization with N-butyl cyanoacrylate in a high-risk surgical patient.

  13. Utility of morphine-augmented hepatobiliary scanning in evaluation of acute cholecystitis

    International Nuclear Information System (INIS)

    The authors review experience with morphine sulfate-augmented cholescintigraphy in suspected acute cholecystitis. MS has been recommended to reduce study time while maintaining accuracy of hepatobiliary scans. Patients received 5-mCi injections of Tc-99m mebrofenin and imaged on a low-field-view gamma camera. In 32 patients with nonvisualization of the gallbladder at 30-40 minutes after injection, 2 mg MS was given intravenously, and imaging continued for an additional 30 minutes

  14. Calculous cholecystitis and hepatic cirrhosis as sonographic co-confounders for gallbladder evaluation

    International Nuclear Information System (INIS)

    To compare the sonographic features of gallbladder in symptomatic calculous cholecystitis and cirrhosis with silent cholelithiasis. Two hundred adult patients of both genders were studied after dividing into two groups. Group A had clinically suspected calculous cholecystitis and group B had patients from outpatient department and medical wards with clinical diagnosis of cirrhosis, with incidentally diagnosed cholelithiasis. The sonographic features of gallbladder were determined and compared. Significance was computed for the sonographic variables including morphological features as well as demographic features by Chi square and t-test, keeping significance at p<.001 Group A (with calculous cholecystitis) had 100 patients with mean age of 47+-3.2 years with 71 females. Group B (cirrhosis with silent cholelithiasis) comprised of 100 patients with mean age of 38 +-4.2 years with 58 females. Among them, 54 were hepatitis C virus(HCV) positive, 38 had positive serology for Hepatitis B virus (HBV) positive and 08 had positive serology for both. Both groups had more multiple than single calculi. The average size of the largest calculus was 1.5 cm in group A and 1.2 cm in the group B. The mean gallbladder wall thickness was greater in cirrhotic than in the other group (4.9 vs. 4.2 cm, p-value 0.7). Gallbladder wall irregularity was significantly more common in group B than in group A (57 vs. 25 mm, p=0.001). The pericholecystic fluid layer thickness was significantly greater in the cirrhotic group (18.5 +7.1 vs. 5.7 +1.8 mm, p<0.001). Positive sonographic Murphy's sign was positive in 89% calculous cholecystitis cases and 77% of the cirrhotic group. (author)

  15. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    Chen-Wang Chang; Wen-Hsiung Chang; Ching-Chung Lin; Cheng-Hsin Chu; Tsang-En Wang; Shou-Chuan Shih

    2009-01-01

    AIM: To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis. METHODS: The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct (CBD) stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed. RESULTS: In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 (51.0%) had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 (41.2%) had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitis in the group undergoing urgent surgery (total 74 patients), the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin (1.14 ± 1.27 mg/dL vs 2.66 ± 1.97 mg/dL, P < 0.001) and white cell count (9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018). CONCLUSION: Acute hepatocel lular injury in cholelithiasis and cholecystitis without choledocholithiasis is mi ld and t ransient . Hyperbi l irubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

  16. Thirty Cases of Chronic Cholecystitis Treated by Acupuncture and Oral Adiministration of Da Chai Hu Tang

    Institute of Scientific and Technical Information of China (English)

    Zhou Shenghong

    2008-01-01

    @@ Chronic cholecystitis is a common disorder of the digestive system.with the symptoms of distension or vague pain in the right hypochondriac region,dry mouth with bitter taste.poor appetite,and anorexia for greasy food.Tlraditional Chinese medicine may show better erects than that of western medicine.So,acupuncture and herbal medication were adopted for the treatment.with the erects compared to the therapy with herbal medicine used alone.

  17. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines

    OpenAIRE

    Miura, Fumihiko; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Wada, Keita; Hirota, Masahiko; Nagino, Masato; Tsuyuguchi, Toshio; Mayumi, Toshihiko; Yoshida, Masahiro; Steven M. Strasberg; Henry A. Pitt; Belghiti, Jacques; de Santibanes, Eduardo; Gadacz, Thomas R.

    2007-01-01

    Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performe...

  18. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, Adam A.; Prassopoulos, Panos; Petinarakis, Ioannis; Gourtsoyiannis, Nicholas C. [Department of Radiology, University Hospital of Heraklion, Medical School of Crete, Crete (Greece); Sanidas, Elias; Tsiftsis, Dimitrios [Department of Surgical Oncology, University Hospital of Heraklion, Medical School of Crete (Greece); Chrysos, Emmanuel; Chalkiadakis, Georgios [Department of General Surgery, University Hospital of Heraklion, Medical School of Crete (Greece)

    2002-07-01

    Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute cholecystitis. All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score {>=}12. Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients (95.2%) who comprised the PC group. Sixty patients were conservatively treated (CO group). One patient died after unsuccessful PC (1.6%). Resolution of symptoms occurred in 54 of 63 patients (86%). Eleven patients (17.5%) died either of ongoing sepsis (n=6) or severe underlying disease (n=5) within 30 days. Seven patients (11%) were operated on because of persisting symptoms (n=3), catheter dislodgment (n=3), or unsuccessful PC (n=1). Cholecystolithotripsy was performed in 5 patients (8%). Elective surgery was performed in 9 cases (14%). No further treatment was needed in 32 patients (51%). In the CO group, 52 patients (87%) fully recovered and 8 patients (13%) died of ongoing sepsis within 30 days. All successfully treated patients showed clinical improvement during the first 3 days of treatment. Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment. Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment, to critically ill intensive care unit patients, or to candidates for percutaneous cholecystolithotripsy. (orig.)

  19. Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2007-10-01

    Full Text Available Abstract Background Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study. Design A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008 Organisation/Responsibility The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and the Good Clinical Practice guideline (GCP. Trial Registration ClinicalTrials.gov NCT00447304

  20. Cholesterolosis and chronic cholecystitis: comperative analysis of state of gall-bladder wall.

    Directory of Open Access Journals (Sweden)

    Shcherbinina M.B.

    2007-01-01

    Full Text Available The mechanisms of lipid infiltration of gall-bladder (GB wall in case of cholesterolosis are not known now. The aim of this work was studying the morphologic peculiarities of forming cholesterolosis comparing with state of chronic cholecystitis by anatomical parts of GB using system stereometric analysis. There was performed the histological examination of 2 groups of GB removed by standart laparoscopic cholecystectomy due to cholecystolithiasis. The first group contains GB with diffuse reticular form of cholesterolosis (n=28, the second group contains GB with chronic inflammation without signs of activation (n=21. Using G.G.Avtandilov’s recommendations there were determined the volume interrelations of stroma and epithelium (stromal-epithelial index, cellular content of lamina propria of GB mucosa (neutrophyles, eosinophyles, lymphocytes, plasmocytes, xantom cells, lymphocytes-plasmocytes index. The results were evaluated by t-criterion of Student, changes were statistically evident if р<0,05. There was also used the correlative analysis with estimation of correlation coefficient t. There was established that in case of GB cholesterlolsis the morphologic changes in GB wall had dystrophic character and might accompany with not marked sclerotic changes in mucosa. In case of chronic cholecystitis the inflammatory process lead to atrophic-sclerotic changes. In case of cholecystolithiasis with diffuse reticular form of GB cholesterolosis or chronic cholecystitis the prevalent localization of pathology is corpus and fundus of organ.

  1. A trial of surgical treatment in a dog suffering from severe cholecystitis associated with biliary calculus

    International Nuclear Information System (INIS)

    A miniature dachshund, 5 years and 3 months of age, with a history of cholecystitis associated with biliary calculus that had developed one year previously, presented with anorexia and vomiting. A series of examinations, including CT imaging by drip infusion cholangiography (DIC-CT), revealed that no bile was flowing into the gallbladder. Thickening of the gallbladder wall and a biliary calculus occupying the lumen of the gallbladder with a laminated internal structure were also found. Based on the results of a detailed examination, the gallbladder was extracted. E. coli and Enterococcus sp. were isolated by microbiological tests inside the gallbladder and around its outer wall. The findings of drug susceptibility tests indicated that the E. coli could be a substrate-specific, broad spectrum, beta-lactamase-producing bacterium. In this case, administration of faropenem sodium was initiated before the surgery and the postoperative course was good. DIC-CT imaging can properly visualize the biliary duct system, and an explanation that relied on these images was useful for the dog's owner. It was thought that surgical treatment should actively be considered to prevent a relapse of cholecystitis in cases involving cholecystitis associated with biliary calculi

  2. Male gender and sonographic gall bladder wall thickness: important predictable factors for empyema and gangrene in acute cholecystitis

    International Nuclear Information System (INIS)

    Objective: To underline the status of male gender and gall bladder wall thickness as significant risk factors for acute cholecystitis complications. Methods: The retrospective study, with purposive sampling of the patients of acute cholecystits in age above 18 years, who were operated within 10 days of onset of symptoms, was conducted at the Department of Surgery, Dow University Hospital, Karachi, by reviewing the patients' medical record from March 2010 to August 2012. Correlation of incidence of acute cholecystitis complications (empyema and gangrene) to male gender and to the sonographic gall bladder wall thickness more than 4.5mm was analysed using SPSS 16. Result: Out of 62 patients, 8 (13%) patients had gangrene while 10 (16.12%) had empyema. Overall, there were 21 (33.87%) males in the study. Ten (47.6%) of the male patients developed empyema or gangrene of the gall bladder as a complication of acute cholecystitis. Of the 41 (66.12%) female patients, only 8 (19.5%) developed these complications. There were 22 (35.48%) cases of gall bladders with sonographic wall thickness more than 4.5mm who were operated for acute cholecystitis. Of them, 16 (72.7%) had empyema or gangrene. Conclusion: Male gender and sonographic gall bladder wall thickness more than 4.5mm were statistically significant risk factors for suspicion of complicated acute cholecystitis (empyema/gangrene) and by using these risk factors, we can prioritise patients for surgery in the emergency room. (author)

  3. Another Report of Acalculous Cholecystitis in a Greek Patient with Infectious Mononucleosis: A Matter of Luck or Genetic Predisposition?

    Science.gov (United States)

    Koufakis, Theocharis; Gabranis, Ioannis

    2016-01-01

    We here report a case of a young, male patient who presented with jaundice and was diagnosed with acalculous cholecystitis during the course of a primary Epstein-Barr Virus (EBV) infection. The coexistence of cholestatic hepatitis and acalculous cholecystitis in patients with infectious mononucleosis is extremely uncommon and only few cases can be found in the literature. Moreover, almost one-fourth of the total reports of this rare entity are coming from Greece. Whether this is a result of physicians' high index of suspicion due to previous reports or a consequence of genetic predisposition is an issue that deserves further investigation in the future. More studies are required in order to clarify the pathophysiological and genetic backgrounds that connect acalculous cholecystitis and EBV infection. PMID:26885417

  4. Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: Added value of diffusion-weighted MRI

    International Nuclear Information System (INIS)

    Aim: To evaluate the benefit of diffusion-weighted imaging (DWI) in differentiating xanthogranulomatous cholecystitis from the wall-thickening type of gallbladder cancer. Materials and methods: This retrospective study was approved by the institutional review board. Fourteen patients with xanthogranulomatous cholecystitis and 19 patients with the wall-thickening type of gallbladder cancer were included. Qualitative (visual diffusion restriction compared to liver parenchyma) and quantitative [apparent diffusion coefficient (ADC)] analyses were performed. Conventional MRI findings including dynamic enhancement pattern between the two groups were also analysed. Two observers independently reviewed conventional magnetic resonance imaging (MRI) images and subsequently reviewed combined conventional MRI and DWI images. Pairwise comparison of the receiver operating characteristic (ROC) curves was used to compare diagnostic performances. Results: In conventional MRI findings, xanthogranulomatous cholecystitis showed significant continuity of enhancing mucosal line [79% (11/14) versus 26% (5/19), p = 0.003] and intramural T2-high signal intensity [64% (9/14) versus 21% (4/19), p = 0.012] compared to the wall-thickening type of gallbladder cancer. The enhancement pattern of gallbladder cancer compared to liver parenchyma showed earlier onset than that of xanthogranulomatous cholecystitis (p = 0.001). Diffusion restriction was more frequently seen in the wall-thickening type of gallbladder cancer (68%, 13/19) than in xanthogranulomatous cholecystitis (7%, 1/14; p −3 mm2/s versus 1.076 × 10−3 mm2/s, p = 0.005). Diagnostic performance [area under ROC curve (Az)] of both observers improved significantly after additional review of DWI; Az improved from 0.737 to 0.930 (p = 0.027) for observer 1 and from 0.675 to 0.938 (p = 0.008) for observer 2. Conclusion: Addition of DWI to conventional MRI improves discrimination between xanthogranulomatous cholecystitis and the wall

  5. Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis.

    Science.gov (United States)

    Özkaya, Ahmet Kağan; Güler, Ekrem; Çetinkaya, Ahmet; Karakaya, Ali Erdal; Göksügür, Yalçın; Katı, Ömer; Güler, Ahmet Gökhan; Davutoğlu, Mehmet

    2016-05-01

    Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis. PMID:27077617

  6. Immunoglobulin G4-related sclerosing cholecystitis presenting as gallbladder cancer: a case report

    OpenAIRE

    Takahashi, Kodai; Ito, Hideto; Katsube, Toshio; Tsuboi, Ayaka; Hashimoto, Masatoshi; Ota, Emi; Mita, Kazuhito; Asakawa, Hideki; Hayashi, Takashi; Fujino, Keiichi; Okamoto, Sigeru

    2015-01-01

    Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic inflammatory syndrome, and an understanding of its characteristics is currently evolving. IgG4-related cholecystitis is a manifestation of IgG4-related sclerosing disease in the gallbladder. This case report describes the clinical, radiographic, and histopathological findings in a young male patient who presented with a synchronous mass in the gallbladder. Serum levels of IgG4 and the IgG4/IgG ratio were normal, and there was n...

  7. 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.

  8. Chilaiditi Sign on 99mTc-Mebrofenin Hepatobiliary Scan Mimicking Bile Leak in Acute Cholecystitis.

    Science.gov (United States)

    Pascarella, Suzanne; Dadparvar, Simin

    2016-06-01

    Chilaiditi sign is the incidental radiologic finding of intestinal interposition between the liver and diaphragm, whereas Chilaiditi syndrome describes the presence of accompanying clinical symptoms including abdominal pain, constipation, vomiting, and respiratory distress. We describe a case of radiotracer accumulation over the liver dome on Tc-mebrofenin hepatobiliary scan performed on a 72-year-old man with acute cholecystitis mimicking a bile leak. However, chest radiograph and CT revealed intestinal hepatodiaphragmatic interposition. This case illustrates the importance of being familiar with the scintigraphic appearance of the Chilaiditi sign and correlating abnormal nuclear medicine scan findings with other available radiologic modalities. PMID:26859214

  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. The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic study: Multicenter randomized, double-blind, controlled trial of laparoscopic (LC versus open (LTC surgery for acute cholecystitis (AC in adults

    Directory of Open Access Journals (Sweden)

    Bassi Uberto A

    2008-01-01

    Full Text Available Abstract Background In some randomized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy. Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery. Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not standardized. These studies also do not report all eligible patients and are not double blinded. Design The present study project is a prospective, randomized investigation. The study will be performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy, a large teaching institutions, with the participation of all surgeons who accept to be involved in (and together with other selected centers. The patients will be divided in two groups: in the first group the patient will be submitted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be submitted to laparotomic cholecystectomy within 72 hours after the diagnosis. Trial Registration TRIAL REGISTRATION NUMBER ISRCTN27929536 – The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic study. A multicentre randomised, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis in adults.

  11. LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS DUE TO CHOLELITHIASIS IN GERIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    D. Vasincu

    2007-07-01

    Full Text Available This study is focused on the results of laparoscopic cholecystectomy for acute cholecystitis due to cholelithiasis in geriatric patients. The records of all patients from „St. Joan” Emergency Hospital Iaşi from January 2001 to December 2005 and from General Surgery Clinic in S. Orsola - M. Malpighi Hospital Bologna – Italia from January 2003 to December 2004 who undergo cholecystectomy were reviewed. The entire series consists of 557 patients. This report identifies 161 patients who were aged 65 years or older at the time of laparoscopic cholecystectomy. The results are reported in three progressive age groups: 65 to 74, 75 to 84, and over 85 years. At 101 geriatric patients was practiced laparoscopic cholecystectomy. Gallstones were present in all patients. In this series of laparoscopic cholecystectomy, 32.6% had an emergency procedure and the remainder had an elective or semielective procedure. The conversion rate was 5.6%. 74.2% of the patients were discharged home after 3-5 days of postoperative observation. Laparoscopic cholecystectomy is a safe procedure and should be recommended for all geriatric patients who have acute cholecystitis due to cholelithiasis before the development of complications.

  12. Tight junction proteins in gallbladder epithelium: different expression in acute acalculous and calculous cholecystitis.

    Science.gov (United States)

    Laurila, Jouko J; Karttunen, Tuomo; Koivukangas, Vesa; Laurila, Päivi A; Syrjälä, Hannu; Saarnio, Juha; Soini, Ylermi; Ala-Kokko, Tero I

    2007-06-01

    There is a paucity of information of tight junction (TJ) proteins in gallbladder epithelium, and disturbances in the structure of these proteins may play a role in the pathogenesis of acute acalculous cholecystitis (AAC) and acute calculous cholecystitis (ACC). Using immunohistochemistry, we investigated the expression of TJ proteins claudin-1, -2, -3, and -4, occludin, zonula occludens (ZO-1), and E-cadherin in 9 normal gallbladders, 30 gallbladders with AAC, and 21 gallbladders with ACC. The number of positive epithelial and endothelial cells and the intensity of the immunoreaction were determined. Membrane-bound and cytoplasmic immunoreactivities were separately assessed. We found that TJ proteins were uniformly expressed in normal gallbladder epithelium, with the exception of claudin-2, which was present in less than half of the cells. In AAC, expression of cytoplasmic occludin and claudin-1 were decreased, as compared with normal gallbladder. In ACC, expression of claudin-2 was increased, and expression of claudin-1, -3, and -4, occludin, and ZO-1 were decreased, as compared with normal gallbladder or AAC. We conclude that there are significant differences in expression of TJ proteins in AAC and ACC, supporting the idea that AAC represents a manifestation of systemic inflammatory disease, whereas ACC is a local inflammatory and often infectious disease. PMID:17283368

  13. Acute acalculous cholecystitis in a Lebanese girl with primary Epstein-Barr viral infection.

    Science.gov (United States)

    Majdalani, Marianne; Milad, Nadine; Sahli, Zeyad; Rizk, Sarah

    2016-01-01

    Acute acalculous cholecystitis (AAC) constitutes 5-10% of all cases of cholecystitis in adults, and is even less common in children. The recent literature has described an association between primary Epstein-Barr virus (EBV) infection and AAC, however, it still remains an uncommon presentation of the infection. Most authors advise that the management of AAC in patients with primary EBV infection should be supportive, since the use of antibiotics does not seem to alter the severity or prognosis of the illness. Furthermore, surgical intervention has not been described as necessary or indicated in the management of uncomplicated AAC associated with EBV infection. We report a case of a 16-year-old Lebanese girl with AAC associated with primary EBV infection. She presented to the emergency department, with high-grade fever, fatigue, vomiting and abdominal pain. Liver enzymes were elevated with a cholestatic pattern, and imaging confirmed the diagnosis of AAC. She was admitted to the regular floor, and initial management was conservative. Owing to persistence of fever, antibiotics were initiated on day 3 of admission. She had a smooth clinical course and was discharged home after a total of 9 days, with no complications. PMID:27090538

  14. [A Case of Acute Acalculous Cholecystitis During Infectious Mononucleosis Caused by the Epstein-Barr Virus in a Young Woman].

    Science.gov (United States)

    Ono, Shiro; Kobayashi, Tadanao; Nishio, Kenji

    2016-05-01

    Infection with the Epstein-Barr virus (EBV) is a common disease and is mainly asymptomatic during childhood, whereas infectious mononucleosis with clinical signs such as fever, pharyngitis, lymphadenopathy and hepatosplenomegaly often occurs in adolescents and adults with primary infection. Acalculous cholecystitis has been reported as a rare complication. We report herein a case of acalculous cholecystitis accompanied by infectious mononucleosis by EBV, which was treated successfully by medical treatment. A 33-year-old woman who had been admitted by fever, pharyngitis and lymphadenopathy developed a right upper quadrant pain, that was diagnosed as acalculous cholecystitis based on an imaging study. Antibiotic treatment did not resolve the symptoms, and surgical intervention was considered. We diagnosed her as having infectious mononucleosis based on a typical physical presentation and seropositivity for the EBV viral capsid antigen, suggesting that the acalculous cholecystatis might have been a complication of the EBV infection. After the administration of glucocorticoid and acyclovir, the patient became afebrile and the abdominal pain disappeared. Though acalculous cholecystitis rarely accompanies infectious mononucleosis caused by EBV, clinicians should be aware of this complication to avoid unnecessary cholecystectomy. PMID:27529970

  15. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  16. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Gurusamy, K; Samraj, K; Gluud, C; Wilson, E; Davidson, B R

    2010-01-01

    BACKGROUND:: In many countries laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute episode has settled because of the anticipated increased risk of morbidity and higher conversion rate from laparoscopic to open cholecystectomy. METHODS:: A systematic review was...... performed with meta-analysis of randomized clinical trials of early laparoscopic cholecystectomy (ELC; performed within 1 week of onset of symptoms) versus delayed laparoscopic cholecystectomy (performed at least 6 weeks after symptoms settled) for acute cholecystitis. Trials were identified from The.......03) days). CONCLUSION:: ELC during acute cholecystitis appears safe and shortens the total hospital stay. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd....

  17. Outcomes of Xanthogranulomatous cholecystitis in laparoscopic era: A retrospective Cohort study

    Directory of Open Access Journals (Sweden)

    Abdul Rehman Alvi

    2013-01-01

    Full Text Available Introduction: Xanthogranulomatous cholecystitis (XGC is a rare variant of cholecystitis and reported incidence of XGC varies from different geographic region from 0.7% -9%. Most of the clinicians are not aware of the pathology and less evidence is available regarding the optimal treatment of this less common form of cholecystitis in the present era of laparoscopic surgery. Materials and Methods: A retrospective cohort study was conducted in a tertiary care university hospital from 1989 to 2009. Histopathologically confirmed XGC study patients (N=27 were compared with non-Xanthogranulomatous cholecystitis (NXGC control group (N=27. The outcomes variables were operative time, complication rate and laparoscopic to open cholecystectomy conversion rate. The study group (XGC was further divided in to three sub groups; group I open cholecystectomy (OC, laparoscopic cholecystectomy (LC and laparoscopic converted to open cholecystectomy (LCO for comparative analysis to identify the significant variables. Results: During the study period 6878 underwent cholecystectomy including open cholecystectomy in 2309 and laparoscopic cholecystectomy in 4569 patients. Histopathology confirmed xanthogranulomatous cholecystitis in 30 patients (0.43% of all cholecystectomies and 27 patients qualified for the inclusion criterion. Gallbladder carcinoma was reported in 100 patients (1.45% during the study period and no association was found with XGC. The mean age of patients with XGC was 49.8 year (range: 29-79, with male to female ratio of 1:3. The most common clinical features were abdominal pain and tenderness in right hypochondrium. Biliary colic and acute cholecystitis were the most common preoperative diagnosis. Ultrasonogram was performed in all patients and CT scan abdomen in 5 patients. In study population (XGC, 10 were patients in group I, 8 in group II and 9 in group III. Conversion rate from laparoscopy to open was 53 % (n=9, surgical site infection rate of 14

  18. Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis.

    Science.gov (United States)

    Bokhari, S; Walsh, U; Qurashi, K; Liasis, L; Watfah, J; Sen, M; Gould, S

    2016-02-01

    Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (preasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (pfinancial rewards for a busy district general hospital. PMID:26673047

  19. Membrane erythrocyte proteins changes under noncalculous cholecystitis and crohn’s disease

    Directory of Open Access Journals (Sweden)

    M. V. Gorelaya

    2010-10-01

    Full Text Available The aim of the investigation was to reveal the changes in erythrocytes’ proteins from human blood under gastroenterological pathologies, namely noncalculous cholecystitis and Crohn’s disease. The erythrocyte was used as a model system. The PAAG electrophoresis with SDSNa method was used. Erythrocyte membrane proteins quantitative changes were observed in patient groups under liver and intestines diseases. High molecular weight proteins content (spectrines α and β was reduced, but any changes were not registered under the Crohn’s disease. Low molecular weight proteins content (anion-transporting protein and protein band 4.5 increased considerably as compared with a control (healthy people group. The structure of erythrocytes’ membrane changed, that led to disturbance of function of cytoskeleton proteins. The research results give more wide explanations of the pathologies genesis.

  20. Ultrasonographic and computed tomographic findings of hemorrhagic cholecystitis; report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bum Soo; Byun, Jae Young; Shinn, Kyung Sub [Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Jong Woo [Kangnung Dongin Hospital, Kangnung (Korea, Republic of)

    1996-01-01

    Hemorrhagic cholecystitis(HC) is a rare complication of gallbladder(GB) disease characterized by mucosal and intraluminal hemorrhage of the GB. We report ultrasonographic(US) and computed tomographic(CT) findings of two cases of HC. Hemorrhagic fluid filled in the inflamed GB lumen was initially seen as homogeneous hyperdense and hyperattenuated lesion on both US and CT, respectively. As resolution of the hematoma and gangrenous change of the GB wall progress, US showed inhomogeneous mixed echogenic lesion in the GB having partially indistinct border, mimicking an invasive mass. At this stage, CT still showed homogeneous hyperdense hematoma and a small amount of fluid in the GB, without evidence of contrast enhancement.

  1. Acute acalculous cholecystitis by Epstein-Barr virus infection: a rare association

    Directory of Open Access Journals (Sweden)

    Liliana Branco

    2015-12-01

    Full Text Available Acute acalculous cholecystitis (AAC is a rare complication of Epstein Barr virus (EBV infection, with only a few cases reported among pediatric population. This clinical condition is frequently associated with a favorable outcome and, usually, a surgical intervention is not required. We report a 16-year-old girl who presented with AAC following primary EBV infection. The diagnosis of AAC was documented by clinical and ultrasonographic examination, whereas EBV infection was confirmed serologically. A conservative treatment was performed, with a careful monitoring and serial ultrasonographic examinations, which led to the clinical improvement of the patient. Pediatricians should be aware of the possible association between EBV and AAC, in order to offer the patients an appropriate management strategy.

  2. Comparison of morphine-augmented cholescintigraphy and US in acute cholecystitis

    International Nuclear Information System (INIS)

    This paper determines the relative efficacy of morphine-augmented cholescintigraphy (MCS) and gallbladder ultrasonography (US) in diagnosing acute cholecystitis (AC). The authors conducted a retrospective study of 33 patients who had undergone both MCS and US. Morphine sulfate (0.04 mg/kg) was administered intravenously 40-60 minutes after 185-296 MBq of Tc-99m mebrofenin whenever small bowel, but not gallbladder 9GB), was visualized. MCS was considered positive for AC whenever GB nonvisualization persisted for an additional 2 hours. US criteria for AC were distended GB containing calculi and right upper quadrant tenderness. Final diagnoses were established clinically in 16 patients and by surgical pathology in 17

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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. Ectopic pancreas in the gallbladder with recurrent cholecystitis and mimicking biliary pancreatitis: A case report

    Institute of Scientific and Technical Information of China (English)

    CUI Yan; ZHOU Jin-lian; JI Min; ZHANG Jian-zhong; LI Cheng-lin

    2005-01-01

    Ectopic pancreas is a rare congenital malformation with pancreatic tissue in an aberrant location and not contiguous with the main gland. Patients suffering from ectopic pancreas usually have lesions in the stomach or duodenum[1,2]. Ectopic pancreatic tissue in the gallbladder is very rare, and only several cases have been reported[3-6]. We report one case of a 33-year-old man with ectopic pancreas presenting as repeatedly colic pain in the right upper quadrant of abdomen. He was first diagnosed as recurrent cholecys titis accompanied by biliary pancreatitis, but surgical pathology proved he suffered from cholecystitis and ectopic pancreas in the gallbladder wall, and the laparoscopic cholecystectomy led to relief.

  6. Acute cholecystitis

    Science.gov (United States)

    ... SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and ... DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and ...

  7. Laparoscopic Cholecystectomy for Severe Acute Cholecystitis in a Patient with Situs Inversus Totalis and Posterior Cystic Artery

    Directory of Open Access Journals (Sweden)

    Theodoros E. Pavlidis

    2008-01-01

    Full Text Available Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.

  8. CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Shuto, R.; Kiyosue, H.; Komatsu, E.; Matsumoto, S.; Mori, H. [Oita Medical Univ. (Japan). Dept. of Radiology; Kawano, K. [Oita Medical Univ. (Japan). Dept. of First Surgery; Kondo, Y.; Yokoyama, S. [Oita Medical Univ. (Japan). Dept. of First Pathology

    2004-03-01

    The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT (n=13) and MRI (n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.

  9. Amine functionalization of cholecyst-derived extracellular matrix with generation 1 PAMAM dendrimer.

    LENUS (Irish Health Repository)

    Chan, Jeffrey C Y

    2008-02-01

    A method to functionalize cholecyst-derived extracellular matrix (CEM) with free amine groups was established in an attempt to improve its potential for tethering of bioactive molecules. CEM was incorporated with Generation-1 polyamidoamine (G1 PAMAM) dendrimer by using N-(3-dimethylaminopropyl)-N\\'-ethylcarbodiimide and N-hydroxysuccinimide cross-linking system. The nature of incorporation of PAMAM dendrimer was evaluated using shrink temperature measurements, Fourier transform infrared (FTIR) assessment, ninhydrin assay, and swellability. The effects of PAMAM incorporation on mechanical and degradation properties of CEM were evaluated using a uniaxial mechanical test and collagenase degradation assay, respectively. Ninhydrin assay and FTIR assessment confirmed the presence of increasing free amine groups with increasing quantity of PAMAM in dendrimer-incorporated CEM (DENCEM) scaffolds. The amount of dendrimer used was found to be critical in controlling scaffold degradation, shrink temperature, and free amine content. Cell culture studies showed that fibroblasts seeded on DENCEM maintained their metabolic activity and ability to proliferate in vitro. In addition, fluorescence cell staining and scanning electron microscopy analysis of cell-seeded DENCEM showed preservation of normal fibroblast morphology and phenotype.

  10. Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case.

    Science.gov (United States)

    Gomes, Maria Miguel; Antunes, Henedina; Lobo, Ana Luísa; Branca, Fernando; Correia-Pinto, Jorge; Moreira-Pinto, João

    2016-01-01

    A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection. PMID:27200203

  11. Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case

    Directory of Open Access Journals (Sweden)

    Maria Miguel Gomes

    2016-01-01

    Full Text Available A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy’s sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy’s sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6 by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160 for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.

  12. Comparison of accuracy of sup(99m)Tc-pyridoxylidene glutamate scanning with oral cholecystography and ultrasonography in diagnosis of acute cholecystitis

    International Nuclear Information System (INIS)

    A prospective study of 116 patients admitted as emergencies with a clinical diagnosis of acute cholecystitis or biliary colic showed that the best investigation for confirming a diagnosis of acute cholecystitis was sup(99m)Tc-pyridoxylidene1 glutamate (PG) scanning. Its sensitivity was 99% and its specificity 86%, whereas those of oral cholecystography were 75% and 82% respectively, and those of ultrasonography were 54% and 62%, respectively. However, estimation of plasma liver enzymes was essential to exclude acute hepatitis before proceeding to early cholecystectomy. (author)

  13. Value of Ultrasonography in the Diagnosis of Cholecystitis%胆囊炎的超声诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐巧梅; 幸依良; 吴慧凤

    2013-01-01

      目的:对超声在胆囊炎诊断中的应用价值进行评价分析,为今后的临床诊断工作提供可靠的参考依据.方法:对62例胆囊炎患者进行超声检查,并对比分析超声检查结果与病理结果的符合情况.结果:超声检查与病理结果符合率达98.39%,且胆囊大小、囊壁厚度以及胆汁透声状态等观察指标在两种检查方法间均不存在显著差异(P>0.05).结论:超声检查在胆囊炎诊断中具有较高的准确性,与病理结果符合率高,值得关注.%Objective: To evaluate the value of ultrasonography in the diagnosis of cholecystitis analysis, to provide a reliable refer-ence for future clinical diagnostic work. Methods: 62 patients with cholecystitis, ultrasound, and comparative analysis of the compli-ance of the ultrasonographic findings and pathologic results. Results: Pathology results in ultrasonography was in line with the rate of 98.39%. Outcome measures, including Gallbladder size, wall thickness, and bile acoustically transparent state, was not exist sig-nificant difference between the two methods (P>0.05). Conclusion: Ultrasonography in the diagnosis of cholecystitis has a higher ac-curacy rate, which is worthy of attention with the higher coincidence rate of pathology results.

  14. Buttressing staples with cholecyst-derived extracellular matrix (CEM) reinforces staple lines in an ex vivo peristaltic inflation model.

    LENUS (Irish Health Repository)

    Burugapalli, Krishna

    2008-11-01

    Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model.

  15. Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goshima, Satoshi, E-mail: gossy@par.odn.ne.j [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Chang, Samuel; Wang, Jin Hong [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Kanematsu, Masayuki [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194 (Japan); Department of Radiology Services, Gifu University School of Medicine, 1-1- Yanagido, Gifu 501-1194 (Japan); Bae, Kyongtae T. [Department of Radiology, University of Pittsburgh School of Medicine, 3362 Fifth Ave., Pittsburgh, PA15213 (United States); Federle, Michael P. [Department of Radiology, University of Pittsburgh Medical Center, Lothrop St., Pittsburgh, PA 15213 (United States); Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5105 (United States)

    2010-06-15

    Purpose: To retrospectively evaluate CT findings of xanthogranulomatous cholecystitis (XGC) and to measure diagnostic performance for distinguishing it from gallbladder (GB) cancer. Methods and materials: Our institutional review board approved this retrospective study. Three blinded radiologists, first independently and then in consensus, retrospectively evaluated postcontrast CT images of 35 patients with histopathologically proved XGC and GB cancer, all of whom subsequently had cholecystectomy. These included 18 patients with XGC (13 male, 5 female; age range, 35-84, mean 63 years) and 17 with GB cancer (6 male, 11 female; age range, 45-95, mean 69). Differences in CT findings between XGC and GB cancer and diagnostic performances for each CT finding were calculated. Sensitivity, specificity, and accuracy were calculated for each radiologist and observer performance was also determined by receiver-operating-characteristic curve analysis. Results: Five CT findings showed significant differences between XGC and GB cancer. Sensitivity, specificity, and accuracy of each finding for the differentiation of XGC were 89%, 65%, 77% with diffuse GB wall thickening, 67%, 82%, 74% with a continuous mucosal line, 61%, 71%, 66% with intra-mural hypo-attenuated nodules, 72%, 77%, 74% with absence of macroscopic hepatic invasion, and 67%, 71%, 69% with absence of intra-hepatic bile duct dilatation, respectively. When at least three of these five CT findings were observed in combination, sensitivity, specificity, and accuracy were 83%, 100% and 91%, respectively. Sensitivities, specificities and Az values for the differentiation of XGC from GB cancer were 83%, 88%, 0.94 for reader 1, 78%, 88%, 0.93 for reader 2, and 78%, 82%, 0.84 for reader 3. Conclusions: The combination of three of the five CT findings that are common with XGC can provide excellent accuracy for the differentiation of XGC and GB cancer.

  16. CT and MR features of xanthogranulomatous cholecystitis: An analysis of consecutive 49 cases

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Feng [Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016 (China); Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Lu, Pu-Xuan [Department of Radiology, Shenzhen Third People' s Hospital, Guangdong Medical College, Shenzhen 518020 (China); Yan, Sen-Xiang [Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003 (China); Wang, Gao-Feng [Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016 (China); Yuan, Jing [Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Zhang, Shi-Zheng, E-mail: shizhengzhang@hotmail.com [Department of Radiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016 (China); Wang, Yi-Xiang J., E-mail: yixiang_wang@cuhk.edu.hk [Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (China); Department of Radiology, Shenzhen Third People' s Hospital, Guangdong Medical College, Shenzhen 518020 (China)

    2013-09-15

    Objective: To study the CT and MR features of xanthogranulomatous cholecystitis (XGC). Materials and methods: 49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed. Results: On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n = 3), stomach (n = 2), and abdominal wall (n = 1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images. Conclusion: Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall.

  17. CT and MR features of xanthogranulomatous cholecystitis: An analysis of consecutive 49 cases

    International Nuclear Information System (INIS)

    Objective: To study the CT and MR features of xanthogranulomatous cholecystitis (XGC). Materials and methods: 49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed. Results: On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n = 3), stomach (n = 2), and abdominal wall (n = 1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images. Conclusion: Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall

  18. Tailoring the properties of cholecyst-derived extracellular matrix using carbodiimide cross-linking.

    LENUS (Irish Health Repository)

    Burugapalli, Krishna

    2009-01-01

    Modulation of properties of extracellular matrix (ECM) based scaffolds is key for their application in the clinical setting. In the present study, cross-linking was used as a tool for tailoring the properties of cholecyst-derived extracellular matrix (CEM). CEM was cross-linked with varying cross-linking concentrations of N,N-(3-dimethyl aminopropyl)-N\\'-ethyl carbodiimide (EDC) in the presence of N-hydroxysuccinimide (NHS). Shrink temperature measurements and ATR-FT-IR spectra were used to determine the degree of cross-linking. The effect of cross-linking on degradation was tested using the collagenase assay. Uniaxial tensile properties and the ability to support fibroblasts were also evaluated as a function of cross-linking. Shrink temperature increased from 59 degrees C for non-cross-linked CEM to 78 degrees C for the highest EDC cross-linking concentration, while IR peak area ratios for the free -NH(2) group at 3290 cm(-1) to that of the amide I band at 1635 cm(-1) decreased with increasing EDC cross-linking concentration. Collagenase assay demonstrated that degradation rates for CEM can be tailored. EDC concentrations 0 to 0.0033 mmol\\/mg CEM were the cross-linking concentration range in which CEM showed varied susceptibility to collagenase degradation. Furthermore, cross-linking concentrations up to 0.1 mmol EDC\\/mg CEM did not have statistically significant effect on the uniaxial tensile strength, as well as morphology, viability and proliferation of fibroblasts on CEM. In conclusion, the degradation rates of CEM can be tailored using EDC-cross-linking, while maintaining the mechanical properties and the ability of CEM to support cells.

  19. Development of genetic diagnosing method for diabetes and cholecystitis based on gene analysis of CCK-A receptor

    Energy Technology Data Exchange (ETDEWEB)

    Kono, Akira [National Kyushu Cancer Center, Fukuoka (Japan)

    2000-02-01

    Based on the gene analysis of cholecystokinin type A receptor (CCKAR) from normal mouse and its sequence analysis in the previous year, CCKAR knock-out gene which allows mRNA expression of {beta}-galactosidase gene in stead of CCKAR gene was constructed. Since some abnormality in CCKAR gene is thought to be a causal factor of diabetes and cholecystitis, a knock-out mouse that expressed LacZ but not CCKAR was constructed to investigate the correlation between the clinical features of diabetes and cholecystitis, and CCKAR gene abnormalities. F2 mice that had mutations in CCKAR gene were born according to the Mendel's low. The expression of CCKAR gene was investigated in detail based on the expression of LacZ gene in various tissues of homo (-/-) and hetero (-/+) knockout mice. Comparative study on blood sugar level, blood insulin level, the formation of biliary calculus, etc. is underway with the wild mouse, hetero and homo knockout mouse. (M.N.)

  20. Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Agnieszka Popowicz

    2016-01-01

    Full Text Available Purpose. Percutaneous cholecystostomy (PC has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC. The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC. Methods. A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008. Results. In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6% in 2003 and 50/833 (6.0% in 2008. The complication rate (Clavien-Dindo ≥ 2 was 4/71 (5.6% after PC and 135/736 (18.3% after acute cholecystectomy. Mean (standard deviation hospital stay was 11.4 (10.5 days for patients treated with PC and 5.1 (4.3 days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P<0.001 but the risk for intervention-related complications was found to be significantly lower (P=0.001 in the PC group. Conclusion. PC can be performed with few serious complications, albeit with a longer hospital stay.

  1. Development of genetic diagnosing method for diabetes and cholecystitis based on gene analysis of CCK-A receptor

    International Nuclear Information System (INIS)

    Based on the gene analysis of cholecystokinin type A receptor (CCKAR) from normal mouse and its sequence analysis in the previous year, CCKAR knock-out gene which allows mRNA expression of β-galactosidase gene in stead of CCKAR gene was constructed. Since some abnormality in CCKAR gene is thought to be a causal factor of diabetes and cholecystitis, a knock-out mouse that expressed LacZ but not CCKAR was constructed to investigate the correlation between the clinical features of diabetes and cholecystitis, and CCKAR gene abnormalities. F2 mice that had mutations in CCKAR gene were born according to the Mendel's low. The expression of CCKAR gene was investigated in detail based on the expression of LacZ gene in various tissues of homo (-/-) and hetero (-/+) knockout mice. Comparative study on blood sugar level, blood insulin level, the formation of biliary calculus, etc. is underway with the wild mouse, hetero and homo knockout mouse. (M.N.)

  2. Personal experience on 71 consecutive patients with acute cholecystitis; Esperienza personale in settantuno pazienti consecutivi con colecistite acuta

    Energy Technology Data Exchange (ETDEWEB)

    Pinto, A.; Romano, L.; Scaglione, M.; Pinto, F. [Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Neaples (Italy). Dipt. di Diagnostica per Immagini; Romano, S.; Grassi, R.; Cappabianca, S. [Neaples Seconda Univ., Neaples (Italy). Ist. di Scienze Radiologiche; Del Vecchio, W. [Neaples Univ. Federico 2, Neaples (Italy). Ist. di Radiologia

    2000-02-01

    Acute cholecystitis is one of the most frequent abdominal inflammatory processes. If untreated or misdiagnosed it can result in severe complications such as gallbladder rupture, abscesses, or peritonitis. It was retrospectively reviewed a series of 71 consecutive patients with surgical confirmation of acute cholecystitis and then compared the results of the diagnostic techniques that have been used preoperatively. Over 16 months, 71 consecutive patients (42 women and 29 men; age range: 34-84 years, mean: 58) with acute abdominal pain were operated on for acute cholecystitis at Cardarelli Hospital, Naples. On abdominal plain films, it was retrospectively searched the following signs: densities projected over the gallbladder, linear calcifications in gallbladder walls, gallbladder enlargement, focal gas collections within the gallbladder, and air-fluid levels in the gallbladder wall lumen. On US images it has been looked for: gallbladder wall thickening (>3 mm), intraluminal content in the gallbladder, pericholecystic fluid, US Murphy's sign, and gallbladder distension. On CT images, it has been investigated: gallbladder distensions, wall thickening, intraluminal content, pericholecystic fluid, and inflammatory changes in pericholecystic fat. On plain abdominal films it was found densities projected over the gallbladder (16.9%) and linear calcifications in the gallbladder wall (4.6%). US appears to be the most useful imaging technique in patients with suspected acute cholecystitis, for both screening and final diagnosis. CT plays a limited role in the early assessment of these patients, but can a useful tool in diagnosing acute cholecystitis in patients with questionable physical findings or in investigating related complications. [Italian] La colecistite acuta e' una delle flogosi addominali con riscontro piu' frequente. Presenta complicanze (perforazione, ascesso, peritonite) quando non curata o non diagnosticata. Gli autori conducono l

  3. Diagnostic value of ultrasonography, infusion tomography of the gall-bladder and sup(99m)Tc-DIDA hepatobiliary scanning in cases of suspected acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Holst Pedersen, J.; Hancke, S.; Christensen, B.; Gammelgaard, J.; Haubek, A.; Ingemann Jensen, L.; Munck, O.; Wied, U. (Koebenhavns amts sygehus i Herlev, kirurgisk gastroenterologisk afd., Herlev, Denmark)

    1982-01-01

    Ultrasonography, infusion tomography of the gall-bladder and sup(99m)Tc-diethyl acetanilide iminodiacetic acid (DIDA) hepatobiliary scanning were compared in a prospective investigation of 45 consecutive patients in whom acute cholecystitis was suspected clinically. The definitive diagosis of acute cholecystitis was established or excluded at operation in 35 patients, by oral cholecystography in five and by intravenous cholangiography in five. The predictive values of positive and negative results of investigation were 100% and 83%. respectively, with ultrasonography and 98% and 88%, respectively, in hepatobiliary scanning. The corresponding values for infusion tomography were 87% and 33%, respectively. It is concluded from these results that ultrasonography and sup(99m)Tc-DIDA hepatobiliary scanning are capable of establishing the diagnosis rapidly and with certainty in cases of suspected acute cholecystitis. A preliminary account of the results of routine employment of sup(99m)Tc-DIDA hepatobiliary scanning in 29 consecutive patients revealed no erroneous diagnoses. In the majority of patients with acute cholecystitis, operation proved possible within 48 hours of admission.

  4. Laparoscopic cholecystectomy for gallstones: A comparison of outcomebetween acute and chronic cholecystitis

    International Nuclear Information System (INIS)

    Laparoscopic cholecystectomy (LC) is now a common method of treatingsymptomatic gallstones and it is increasingly being requested by the informedgeneral public. Our aim was to evaluate the role of LC for cholelithiasis andto establish its outcome and the effect of gender on the results. BetweenSeptember 1994 and June 99, all patients who underwent LC for cholelithiasiswere retrospectively reviewed. They were classified as having acute orchronic cholecystitis (AC or CC). There were 791 patients with CC (633females, 158 males) and 204 patients with AC (124 females, 80 males).Conversion to open cholecystectomy was needed in 0.76% and 11.8% of thepatients with CC and AC, respectively (P<0.00). Four percent of the femalepatients with AC needed conversion as compared to 23.8% in the males(P<0.00). The low conversion rate in CC limited gender comparison. Medianoperation time in the patients with CC was 53+-16 minutes as compared to74.5+-35.7 minutes in those with AC (P<0.00). Operation time in the malepatients with CC and AC was significantly higher than in the female patients,even after excluding the converted cases (P<0.00). Median postoperative stayfor patients with CC was 1.33+-0.9 days as compared to 1.9+-1.34 days inpatients with AC (P<0.00). No statistical significance in the hospital staywas found between males and females (in CC and AC). There was no mortality inthe series. There were three bile duct injuries in the patients with CC. Inpatients with successful LC, gallbladder perforation occurred in 18% and 31%of CC and AC patients, respectively, (P<0.003). Missed stones occurred in1.4% and 3.3% of the patients with successful LC for CC and AC, respectively.Bile collection, which was treated with open drainage, occurred in fourpatients with CC and one patient with AC. LC for symptomatic cholelithiasisis safe and feasible; it should be the first choice before resorting to opensurgery. In patients with AC as compared to CC, there is an increasedconversion rate

  5. The HAC Trial (Harmonic for Acute Cholecystitis Study. Randomized, double-blind, controlled trial of Harmonic(H versus Monopolar Diathermy (M for laparoscopic cholecystectomy (LC for acute cholecystitis (AC in adults

    Directory of Open Access Journals (Sweden)

    Coccolini Federico

    2009-05-01

    Full Text Available Abstract Background In the developmental stage of laparoscopic cholecystectomy (LC it was considered 'unsafe' or 'technically difficult' to perform laparoscopic cholecystectomy for acute cholecystitis (AC. With increasing experience in laparoscopic surgery, a number of centers have reported on the use of laparoscopic cholecystectomy for acute cholecystitis, suggesting that it is technically feasible but at the expense of a high conversion rate, which can be up to 35 per cent and common bile duct lesions. The HARMONIC SCALPEL(R (H is the leading ultrasonic cutting and coagulating surgical device, offering surgeons important benefits including: minimal lateral thermal tissue damage, minimal charring and desiccation. Harmonic Scalpel technology reduces the need for ligatures with simultaneous cutting and coagulation: moreover there is not electricity to or through the patient Harmonic Scalpel has a greater precision near vital structures and it produces minimal smoke with improved visibility in the surgical field. In retrospective series LC performed with H was demonstrated feasible and effective with minimal operating time and blood loss: it was reported also a low conversion rate (3.9%. However there are not prospective randomized controlled trials showing the advantages of H compared to MD (the commonly used electrical scalpel in LC. Methods/Design Aim of this RCT is to demonstrate that H can decrease the conversion rate compared to MD in LC for AC, without a significant increase of morbidity. The patients will be allocated in two groups: in the first group the patient will be submitted to early LC within 72 hours after the diagnosis with H while in the second group will be submitted to early LC within 72 hours with MD. Trial Registration ClinicalTrials.gov Identifier: NCT00746850

  6. Cholecystitis in a child with acquired immunodeficiency syndrome: ultrasonographic findings in a case of uncommon presentation during childhood; Colecistitis en un nino con sida: hallazgos ecograficos en una forma infrecuente de presentacion en la infancia

    Energy Technology Data Exchange (ETDEWEB)

    Rubi-Palomares, I.; Martinez-Leon, M. I.; Alonso-Usabiaga, I.; Ceres-Ruiz, L. [Hospital Materno Infantil del C.H.U. Carlos Haya. Malaga (Spain)

    2001-07-01

    We present the case of a boy with acquired immunodeficiency syndrome (AIDS) in whom ultrasound revealed the presence of acalculous cholecystitis. Abdominal ultrasound was essential in the initial diagnosis and the assessment of the response to treatment. This entity has rarely been reported in the pediatric radiology literature. In our patient, the cholecystitis may have been caused by infection, and the involvement of regional lymphatic obstruction in the pathogenesis is considered. (Author) 14 refs.

  7. Haemobilia causing cholangitis in a patient on dual anti-platelet treatment suffering from acute acalculous cholecystitis

    Science.gov (United States)

    Luhmann, Andreas; Buter, Anton; Abela, Jo-Etienne

    2013-01-01

    INTRODUCTION Haemobilia is a rare cause of upper gastro-intestinal haemorrhage which can be difficult to diagnose. PRESENTATION OF CASE We present the case of a patient who suffered from acute acalculous cholecystitis while on dual anti-platelet therapy with aspirin and clopidogrel. We describe the diagnostic and treatment challenges arising from the patient's complicated past history and the steps leading to the diagnosis of haemobilia causing biliary obstruction and cholangitis. Our patient did not, at any point, manifest anaemia or evidence of haemorrhage. DISCUSSION Haemobilia has a varied aetiology. To our knowledge there is no association with dual anti-platelet treatment in the literature to date. Diagnosis is difficult and relies on multiple modalities. In our patient the final diagnosis was only made in the course of open bile duct exploration. CONCLUSION In acute biliary obstruction we recommend the consideration of haemobilia in the differential diagnosis, especially in patients with a bleeding tendency. PMID:23466686

  8. 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; Stage, J G

    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...

  9. Role of morphine administration with 99m-technetium-labelled di-isopropyl iminodiacetic acid in the diagnosis of acute cholecystitis

    International Nuclear Information System (INIS)

    Patients presenting with a clinical diagnosis suggestive of acute cholecystitis had a 99m-technetium-labelled di-isopropyl iminodiacetic acid (DISIDA) scan. Two groups of patients were investigated. In group 1, 66 patients underwent cholescintigraphy and after 60 minutes morphine was given to all patients whose gallbladders had not filled. The accuracy rate of this procedure was 91%, sensitivity 83%, specificity 97%, positive predictive value 96,2% and negative predictive value 87,5%. In group 2, 97 patients had cholescintigraphy with morphine being administered at the beginning of the procedure. The accuracy rate of this investigation was 97,9%, sensitivity 100%, specificity 96,6%, positive predictive value 95% and negative predictive value 100%. We recommend the early use of morphine in all patients undergoing a DISIDA scan for acute cholecystitis

  10. The Value of D-Dimer in Diagnosis of Acute Mesenteric Ischemia and Differential Diagnosis from Acute Pancreatitis and Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Semih Hot

    2016-03-01

    Full Text Available Objective: Because of its poor prognosis and high mor­tality rate, early diagnosis of acute mesenteric ischemia (AMI is a challenge. The value of serum markers in the diagnosis of AMI is limited and the studies related with the D-dimer test carried out in recent years. In this prospec­tive study we investigated the value of the level of plasma D-dimer in the diagnosis of AMI and the differential diag­nosis from acute pancreatitis and acute cholecystitis. Methods: We included 89 patients who admitted to our emergency department with abdominal pain. The number and the diagnosis of the patients were 17 AMI, 42 acute pancreatitis and 30 acute cholecystitis, respectively. We measured the levels of plasma D-dimer of all patients by using a latex agglutination ‘immunoassay’ method. Even­tually we calculated the sensitivity and specificity of D-dimer test in the diagnosis of AMI. Results: We determined the specificity of the D-dimer test in the differential diagnosis of AMI as 50% from acute pancreatitis, 70% from acute cholecystitis, 58.3% from all the control group and the sensitivity was 100%. Conclusion: The measurement of plasma D-dimer con­centration may be useful in the differential diagnosis of AMI from acute pancreatitis and acute cholecystitis. How­ever, to reveal the diagnostic value of D-dimer test more clearly, further studies with larger series are needed, where cut-off value is highly defined, and other patients with acute abdominal pain are added into the control group.

  11. Episode of Familial Mediterranean Fever-Related Peritonitis in the Second Trimester of Pregnancy Followed by Acute Cholecystitis: Dilemmas and Pitfalls

    OpenAIRE

    Kosmidis, Christophoros; Anthimidis, Georgios; Varsamis, Nikolaos; Makedou, Fotini; Georgakoudi, Eleni; Efthimiadis, Christophoros

    2016-01-01

    Patient: Female, 33 Final Diagnosis: Acute cholecystitis after Familial Mediterranean Fever-related peritonitis Symptoms: Acute abdomen • fever Medication: Colchicine Clinical Procedure: Laparoscopic cholecystectomy and adhesiolysis in the second trimester of pregnancy Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Differential diagnosis of acute abdomen in pregnant patients is one of the greatest challenges for the clinician. Occurrence of Familial Medite...

  12. The Successful Treatment of Chronic Cholecystitis with SpyGlass Cholangioscopy-Assisted Gallbladder Drainage and Irrigation through Self-Expandable Metal Stents

    OpenAIRE

    Gutkin, Ellen; Hussain, Syed A; Kim, Sang H

    2012-01-01

    A 34-year-old female with a history of advanced pulmonary sarcoidosis and right-sided heart failure presented with chronic, postprandial right upper quadrant pain, and weight loss. Endoscopic biliary drainage was deemed to be the most appropriate therapeutic option for her chronic cholecystitis. Endoscopic retrograde cholangiopancreatography utilizing the SpyGlass cholangioscopy system allowed us to access the cystic duct through which the gallbladder was ultimately decompressed, via biliary ...

  13. Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Sven Jonas; Jan M Langrehr; Peter Neuhaus; Guido Schumacher; Andreas Pascher; Enrique Lopez-Hanninen; Hussain Al-Abadi; Christoph Benckert; Igor M Sauer; Johann Pratschke; Ulf P Neumann

    2006-01-01

    Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy,right hemicolectomy, and a partial duodenal resection.Pathological examination unexpectedly revealed an XGC.Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.

  14. Successful management of aortic thrombi resulting in spinal cord infarction in a patient with antiphospholipid antibody syndrome and acute cholecystitis

    Directory of Open Access Journals (Sweden)

    Izumi M

    2011-12-01

    Full Text Available Manabu Izumi, Shoko Teraoka, Keisuke Yamashita, Kenji Matsumoto, Tomohiro Muronoi, Yoshimitsu Izawa, Chikara Yonekawa, Masaki Ano, Masayuki SuzukawaDepartment of Emergency and Critical Care Medicine, Jichi Medical University, Tochigi, JapanAbstract: A 74-year-old man with coronary artery disease was suffering from acute nonobstructive cholecystitis and was admitted to a nearby hospital. Dual antiplatelet (aspirin and ticlopidine therapy was discontinued before preparation for surgical resection of the gall bladder. During his time in hospital he was aware of lumbar pain and weakness in both legs. He was transferred to our hospital for further evaluation and therapy. Diffuse intra-aortic thrombi were revealed by computed tomography with contrast media, and magnetic resonance imaging showed spinal cord infarction. However, computed tomography scans of the descending aorta obtained 4 months before admission exhibited no signs of atherosclerotic plaques or intra-aortic thrombi. Laboratory data suggest that antiphospholipid antibody syndrome might have caused these acute multiple intra-arterial thrombi. By restarting dual antiplatelet therapy and increasing the dose of heparin (from 10,000 IU/day to 15,000 IU/day we successfully managed the patient's clinical condition and symptoms. It is important to understand that stopping antiplatelet therapy may rapidly grow thrombi in patients with a hypercoagulative state.Keywords: intra-aortic thrombus, antiphospholipid antibody syndrome, spinal cord infarction

  15. Evaluating the effectiveness of the treatment of inflammatory periodontal disease on a background of chronic cholecystitis with the combined effect of the running of the alternating magnetic fields and low-intensity laser radiation

    Directory of Open Access Journals (Sweden)

    Dyakova E.S.

    2011-03-01

    Full Text Available The aim of the study was to determine the characteristic clinical, instrumental and diagnostic criteria of inflammatory periodontal diseases on the background of chronic cholecystitis with subsequent evaluation of the effectiveness of therapeutic measures using the combined action of the running of an alternating magnetic field and low-intensity helium-neon laser. Application low-intensiti laser radiation and a running variable magnetic field in complex treatment of patients periodontitis with cholecystitis expressed anti-inflammatory action allows to stop quickly inflammatory process in periodontium and to reduce treatment terms

  16. 62例急性胆囊炎的腹腔镜胆囊切除术%62 cases of clinical analysis of laparoscopic cholecystectomy for acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    杜愚贱; 胡立光; 李俊国

    2012-01-01

      目的:总结急性胆囊炎的腹腔镜切除术临床治疗.方法:回顾性分析本院62例实施腹腔镜胆囊切除术的急性胆囊炎患者的临床资料.结果:62例患者均进行腹腔镜胆囊切除术,手术时间30min-1.5h,其中有10例中转开腹,无一例发生肝外胆管损失及肝漏等并发症,无死亡病例.结论:急性胆囊炎进行腹腔镜胆囊切除术针对性好、创伤小、伤口愈合快、不易出现并发症,广为外科医生及患者所接受.%  Objective To summarize the clinical treatment of laparoscopic cholecystectomy for acute cholecystitis. Methods Retrospective analysis of the implementation of 62 cases of laparoscopic cholecystectomy for acute cholecystitis in patients with clinical data. Results 62 cases of laparoscopic cholecystectomy in patients with, operation 30min-1.5h, of which 10 have been converted to open, without a case of extrahepatic bile duct loss and liver complications, such as leakage, no deaths. Conclusion Targeted well in laparoscopic cholecystectomy for acute cholecystitis, small wounds, wound healing, and is less prone to complications, widely accepted by surgeons and patients.

  17. The Value of D-Dimer in Diagnosis of Acute Mesenteric Ischemia and Differential Diagnosis from Acute Pancreatitis and Acute Cholecystitis

    OpenAIRE

    Semih Hot; Nüvit Duraker; Ayhan Sarı; Kenan Çetin

    2016-01-01

    Objective: Because of its poor prognosis and high mor­tality rate, early diagnosis of acute mesenteric ischemia (AMI) is a challenge. The value of serum markers in the diagnosis of AMI is limited and the studies related with the D-dimer test carried out in recent years. In this prospec­tive study we investigated the value of the level of plasma D-dimer in the diagnosis of AMI and the differential diag­nosis from acute pancreatitis and acute cholecystitis. Methods: We included 89 patients w...

  18. Care of surgical resection of cholelithiasis with cholecystitis%胆囊结石并胆囊炎手术切除的护理

    Institute of Scientific and Technical Information of China (English)

    周丽

    2014-01-01

    Objective To investigate the perioperative nursing care effect of gallstones and cholecystitis surgical resection. Methods 100 patients with gallstones and cholecystitis who were treated in this hospital between September 2012 and September 2013 were chosen in this study and randomly divided into two groups. The observation group of 50 patients received perioperative nursing care.The control group of the other 50 patients received conventional nursing care. The nursing effects of two groups were observed. Results The occurrence condition of the postoperative complications,the healing condition of the incision and the nursing satisfaction in the observation group were better than those in the control group(P<0.05). Conclusion The perioperative nursing care of gallstones and cholecystitis surgical resection can reduce the incidence of surgical complications and improve the treatment effect and the care satisfaction to establish a good image for the hospital. The perioperative nursing care of gallstones and cholecystitis surgical resection is well worth popularizing and applicating.%目的:探讨胆囊结石并胆囊炎手术切除的围期护理效果。方法选取2012年9月~2013年9月期间本院收治的100例胆囊结石并胆囊炎患者,随机分为两组。观察组50例,给予手术围期护理;对照组50例,给予常规护理。观察两组患者的护理效果。结果观察组在术后并发症的发生情况、切口的愈合情况和护理满意度上均优于对照组(P<0.05)。结论胆囊结石并胆囊炎手术切除的围期护理能够降低手术并发症的发生率,提高治疗效果和护理满意度,为医院树立了良好的形象,值得推广应用。

  19. Hemorrhagic cholecystitis and hemobilia: two infrequent complications of systemic lupus erythematosus Colecistitis hemorrágica y hemofilia: dos complicaciones infrecuentes del lupus eritematoso sistémico

    Directory of Open Access Journals (Sweden)

    Rocío García Pérez

    2011-08-01

    Full Text Available Introduction: the patients affected by systemic lupus erythematosus (SLE often suffer gastrointestinal symptoms. The differential diagnosis should contemplate pathology of the gall bladder. We present the case of a patient with hemorrhagic lithiasic cholecystitis and hemobilia. Case report: 24 year old female diagnosed with SLE under treatment with Sintrom®, Dacortin® and Dolquine® that presented acute lithiasic cholecystitis and hemobilia with a distal calculus. Cholecystectomy and aperture of the ductus choledochus were performed allowing to confirm the hemobilia and to extract the calculus. Discussion: the treatment of cholecystitis in the patients with SLE is controversial due to the fact that most reviewed cases have been solved with cholecystectomy, or in other cases with conservative treatment with corticosteroids. We believe that the presence of cholelithiasis in a patient with SLE with pain on the right hypochondrium and ultrasound confirming the suspicion of cholecystitis demands a surgical treatment since the cause may be vascular, lithiasic or combined. Besides, the possible complications will not respond to pharmaceutical treatment.Introducción: los pacientes afectos de lupus eritematoso sistémico (LES sufren con frecuencia síntomas gastrointestinales. Debe incluirse en su diagnóstico diferencial la patología de la vesícula biliar. Presentamos el caso de una paciente con colecistitis alitiásica y hemobilia. Caso clínico: mujer de 24 años diagnosticada de LES en tratamiento con Sintrom®, Dacortin® y Dolquine® que presentó cuadro de colecisititis aguda litiásica y hemobilia, con presencia de cálculo enclavado en papila. Se realizó colecistectomía y apertu-ra del colédoco, lo que permitió confirmar la hemobilia y extracción del cálculo. Discusión: el tratamiento de la colecistitis en los pacientes con LES es controvertido ya que, aunque la mayoría de los casos revisados se han resuelto con la colecistectom

  20. Contribution of cholescintigraphy to the early diagnosis of acute acalculous cholecystitis in intensive-care-unit patients

    Energy Technology Data Exchange (ETDEWEB)

    Prevot, N.; Granjon, D.; Dubois, F. [Dept. of Nuclear Medicine, Service de Medecine Nucleaire, Hopital Nord, CHRU Saint-Etienne (France); Mariat, G.; Mahul, P.; Jospe, R.; Auboyer, C. [Department of Intensive Care, Hospital Nord, CHRU Saint-Etienne (France); Cuilleron, M. [Department of Radiology, Hospital Nord, CHRU Saint-Etienne (France); Tiffet, O. [Department of Surgery, Hospital Nord, CHRU Saint-Etienne (France); De Filipis, J.-P. [Department of Nephrology, Hospital Nord, CHRU Saint-Etienne (France)

    1999-10-01

    Thirty-two intensive care unit patients (78% on long-term total parenteral nutrition) suspected of having acute acalculous cholecystitis (AAC) were studied prospectively. All of these patients underwent abdominal ultrasonography and cholescintigraphy with technetium-99m mebrofenin. Morphine sulphate (0.04 mg/kg) was administered only if the gallbladder was not visualised after 1 h (16 patients). The final diagnosis was reached after clinical improvement, or upon the discovery of another aetiology for the symptoms presented, or on the basis of histopathology following cholecystectomy (when this was performed). We analysed the contribution of individual cholescintigraphic findings (I: non-visualisation of the gallbladder during the first 60 min of the examination; II: persistent non-visualisation of the gallbladder 30 min following morphine administration; III: non-visualisation of the small bowel for at least 90 min) and their various combinations. We obtained a sensitivity of 79% and a specificity rate 100% using the interpretative criteria ''I and II or III''. Excluding obstructive syndrome (''I and II''), the sensitivity and specificity figures were 70% and 100% respectively (28 patients). We had no false-positive results in our patient population. Cholescintigraphy was found to complement ultrasonography, which had either good sensitivity (93%) and poor specificity (17%), when at least two of the three major signs were present (sludge, thickened wall, gallbladder distension), or poor sensitivity (36%) and good specificity (89%) when all three signs were present. We conclude that cholescintigraphy is a useful tool for early diagnosis of AAC in critically ill patients, in whom ultrasonography alone does not provide enough information to permit a sufficiently early decision regarding the use of surgery. (orig.)

  1. Morphine-augmented cholescintigraphy and acute a calculous cholecystitis in critically ill patients: interest and new way of interpreting

    International Nuclear Information System (INIS)

    Introduction: Acute acalculous cholecystitis (AAC) is a serious disease, difficult to diagnose in critically ill patients. The aim of the study was to evaluate the diagnostic performances of abdominal ultrasonography (US) and morphine-augmented cholescintigraphy (MC) and to improve diagnostic strategy in patients of intensive care unit (ICU) with suspected AA C. Methods: We retrospectively studied 82 consecutive ICU patients with suspected AA C. US was positive if the triad of gallbladder distension, gallbladder wall thickening and sludge was found. MC was positive if the gallbladder remained non-visualized after morphine injection. In a second time, other scintigraphic criteria of interpretation were tested, according to the visualization of the gallbladder before or after morphine administration. Treatment was decided on the basis of clinical, laboratory and imaging data. Results: The diagnosis of AAC was retained in 34 patients. US and MC had respectively for the diagnosis of AAC a sensitivity of 20.6 and 70.6%, and a specificity of 95.8 and 100%. Interpreting the MC as positive if the gallbladder remains non-visualized after morphine, as negative if it appears before, and as non-conclusive if visualized after, makes it possible to define respectively patients with high probability (100%), with low probability (7.5%) or with intermediate probability (39%) of AAC. Conclusions: MC is better than US for diagnosing AAC in critically ill patients, having in particular excellent specificity using the classical criteria of interpretation. MC must be thus performed in patients at risk for AAC, determined with clinical, laboratory and eventually echographic findings. To decrease false negative rate of MC, a probability categorical classification is proposed to improve patients' care. (author)

  2. Individualized nomogram improves diagnos-tic accuracy of stage I-II gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening

    Institute of Scientific and Technical Information of China (English)

    Di Zhou; Jian-Dong Wang; Yong Yang; Wen-Long Yu; Yong-Jie Zhang; Zhi-Wei Quan

    2016-01-01

    BACKGROUND: Early diagnosis of gallbladder cancer (GBC) can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage I-II GBC in chronic cholecystitis patients with gallblad-der wall thickening. METHODS: The nomogram was developed using logistic re-gression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage I-II GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimina-tion, calibration and a prospective cohort treated at another center between January 2012 and December 2014 (n=928). RESULTS: Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calciifcation, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves iftted well. The area under the receiver-operating characteristic curves of the no-mogram was higher than that of multidetector row computed tomography in diagnosis of stage I-II GBC (P CONCLUSION: The proposed nomogram improves individu-alized diagnosis of stage I-II GBC in chronic cholecystitis pa-tients with gallbladder wall thickening, especially for those the imaging features alone do not allow to conifrm the diagnosis.

  3. Papel de la cirugía video laparoscópica en la colecistitis aguda Video-laparoscopic surgery role in acute cholecystitis

    Directory of Open Access Journals (Sweden)

    Gilberto L Galloso Cueto

    2011-06-01

    Full Text Available Introducción: la colecistitis aguda es reconocida como una de las principales causas de abdomen agudo. Su tratamiento es eminentemente quirúrgico, para evitar grandes complicaciones e incluso la muerte. En la actualidad, gracias al desarrollo alcanzado por la cirugía laparoscópica, es posible la realización de esta tipo de intervención a través de este método, con un escaso índice de conversión (necesidad de realizar laparotomía para completar el proceder quirúrgico. Objetivo: exponer los principales resultados de la colecistectomía video laparoscópica en el tratamiento de la colecistitis aguda. Diseño: estudio descriptivo de corte transversal. Contexto: servicio de urgencias del Hospital Militar Docente Dr. Mario Muñoz Monroy. Universo: 70 pacientes operados de colecistitis aguda por cirugía video laparoscópica en el período comprendido de febrero de 2000 a junio de 2009. Variables: sexo, edad, tiempo quirúrgico, enfermedades que condicionan riesgo quirúrgico, antecedentes de operaciones anteriores, complicaciones más frecuentes, tipo de operación, causas de conversión, estadía hospitalaria y mortalidad. Principales resultados: el sexo más afectado fue el femenino (66 %; la edad promedio fue de 50 años; el tiempo quirúrgico promedio fue de 42 minutos; la principal enfermedad que ocasiona riesgo fue la hipertensión arterial; el 73 % de los pacientes no tenía antecedentes de operaciones sobre el abdomen; se presentaron complicaciones relacionadas con el acto quirúrgico en el 7,1 %, y postoperatorias en el 12,8 %, el índice de conversión fue de un 2,8 %; el 88,6 % de los pacientes tuvo una estadía hospitalaria menor de 24 horas, y la mortalidad general fue de 1,4 %.SUMMARY Introduction: The acute cholecystitis is recognized as one of the main causes of the acute abdomen. Its treatment is mainly surgical, to avoid big complication and even death. Nowadays, thanks to the development reached by laparoscopic surgery

  4. Roflumilast, ursodeoxycholic acid and nucleinate efficiency in patients with chronic obstructive pulmonary disease with accompanying chronic non-stone cholecystitis.

    Directory of Open Access Journals (Sweden)

    Dudka T.V.

    2014-11-01

    Full Text Available Global Initiative for diagnosis, treatment and prevention of COPD has recently included roflumilast (R - an inhibitor of phosphodiesterase-4 (PDE-4 as a new therapeutic agent to the recommendations for the management of patients suffering from COPD with severe and moderate course. Objective. To investigate the efficacy of roflumilast, ursodeoxycholic and ribonucleinic acids in patients with COPD with an accompanying chronic non-stone cholecystitis. Materials and methods. The study involved 40 patients with COPD stage II-III, in the acute phase with an accompanying CNC in the acute phase and 20 practically healthy individuals (PHI. Patients of the control group (group 2 received berodual, UA500 mg overnight for 30 days, under the conditions of infective exacerbation of COPD - antibiotic therapy. Group 1 (study, 20 people received roflumilast 500 mg additionally once a day, nucleinas 500 mg 3 times daily for 30 days. Results and discussion. The results obtained in the study of the dynamics of treatment and their analysis indicate that exposure to complex therapy, amelioration, reducing the signs of exacerbation of COPD and CNC, a significant improvement of quality of life in patients of group 1 were noticed sooner. Figures of external respiration functions(FER in dynamics of treatment in patients with COPD with an accompanying CNC show higher efficiency of the proposed therapy too. In particular, the rate of forced expiration for the first second after treatment in patients of group 1 increased by 31,5% (p<0,05, while patients in group 2 - by 14,0% (p<0,05 probable presence of intergroup differences (p<0,05. Taking into consideration the fact that the treatment of patients of group 1 included antioxidant preparation H - dynamic performance and the intensity of lipid peroxidation were significantly different from baseline in all periods of observation. For instance, the content of MA (malonic aldehyde in plasma after treatment in group 1 decreased

  5. Value of ROC analysis of Doppler ultrasound in diagnosis of acute infectious cholecystitis%ROC分析法评价多普勒超声对急性感染性胆囊炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    郁素云; 王磊; 陈云素

    2013-01-01

    目的 探讨彩色多普勒超声对急性感染性胆囊炎的定性诊断价值,为提高急性感染性胆囊炎的定性诊断率提供理论依据.方法 对68例急性感染性胆囊炎行腹部彩色多普勒超声检查,评价患者的胆囊形态、超声Murphy征、胆汁透声的好与差及胆囊壁的厚、薄或粗糙程度;利用受试者的工作特征(ROC)曲线评价上述指标对急性感染性胆囊炎的诊断价值.结果 急性胆囊炎组胆囊肿大62例、超声Murphy征阳性66例、胆汁透声差57例、胆囊壁厚或粗糙63例,阳性率分别为91.2%、97.1%、83.8%、92.6%,均明显高于非胆囊炎组,差异有统计学意义(P<0.01);将上述4个指标加以综合对急性感染性胆囊炎的诊断正确率为95.0%,灵敏度为95.2%,特异性为94.7%,ROC曲线下面积为0.985.结论 多普勒超声能评价急性感染性胆囊炎的胆囊形态、胆囊壁厚或粗糙程度、胆汁透声情况及超声Murphy征,可提高该病定性诊断准确率.%OBJECTIVE To evaluate the qualitative value of color Doppler ultrasound in diagnosis of acute infectious cholecystitis so as to provide a theoretical basis for improving the qualitative diagnosis of acute infectious cholecystitis. METHODS A total of 68 cases of acute infectious cholecystitis patients underwent the abdominal color Doppler ultrasound. The gallbladder morphology, ultrasound Murphy sign, the good or poor sound for bile, thick or thin or roughness of gallbladder wall were evaluated by the method of Doppler ultrasound; the diagnostic value of the above indicators for the acute infectious cholecystitis was evaluated by receiver operating characteristics (ROC) curves. RESULTS There were 62 cases (91. 2%) with acute cholecystitis gallbladder enlargement, 66 cases (97. 1%) with ultrasound Murphy sign, 57 cases (83. 8%) with the poor sound of bile, and 63 cases (92.6%) with gallbladder wall thickness or roughness, significantly higher than that of the

  6. The role of cholescintigraphy in the diagnosis of acute cholecystitis and other biliary tract emergencies; Place de la scintigraphie des voies biliaires dans la cholecystite aigue et les autres urgences bilio-digestives

    Energy Technology Data Exchange (ETDEWEB)

    Delcourt, A.

    1996-12-31

    Patients suspected of having acute cholecystitis can present a difficult diagnostic problem. Cholescintigraphy using {sup 99m}Tc-labeled analogues of imino-diacetic acid (IDA) is a sensitive and specific test for the early diagnosis of acute cholecystitis. The radiopharmaceutical enters the bilirubin metabolic pathway and follows the hepatic bile flow. A cystic duct obstruction is suspected if the gall-bladder does not take up the tracer 40 to 60 min after the injection, provided that the radiotracer is seen the small intestine. At that moment, morphine sulfate can be given intravenously. Acute cholecystitis is deemed present if the gall-bladder is still unseen 30 min after morphine injection or 4 hours after the radiotracer administration if morphine is contraindicated. Cholescintigraphy proves also useful in diagnosing post-surgical or post-traumatic biliary injuries. This test conveys complementary information to ultrasonography and computed tomography in cases of bile leakage, collected or free in the peritoneal cavity, in confirming the biliary origin of the collection. (author). 88 refs.

  7. Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

    Directory of Open Access Journals (Sweden)

    Winnekendonk Guido

    2010-11-01

    Full Text Available Abstract Introduction Cases of gallstone ileus account for 1% to 4% of all instances of mechanical bowel obstruction. The majority of obstructing gallstones are located in the terminal ileum. Less than 10% of impacted gallstones are located in the duodenum. A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Gallstones usually enter the bowel through a biliary enteral fistula. Little is known about the formation of such fistulae in the course of gallstone disease. Case presentation We report the case of a 72-year-old Caucasian woman born in Germany with a gastric outlet obstruction due to a gallstone ileus (Bouveret syndrome, with a large gallstone impacted in the third part of the duodenum. Diagnostic investigations of our patient included plain abdominal films, gastroscopy and abdominal computed tomography, which showed a biliary enteric fistula between the gallbladder and the duodenal bulb. Our patient was successfully treated by laparotomy, duodenotomy, extraction of the stone, cholecystectomy, and resection of the fistula in a one-stage surgical approach. Histopathological examination showed chronic and acute cholecystitis, with perforated ulceration of the duodenal wall and acute purulent inflammation of the surrounding fatty tissue. Four months prior to developing a gallstone ileus our patient had been hospitalized for cholecystitis, a large gallstone in the gallbladder, cholangitis and a small obstructing gallstone in the common biliary duct. She had been treated with endoscopic retrograde cholangiopancreatography, endoscopic biliary sphincterotomy, balloon extraction of the common biliary duct gallstone, and intravenous antibiotics. At the time of her first presentation, abdominal ultrasound and endoscopic examination (including esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography had not shown any evidence of a biliary enteral fistula. In the four months preceding the

  8. Factor Analysis Influencing Postoperative Hospital Stay and Medical Costs for Patients with Definite, Suspected, or Unmatched Diagnosis of Acute Cholecystitis according to the Tokyo Guidelines 2013

    Science.gov (United States)

    Hayasaki, Aoi; Takahashi, Koji; Fujii, Takehiro; Kumamoto, Koji; Fujii, Koji; Matsumoto, Eiichi; Miyahara, Shigeki; Kusuta, Tsukasa; Azumi, Yoshinori; Isaji, Shuji

    2016-01-01

    Purpose. To identify significant independent preoperative factors influencing postoperative hospital stay (PHS) and medical costs (MC) in 171 patients who underwent cholecystectomy for benign gallbladder diseases and had definite, suspected, or unmatched acute cholecystitis (AC) diagnosis according to the Tokyo Guidelines 2013 (TG13). Methods. The 171 patients were classified according to the combination of diagnostic criteria including local signs of inflammation (A), systemic signs of inflammation (B), and imaging findings (C): A+ B+ C (definite diagnosis, n = 84), A+ B (suspected diagnosis, n = 25), (A or B) + C (n = 10), A (n = 41), and B (n = 11). Results. The A+ B + C and (A or B) + C groups had equivalent PHS and MC, suggesting that imaging findings were essential for AC diagnosis. PHS and MC were significantly increased in the order of severity grades based on TG13. Performance status (PS), white blood cell count, and severity grade were identified as preoperative factors influencing PHS by multivariate analysis, and significant independent preoperative factors influencing MC were age, PS, preoperative biliary drainage, hospital stay before surgery, albumin, and severity grade. Conclusion. PS and severity grade significantly influenced prolonged PHS and increased MC.

  9. Quality of life (GIQLI) and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis) Calidad de vida (GIQLI) y utilidad de la colecistectomía laparoscópica en pacientes con disfunción vesicular o dolor crónico biliar alitiásico (colecistitis crónica alitiásica)

    OpenAIRE

    M. Planells Roig; J. Bueno Lledó; A. Sanahuja Santafé; R. García Espinosa

    2004-01-01

    Objective: the aim of this study was to evaluate the incidence, clinical features and role of laparoscopic cholecystectomy (LC) in patients with chronic acalculous cholecystitis (CAC) in comparison with a control group of patients who underwent cholecystectomy for chronic calculous cholecystitis (CCC). Material and methods: prospective evaluation of 34 patients with CAC in contrast with 297 patients with CCC. Outcome measures: clinical presentation, quality of life using the Gastrointestinal ...

  10. 超声检查在急性胆囊炎腹腔镜胆囊切除术前的应用价值%Value of preoperative ultrasonography for acute cholecystitis patients undergoing laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    王晶明; 丁蓉; 白新艳; 袁雪红; 李霞

    2011-01-01

    Objective To observe the value of preoperative ultrasound in predicting possible difficulties of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Methods A total of 180 patients with acute cholecystitis received ultrasonography before LC. The gallbladders were comprehensively examined to observe the contour, gallbladder necks, wall thickness, wall echoes and intracyst echoes. Preoperative data and intraoperative data were compared for accessing the grade of adherence in the pericholecystic and Calot triangular area. Results The sensitivity, specificity and accuracy of preoperative ultrasonography for predicting the grade of adherence between the gallbladder and the tissue around it was 92. 78% (90/97), 93.98% (78/83) and 93. 33% (168/180), respectively. Conclusion Preoperative ultrasonography is valuable for predicting difficulties during LC in patients with acute cholecystitis.%目的 评价术前超声检查对预测腹腔镜胆囊切除术(Lc)治疗急性胆囊炎难度的价值.方法 对180例因急性胆囊炎接受LC的患者,术前超声检查综合分析胆囊轮廓、胆囊颈部、囊壁厚度、囊壁回声、囊内回声情况,评估胆囊周围、Calot三角区的粘连程度,并与手术病理进行对照.结果 超声检查综合性评估胆囊与周围组织粘连程度的敏感度为92.78%(90/97),特异度为93.98%(78/83),准确率为93.33%(168/180).结论 术前超声检查对预测LC治疗急性胆囊炎的难度有重要价值.

  11. The impact of the Japanese clinical guidelines on the clinical management of patients with acute cholecystitis%国外最新医学摘要

    Institute of Scientific and Technical Information of China (English)

    Satoshi Shinya; Yuichi Yamashita; Tadahiro Takada

    2015-01-01

    Background/purpose The Japanese clinical guidelines for treating acute cholecystitis (AC), proposed in 2005, provide criteria not only for diagnosis, but also for management depending on the severity of the disease. The aim of this study was to assess how the Japanese guidelines for AC have impacted the clinical situation in Japan. Methods A postal questionnaire was sent to the councillors of the Japanese Society of Abdominal Emergency Medicine three times to ascertain the impact of the Japanese guidelines for AC. We surveyed 291 councillors one year before publication of the guidelines (2004), 279 councillors one year after publication (2006), and 191 councillors six years after publication (2011). Results The response rate was 72.5% one year before publication of the guidelines, 51.9% one year later and 69.1% six years after publication. Early cholecystectomy was used by 41.7% of the respondents one year before publication, while 57.3% of the respondents used this treatment one year after publication and 62.3% of the respondents used it six years after publication. Laparoscopic cholecystectomy was used by 79.1% of the respondents one year before the guidelines were published, while 87.3% of the respondents used it one year after publication and 90% of the respondents reported its use six years after publication. Conclusions The Japanese guidelines for AC are increasingly used and have changed the clinical management of patients with AC. The use of early and laparoscopic cholecystectomy for treating patients with AC has been increasingly adopted in Japan.

  12. Laparoscopic cholelithotomy and polypectomy of gallbladder polyps for cholelithiasis and/or cholecystic polyps: An analysis of 53 cases%腹腔镜保胆取石术和息肉切除术临床分析53例

    Institute of Scientific and Technical Information of China (English)

    徐新保; 张辉; 张洪义; 刘承利; 何晓军; 肖梅; 张宏义; 冯志强

    2012-01-01

    AIM: To discuss the indications, methods, and therapeutic effect of laparoscopic cholelithotomy and polypectomy in treating cholecystolithiasis and polyps.METHODS: The clinical data for 53 patients with cholelithiasis and cholecystic polyps who were treated by laparoscopic cholelithotomy and polypectomy between January 2009 and September 2011 were analyzed. Of the 53 patients, 39 suffered from only cholecystolithiasis (including 12 with a single stone and 27 with multiple stones), 8 suffered from cholecystic polyps (including 3 with adenomatous polyps and 5 with cholesterol polyps), and 6 simultaneously suffered from cholecystolithiasis and cholecystic polyps. Of 39 patients suffering from cholecystolithiasis, 2 had liver cirrhosis, 1 had primary hepatocellular carcinoma, and 3 had acute cholecystitis. Before the stones were removed, the bottom of the gallbladder was incised in 37 of 39 cases with cholelithiasis, and the neck of the gallbladder was incised in the remaining two patients. Of 8 patients with cholecystic polyps, 5 had cholesterol polyps and underwent polyp removal, and the other 3 had adenomas of the gallbladder and underwent partial cholecystectomy around the adenoma. In six patients with combined cholecystolithiasis and cholecystic polyps, the bottom of the gallbladder was excised to remove the stones and polyps. The incisions were sutured continuously with a 4/0 prolene suture in 10 cases, and interrupted or continuous suturing was performed with a 3/0 absorption suture in the other 43 cases. Both choledochoscopy and laparoscopy were used in 33 cases, and only laparoscopy was used in the other 20 patients during operation to see if the stones and polyps had been removed. Celiac drainage tube was placed under the right hepatic lobe in 19 cases during operation and was removed one to five days later. Thirty-three patients with cholecystolithiasis took choleretic drugs for one week to 4 weeks after operation, and the other 12 cases with

  13. Laparoscopic Treatment of Acute Cholecystitis Timing of Surgery and Efficacy%腹腔镜手术治疗急性胆囊炎的手术时机与疗效探讨

    Institute of Scientific and Technical Information of China (English)

    胡耀锋; 韦德才; 王威; 区演乐

    2014-01-01

    目的:研究并分析腹腔镜手术治疗急性胆囊炎的手术时机与疗效。方法选择我院于2012年1月至2013年1月收治的120例急性胆囊炎患者为研究对象,按手术时间的不同分为早期手术组与晚期手术组,总结两组的手术时间、术后住院时间与总住院时间。结果早期手术组52例患者平均手术时间、术后住院时间、总住院时间均优于晚期手术组,早期手术组术后无患者发生并发症,晚期手术组术后3例患者发生并发症,两组数据比较差异显著(P<0.05),差异有统计学意义。结论对于急性胆囊炎患者在行腹腔镜手术时应该尽早的进行手术,这样能够降低中转开腹率,降低患者的住院费用,缩短住院时间。%Objective To study and analyze the treatment of acute cholecystitis laparoscopic surgical timing and effect. Methods Our hospital in January 2012 to January 2013, 120 cases of acute cholecystitis treated patients for the study, according to the operation time of the surgery group were divided into early and late surgery group, summed up the two groups operative time, intraoperative after hospitalization time and total hospitalization time. Results 52 patients early surgery group, mean operative time, postoperative hospital stay, total hospitalization time were better than late surgery group, early surgery group occurred in patients with no postoperative complications, late surgery group, 3 patients had complications after surgery, significant difference between two sets of data (P<0.05), the difference was statistically significant. Conclusion For patients with acute cholecystitis line laparoscopic surgery should be performed as soon as possible, this can reduce the laparotomy rate and reduce hospitalization costs, shorter hospital stays.

  14. 误诊为急性结石性胆囊炎31例病例分析%The analysis of misdiagnosed as acute calculos cholecystitis in 31 cases.

    Institute of Scientific and Technical Information of China (English)

    陈永友

    2012-01-01

    Objective To analyze and explore the causes of misdiagnosed as acute calculos cholecystitis. Methods Thirty - one cases misdiagnosed as acute calculous cholecystitis in our hospital from July 2000 to May 2012 were retrospectively analyzed and summarized. Results Thirty - one patients with cholecystolithiasis were misdiagnosed as acute calculous cholecystitis, The final diagnosis of misdiagnosis cases: 6 cases of acute myocardial infarction , 5 cases of herpes zoster, 4 cases of carcinoma of gallbladder, 3 cases of high - position appendicitis, 2 cases of pancreatitis, 2 cases of pneumonia, 2 cases of colon tumor, 2 cases of upper digestive tract perforation, 2 cases of renal calculus, 1 case of dissection of aorta, 1 case of pleuritis, 1 case of ascariasis of biliary tract. Conclusion Dont detailed inquest the case history, examine the body carelessly, lack of relevant knowledge and experience, ignoring the other disease diagnosis while gallstones found were the main causes of misdiagnosis.%目的 分析、总结其他疾病误诊为急性结石性胆囊炎的原因,积累经验.方法 对2000年7月至2012 年5月收治的31例临床误诊为急性结石性胆囊炎病例进行回顾性分析、总结.结果 31例患者均因原有胆囊结石而误诊为急性结石性胆囊炎.误诊疾病的最终诊断为:急性心肌梗死6例(19.35%),带状疱疹5例(16.13%),胆囊癌4例(12.9%),高位阑尾炎3例(9.68%),胰腺炎2例(6.45%),肺炎2例(6.45%),结肠肿瘤2例(6.45%),上消化道穿孔2例(6.45%),右肾结石2例(6.45%),主动脉夹层1例(3.22%),胸膜炎1例(3.22%),胆道蛔虫1例(3.22%).结论询问病史不详细、查体不仔细、缺少对相关疾病鉴别诊断的知识和经验、发现胆囊结石而忽略其它疾病诊断是造成误诊的主要原因.

  15. 应用Simpson法评价针刺穴位联合药物治疗胆囊炎的临床疗效%Evaluation of therapeutic effects of acupuncture and drug on cholecystitis using Simpson method

    Institute of Scientific and Technical Information of China (English)

    曹子洋; 吕培瑾; 高伟; 张蓓蓓; 耿喆

    2011-01-01

    Objective To investigate the clinical value of Simpson method in evaluating the therapeutic effects of acupuncture and drug on cholecystitis.Methods Forty-two cases of cholecystitis were treated by acupuncture and drug.The ultrasound image of the gallbladder on long axis view was collected.Modified Simpson method was used to evaluate the volume of the gallbladder.The emptying rate of the gallbladder was calculated.Results After treatment the contractibility of the gallbladder increased significantly,tension of the gallbladder decreased,echo of the gallbladder reduced or disappeared,and the wall of gallbladder thinned(P<0.05).Conclusions Modified Simpson method is easy and simple in evaluating the volume of the gallbladder,and can apply to evaluating the therapeutic effects of acupuncture and drug on cholecystitis.%目的 应用Simpson法测量技术评价针刺穴位联合药物治疗胆囊炎的临床疗效.方法 对42例胆囊炎患者应用针刺穴位联合药物治疗,采用脂餐试验,采集胆囊长轴切面声像图,应用改良Simpson法直接测量脂餐前后两组胆囊的容积,并统计胆囊排空率.结果 治疗后较治疗前胆囊收缩功能明显提高,胆囊张力减低、胆囊回声减少或消失、胆囊壁厚度变薄,经统计学处理差异有统计学意义(P<0.05).结论 改良Simpson法测量胆囊容积简便易行,可用于针刺穴位联合药物治疗胆囊炎的临床疗效评价.

  16. Cholecystic fistula with atypical symptoms

    DEFF Research Database (Denmark)

    Bang, U.C.; Hasbak, P.; From, G.

    2008-01-01

    We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...

  17. L-form bacteriologic assessment of bile from gallbladder in patients with gallstones and cholecystitis and implication%检测胆囊结石胆汁中L型细菌的研究及其意义

    Institute of Scientific and Technical Information of China (English)

    韩文胜; 石景森; 杨毅军; 李国才; 韩月; 焦兴元; 卓健生

    2001-01-01

    Objective To evaluate the role of L-form bacteria in the development of gallstone and cholecystitis. Methods A L-form bacteriological study was made on 130 patients undergoing elective surgery for gallbladder diseases and 20 subjects with a normal biliary tract as a control group. Results The positive rate of bacterial L-form was 59.2 % in benign gallbladder diseases and 5.0 % in the control group. In the bile from gallbladder, the detectable rate for pigment stones was the highest (88.9 %), followed by mixed, cholesterol and black stones (80.0 %, 54.8 % and 50.0 % respectively). There was relationship between the number of gallstone and the L-form bacterial positive rate, as well as the age of the patients. Conclusion L-form bacterial infection might play a certain role in stone formation in gallbladder and the therapy for L-form bacterial infection in the patients with gallstones and chronic cholecystitis should be performed clinically.%目的探讨L型细菌在胆囊结石、胆囊炎发病中的意义。方法应用高渗培养技术对130例胆囊结石、胆囊炎及20例非胆道疾病的患者胆囊胆汁标本进行普通菌及L型菌联合培养。结果 L型菌总检出率胆囊疾病组为59.2%,对照组为5.0%;胆囊结石胆汁中,检出率最高为胆色素类结石(88.9%),其次为混合性胆石(80.0%)、胆固醇结石(54.8%)和黑色结石(50.0%);多发结石明显高于单个结石。随年龄增加,其感染检出率增高。结论 L型菌感染可能在胆囊结石、胆囊炎发生发展中有重要意义,临床上应重视其检测和治疗。

  18. The Clinical Features, Diagnosis and Treatment of Cholecystitis in the Old Obese Patients%老年肥胖胆囊炎患者的临床特点及诊治经验

    Institute of Scientific and Technical Information of China (English)

    李坤平; 林帆; 古维立; 徐波; 范少峰; 赖越元; 林春明

    2011-01-01

    Objective To investigate the clinical characteristics of the old obese patients of cholecystitis. Methods The clinical data of 129 old obese cases were retrospectively studied, in whom 55 received conservative treatment and 74 cases received operations (routine cholecystectomy in 67, gallbladder resection + cholecystomy in 5 and partial cholecystectomy in 2). Results In 74 surgical cases, there were 3 cases complicated with bile leakage, 1 with bleeding and 2 with wound seroma, and all got cured. In 55 cases of conservative treatment, there were 2 cases suffered from the liver function failure and died later. It showed longer operative time, more bleeding, longer hospital stay and higher complication rate in the diabetes and ( or ) BMI ≥28 patients. Conclusion The aged, especially in the obese patients, may be one of the risk factors for acute exacerbation of chronic cholecystitis and gallstone; clinical symptoms may be not typical with a strong hidden of advance complications, relative risks of certain difficulties brought on the diagnosis and treatment which needs closer attentions.%目的 探讨老年肥胖患者胆囊炎的临床特点.方法 我科2008年1月~2011年3月收治898例胆囊炎患者,其中129例为老年肥胖患者,129例中行保守治疗55例,余74例行手术治疗,其中胆囊切除术67例,胆囊切除+胆囊造瘘术5例,胆囊大部分切除术2例.结果 74例手术患者术后出现胆漏3例,出血1例,伤口脂肪液化2例,均治愈.55例保守治疗患者中2例并发肝功能衰竭死亡.伴有糖尿病及BMI≥28的患者,其手术时间长,术中出血量大、住院时间久,并发症发生率高(P<0.05).结论 老年,尤其是肥胖患者,可能是慢性胆囊炎急性发作、胆囊结石的危险因素之一;其临床症状不典型,具有较强的隐蔽性,并发症相对较多,预后相对较差,应该及早诊治.

  19. Pharmaceutical Care for A Patient with Acute Cholecystitis during the Antibacterial Treatment%1例急性胆囊炎患者抗感染治疗的药学监护

    Institute of Scientific and Technical Information of China (English)

    张晓裕; 刘腾

    2014-01-01

    A case of pharmaceutical care by clinical pharmacists during the antibacterial treatment of acute cholecystitis was introduced. Combined with a case,Pharmacists upervising the main changes of indicators, and analyzing the whole process of medication, clinical pharmacists provided timely recommendations for antimicrobial drugs selection.With the cooperation of clinical pharmacists, the doctors adjusted the treatment plans and the patients got great benefit from the pharmaceutical care. Clinical pharmacists would play a very important role in clinical rational drug use.%本文介绍1例临床药师结合急性胆囊炎患者具体病情,对给药方案进行分析、审核,协助临床调整抗菌治疗方案的过程。在药师参与下,临床医生更合理的应用抗菌药物,提高了患者用药安全性、有效性,使患者更大限度受益。体现了临床药师对患者进行的药学监护在临床合理用药中发挥非常重要的作用。

  20. 彩色多普勒超声检查早期诊断急性感染性胆囊炎的临床研究%Clinical study of color Doppler ultrasound for early diagnosis of acute cholecystitis infection

    Institute of Scientific and Technical Information of China (English)

    徐永通; 黄楠; 冯涛; 孙建东; 郭瑞

    2014-01-01

    目的:探讨彩色多普勒超声检查早期诊断急性感染性胆囊炎的临床价值,以期提高急性感染性胆囊炎诊断水平。方法选择36例急性感染性胆囊炎患者为研究对象(观察组),随机选取同期体检正常者为对照组,观察两组彩色多普勒超声声像图的表现,测量两组肝动脉和胆囊动脉的血流最大峰值流速( Vmax)和阻力指数( RI)。采用ROC曲线观察彩色多普勒超声对该疾病的特异性。结果对照组胆汁透声差、胆囊壁厚、胆囊肿大、超声Murphy阳性发生率分别为25.0%、16.7%、22.2%、8.3%,观察组胆汁透声差、胆囊壁厚、胆囊肿大、超声Murphy阳性发生率分别为72.2%、47.2%、100.0%、94.4%,两组差异均有统计学意义(χ2=4.571、4.571、4.589、5.689,均P<0.05);两组肝动脉和胆囊动脉的Vmax和RI差异有统计学意义(P<0.05)。进行ROC曲线比较,观察组胆囊增大的正确率最高,为90.7%,特异性为90.7%,灵敏度为90.6%,与其他超声指标比较差异无统计学意义(χ2=0.893,P>0.05)。结论彩色多普勒超声检查能显示急性感染性胆囊炎的形态、胆囊壁程度、胆汁透声等情况,可提高对该疾病的诊断价值。%Objective To investigate the clinical value of color Doppler ultrasound in the early diagnosis of acute cholecystitis infection ,in order to improve the diagnosis of acute cholecystitis infection .Methods 36 cases with acute cholecystitis infection were selected as the observation group , and during the same period the healthy people were randomly selected as the control group .The color Doppler performance of ultrasound was observed .The hepatic artery blood flow velocity and the maximum peak of the cystic artery (Vmax) and resistance index(RI) were meas-ured.ROC curve was observed to evaluate the specificity of color Doppler ultrasound for the

  1. Morphine-augmented cholescintigraphy and acute a calculous cholecystitis in critically ill patients: interest and new way of interpreting; Cholescintigraphie et cholecystite aigue alithiasique en reanimation: place et proposition d'une nouvelle interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Emptaz, A.; Prevot, N.; Dubois, F. [Centre Hospitalier Universitaire, Hopital Nord, Service de Medecine Nucleaire, 42 - Saint-Etienne (France); Mahul, P.; Mariat, G.; Jospe, R.; Auboyer, C. [Centre Hospitalier Universitaire, Hopital Nord, Service de Reanimation, 42 - Saint-Etienne (France); Cuilleron, M. [Centre Hospitalier Universitaire, Hopital Nord, Service de Radiologie, 42 - Saint-Etienne (France)

    2005-01-15

    Introduction: Acute acalculous cholecystitis (AAC) is a serious disease, difficult to diagnose in critically ill patients. The aim of the study was to evaluate the diagnostic performances of abdominal ultrasonography (US) and morphine-augmented cholescintigraphy (MC) and to improve diagnostic strategy in patients of intensive care unit (ICU) with suspected AA C. Methods: We retrospectively studied 82 consecutive ICU patients with suspected AA C. US was positive if the triad of gallbladder distension, gallbladder wall thickening and sludge was found. MC was positive if the gallbladder remained non-visualized after morphine injection. In a second time, other scintigraphic criteria of interpretation were tested, according to the visualization of the gallbladder before or after morphine administration. Treatment was decided on the basis of clinical, laboratory and imaging data. Results: The diagnosis of AAC was retained in 34 patients. US and MC had respectively for the diagnosis of AAC a sensitivity of 20.6 and 70.6%, and a specificity of 95.8 and 100%. Interpreting the MC as positive if the gallbladder remains non-visualized after morphine, as negative if it appears before, and as non-conclusive if visualized after, makes it possible to define respectively patients with high probability (100%), with low probability (7.5%) or with intermediate probability (39%) of AAC. Conclusions: MC is better than US for diagnosing AAC in critically ill patients, having in particular excellent specificity using the classical criteria of interpretation. MC must be thus performed in patients at risk for AAC, determined with clinical, laboratory and eventually echographic findings. To decrease false negative rate of MC, a probability categorical classification is proposed to improve patients' care. (author)

  2. [Changes in the L-serine and L-threonine dehydrogenase activities in the blood serum of those who worked in the cleanup of the aftermath of the accident at the Chernobyl Atomic Electric Power Station who became ill with chronic acalculous cholecystitis].

    Science.gov (United States)

    Komarenko, D I; Soboleva, L P; Ovsiannikova, L M; Kadiuk, E N; Shvaĭko, E A; Nosach, E V

    1999-06-01

    Activity was studied of blood serum plasmic enzymes L-serine and L-threonine dehydrogenazes (SDG and ThDG) in 92 liquidators of aftermath of the Chernobyl atomic power plant breakdown, presenting with chronic non-calculous cholecystitis during the stage of moderately severe exacerbation with no clinical and laboratory and sonographic signs of affection of the liver. A quarter of the examinees demonstrated an increased activity of the enzymes under study, which fact is regarded by the authors as a preclinical sign of reactive hepatitis. Recommendations are given as to the outpatient registration and prophylactic management and therapy of those persons having taken part in the elimination of the effects of the Chernobyl accident, presenting with biliary pathologies. PMID:10476630

  3. Biliary tree and cholecyst: post surgery imaging

    Energy Technology Data Exchange (ETDEWEB)

    Valek, Vlastimil [Department of Radiology, University Hopistal Brno, Jihlavska 20, 63900 Brno (Czech Republic)]. E-mail: v.valek@fnrbno.cz; Kala, Zdenek [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic); Kysela, Petr [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic)

    2005-03-01

    Recently, with improvements in surgical techniques there has been a substantial reduction in the incidence of biliary complications of hepatobiliary surgery. Nevertheless, bile duct injuries and other post-cholecystectomy complications are a serious problem and a major cause of morbidity and mortality. Early complications may include bile duct injury caused by mistakenly placed clips, erroneous cutting of bile ducts based on misinterpretation of biliary anatomy, periductal bile leakage that causes edema, fibrosis and secondary stricturing, and ischemia due to injury to the right hepatic artery. Bile duct strictures are the most common of the late complications and can develop a few months or many years after surgery. Early detection and accurate diagnosis have a fundamental importance for the successful treatment of these complications. Therefore, early and meaningful application of the imaging methods immediately after detection of the first symptoms is essential. Peroperative ultrasound and direct iodine contrast application into the biliary tree (operative cholangiography) are highly important for immediate visualization of the complications during surgery. Ultrasound can be used to aid in identification of ductal structures and the cholangiogram should be obtained to document the anatomy. Plain abdominal film could be made in the patients in poor clinical conditions after biliary surgery. Oral cholecystography has largely been replaced by ultrasonography (US) for evaluation of cholelithiasis and complications like post-cholecystectomy fluid collections. The same methodology replaced the conventional intravenous cholangiography. Nowadays computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP) and ultrasound (US) have essential roles as primary imaging modalities after biliary tree and gallbladder surgery in the evaluation of associated complications and residual biliary stones. We review the role of the imaging in complications after biliary tree and gallbladder surgery.

  4. Prevalence of Helicobacter spp in chronic cholecystitis and correlation with changes on the histological pattern of the gallbladder Prevalência do Helicobacter spp na colecistite crônica calculosa e correlação com as alterações histológicas da vesícula biliar

    Directory of Open Access Journals (Sweden)

    André de Moricz

    2010-06-01

    Full Text Available PURPOSE: Establish the prevalence of Helicobacter spp in chronic cholecystitis and its correlation with the gallbladder's histological findings. METHODS: 100 patients were operated for chronic cholecystitis with cholecystolithiasis. In pathological examination of the gallbladder, were evaluated the presence of metaplasia, dysplasia, lymphoid follicles, anaplasia and tumors that might be related to the presence of Helicobacter plus the presence of the bacilli Giemsa? by optical microscopy. From the DNA extracted from the gallbladder's bile, PCR was performed by using specific primers for the identification of Helicobacter spp with amplification of the 400bp segment of rRNA gene16S, with positive control DNA from Helicobacter pylori. All the cases negative for isolation of genetic material were excluded. The cases of PCRΘ and GiemsaΘ were used as negative control group. The histological findings were compared to the presence of bacilli and PCR data using a chi-square and Fisher's Exact test (CI = 95.0%, p OBJETIVO: Estabelecer a prevalência do Helicobacter spp nos doentes com colecistopatia crônica calculosa e correlacioná-la com as alterações histológicas da vesícula biliar. MÉTODOS: Foram operados 100 doentes portadores de colecistite crônica calculosa. No anátomo-patológico foram avaliadas a presença de, metaplasias, displasias, folículos linfóides, anaplasias e tumores que pudessem se relacionar à presença do helicobacter e a presença de bacilos Giemsa ? à microscopia. A partir do DNA extraído da bile foi realizada PCR utilizando-se primers específicos para identificação de Helicobacter spp com amplificação de segmento de 400bp do gene16S rRNA, com controle positivo de DNA de Helicobacter Pylori. Os casos negativos para isolamento de material genético na bile foram excluídos. Os casos de PCR e Giemsa negativos foram utilizados como grupo controle. Os achados histológicos foram comparados ao Giemsa e à PCR

  5. Estudo da incidência de coledocolitíase em pacientes com colecistite calculosa aguda e crônica submetidos à colecistectomia vídeolaparoscópica Study of incidence of choledocholitiasis: in patients with acute and chronic calculous cholecystitis operated by laparoscopic cholecistectomy

    Directory of Open Access Journals (Sweden)

    Sidney Moreno Gil

    2007-08-01

    Full Text Available OBJETIVO: Avaliar a incidência da coledocolitiase em pacientes submetidos à colecistectomia laparoscópica, portadores de colecistopatia calculosa aguda e crônica. O presente estudo, também, analisa se a era laparoscópica modificou a incidência e a história natural da litíase da via biliar quando compara os dados da literatura com os índices do Grupo estudado. MÉTODO: O estudo foi realizado em um Grupo de 946 pacientes, distribuídos em Grupo A de 214 pacientes de 1991-1995 e Grupo B de 732 pacientes de 1999-2007 colecistectomizados pelo método laparoscópico. O critério diagnóstico de coledocolitíase foi estabelecido por colangiofluoroscopia de rotina em todas as operações. RESULTADOS: A incidência total de coledocolitiase no Grupo A de 9,8% e no B de 5,8% não mostram diferença estatística significativa entre si e com a literatura mundial (p=0,08.Nos pacientes operados por colecistite aguda também não se observou diferença estatística entre o grupo A e B na incidência de litíase da via biliar( p=0,8. A análise dos dados nos pacientes operados por colecistite crônica revela uma taxa de coledocolitíase menor no Grupo B de 3,7% com significância estatística do que no A de 8,4% p=0,03. CONCLUSÃO: O presente estudo revela uma diminuição expressiva na incidência de coledocolitiase no Grupo B em relação ao A e a literatura mundial quando a indicação cirúrgica ocorre na fase não complicada da doença litiásica biliar. O estudo também demonstra um aumento significativo na indicação da colecistectomia laparoscópica eletiva mais precoce no Grupo B como já observado em diversas publicações da literatura médica.BACKGROUND: To evaluate the incidence of choledocholitiasis in patients submitted to the laparoscopic cholecystectomy, carriers of acute and chronic calculous cholecystitis .The present study also analyses if the laparoscopic age modified the incidence and the natural history of lithiasis of the

  6. 急性结石性胆囊炎腹腔镜胆囊切除术手术时机的选择及中转开腹影响因素分析%Timing of Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis and Influencing Factors for Conversion to Open Surgery

    Institute of Scientific and Technical Information of China (English)

    柳己海

    2013-01-01

    目的 探讨腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素.方法 选择2007年6月-2012年6月在我院行腹腔镜胆囊切除术的急性结石性胆囊炎患者230例.按从症状发作到接受腹腔镜胆囊切除术的时间间隔分为4组,Ⅰ组(74例)为症状发作48 h内手术的患者;Ⅱ组(69例)为症状发作后48~72 h内手术的患者;Ⅲ组(53例)为症状发作72 h后手术的患者;Ⅳ组(34例)为入院后先给予抗感染、对症及支持治疗,症状缓解2~4周后再择期手术的患者.比较4组患者术后并发症发生率、中转开腹率及手术时间,同时分析影响中转开腹的相关因素.结果 4组患者术后并发症发生率比较,差异无统计学意义(χ2=1.26,P>0.05);中转开腹率、手术时间比较,差异均有统计学意义(χ2=5.77,P<0.05;F=7.99,P<0.01).单因素分析显示,体温、胆囊肿大、右上腹肌紧张、白细胞计数、胆囊壁厚度、胆囊颈部结石嵌顿、手术时机7个因素与中转开腹有关(P<0.05).多因素Logistic回归分析结果显示,白细胞计数[r=1.298,OR=3.698,95%CI(1.867,4.789)]和手术时机[r=1.062,OR=2.265,95%CI(1.688,3.821)]进入回归方程.结论 急性结石性胆囊炎症状发作后48 h内是腹腔镜胆囊切除术的最佳时机,白细胞计数和手术时机选择是影响中转开腹的两个独立危险因素.%Objective To investigate the best timing of laparoscopic cholecystectomy for acute calculous cholecystitis and influencing factors for conversion to open surgery. Methods 230 patients with acute calculous cholecystitis underwent laparo- scopic cholecystectomy in our hospital from Jimp 2007 to Jimp 2012 were divided into four groups according to the time from onset to underwent laparoscopic cholecystectomy: Group I ( 74 cases ), within 48 h; group II ( 69 cases ), from 48 h to 72 h; group III ( 53 cases ), after72h; group IV ( 34 cases ) . After admitted to the

  7. Technical difficulties and avoidance of complications in delayed laparoscopic cholecystectomy for acute cholecystitis%急性胆囊炎“延期”腹腔镜胆囊切除的手术技巧及并发症预防

    Institute of Scientific and Technical Information of China (English)

    朱斌; 张展志; 张能维; 宫轲; 路夷平; 王岩; 阿民布和; 李凯; 王桐生

    2011-01-01

    Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).Methods The results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.Results There was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P<0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 % vs 2/99 2.02 %,P>0.05).Conclusions Delayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.%目的 探讨急性胆囊炎延期腹腔镜胆囊切除术(LC)的手术技巧及并发症预防.方法 将2004年2月至2008年8月收治的133例急性胆囊炎行LC患者,按急性胆囊炎发作后手术治疗的时间分为两组:急性发作72 h内手术的为早期组(34例)和急性发作72 h后手术的延期组(99例).手术技巧是沿胆囊壶腹分离胆囊管,尽量充分“掏空”、显露Calot三角,顺行切除胆囊;如Calot三角粘连紧密,解剖关系不清,可逆性切除胆囊或自

  8. Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy.

    Science.gov (United States)

    Rodrigue, Paul; Fakhri, Asif; Baumgartner, Andrew

    2015-12-01

    We present a case of a 59-y-old woman who had undergone cholecystectomy and was subsequently found to have an abscess within the gallbladder fossa. A hepatobiliary scan using (99m)Tc-diisopropyliminodiacetic acid demonstrated the characteristic rim sign, a photopenic defect surrounded by a rim of mildly increased activity immediately adjacent to the gallbladder fossa. The rim sign was thought to be the result of reactive inflammation in the hepatic tissue adjacent to a postoperative abscess within the gallbladder fossa. PMID:26111711

  9. A sign of symptomatic chronic cholecystitis on biliary scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Sheikh, W.; Hourani, M.; Barkin, J.S.; Clarke, L.P.; Ashkar, F.S.; Serafini, A.N.

    1983-02-01

    Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with /sup 99m/Tc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography.

  10. A sign of symptomatic chronic cholecystitis on biliary scintigraphy

    International Nuclear Information System (INIS)

    Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with /sup 99m/Tc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography

  11. Quality of life (GIQLI and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis Calidad de vida (GIQLI y utilidad de la colecistectomía laparoscópica en pacientes con disfunción vesicular o dolor crónico biliar alitiásico (colecistitis crónica alitiásica

    Directory of Open Access Journals (Sweden)

    M. Planells Roig

    2004-07-01

    Full Text Available Objective: the aim of this study was to evaluate the incidence, clinical features and role of laparoscopic cholecystectomy (LC in patients with chronic acalculous cholecystitis (CAC in comparison with a control group of patients who underwent cholecystectomy for chronic calculous cholecystitis (CCC. Material and methods: prospective evaluation of 34 patients with CAC in contrast with 297 patients with CCC. Outcome measures: clinical presentation, quality of life using the Gastrointestinal Quality of Life Index (GIQLI, usefulness derived from the therapeutic procedure as measured in quality of life units by GIQLI, and clinical efficacy at one year of follow-up. Results: the incidence of complicated biliary disease was higher in CAC (27%, in comparison with CCC (13.8%. The histological study of the excised gallbladder revealed a higher incidence of cholesterolosis associated with chronic cholecystitis in the CAC group (64.9%. GIQLI showed significant differences between preoperative and postoperative measurements in both groups. The associated usefulness of LC was similar in both groups (73 versus 67.3 per cent, confirming an important increase in quality of life for both categories. Conclusions: the incidence of CAC is 11 per cent with a high association with cholesterolosis. Quality of life and LC usefulness are similar to those of patients with CCC. Due to the fact that cholecistogammagraphy is a technique not available in daily clinical practice, and that oral cholecystography and dynamic ultrasound are reliable when a positive result is obtained, extended clinical evaluation is still the most reliable indicator for cholecystectomy.Objetivo: evaluar la incidencia, manifestaciones clínicas y el papel de la colecistectomía laparoscópica (CL en pacientes con diagnóstico de colecistitis crónica alitiásica (CCA en comparación con un grupo control de pacientes intervenidos por colecistitis crónica litiásica (CCL. Material y m

  12. Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Er-Zhen Chen; Jie Huang; Zhi-Wei Xu; Jian Fei

    2013-01-01

    BACKGROUND: The  effects  of  gangrenous  cholecystitis  (GC) and consequent surgical interventions on the clinical outcomes and  prognosis  of  patients  with  severe  acute  pancreatitis  are not  clear.  The  present  study  was  to  characterize  the  clinical outcomes of patients with severe acute pancreatitis complicated with GC. METHODS: We  retrospectively  analyzed  253  consecutive patients  hospitalized  for  acute  pancreatitis  in  intensive  care unit. Among them, 68 were diagnosed as having severe acute pancreatitis;  10  out  of  the  68  patients  had  GC.  We  compared these  10  patients  with  GC  and  58  patients  without  GC.  The indices  analyzed  included  sepsis/septic  shock,  pancreatic encephalopathy,  acute  respiratory  distress  syndrome,  acute renal failure, multiple organ dysfunction syndrome, and death. RESULTS: Specific CT images of GC in patients with severe acute pancreatitis  included  enlarged  and  high-tensioned  gallbladder, wall  thickening,  lumenal  emphysema,  discontinuous  and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P CONCLUSION: CT  scans  can  help  to  identify  early  GC  in patients  with  severe  acute  pancreatitis;  early  diagnosis  and intervention  for  patients  with  GC  can  reduce  morbidity  and mortality.

  13. A Cholecystocolonic Fistula Detected by MRCP in a Patient with Chronic Cholecystitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    A cholecystocolonic fistula is an uncommon late complication of chronic gallstone disease. Although it may cause acute life-threatening complications such as bowel obstruction or massive hemorrhaging, its accurate preoperative diagnosis may be difficult due to minimal or nonspecific symptoms. Cholecystocolonic fistulas have been diagnosed by various methods, including ERCP. However, the diagnosis of a cholecystocolonic fistula using MRCP has not been reported in the literature. In this case report, we describe a case of a cholecystocolonic fistula detected by MRCP.

  14. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    International Nuclear Information System (INIS)

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

  15. Heterotopic Pancreas of the Gallbladder Associated with Chronic Cholecystitis and High Levels of Amylasuria

    Directory of Open Access Journals (Sweden)

    Thanasis Klimis

    2011-09-01

    Full Text Available Context Heterotopic pancreas of the gallbladder is an extremely rare entity, especially when pancreatic tissue appears histologically with an exclusively exocrine structure. Case report We report the case of a 35-year-old man who presented with symptoms of acalculous gallbladder disease with high levels of amylasuria. Immunohistochemical analysis of the surgical specimen of the cholecystectomy revealed pancreatic tissue at the gallbladder wall. Conclusions Heterotopic pancreatic tissue is a rare pathological finding in the gallbladder. It requires consideration and sensitization in the differential diagnosis of acalculous gallbladder disease, which can explain hyperamylasuria in cases of unknown origin.

  16. Unexpectedly Diagnosed Caroli’s Disease on HIDA Scintigraphy in a Patient with Calculous Cholecystitis

    OpenAIRE

    Shinto, Ajit S.; Selvakumar, Job

    2010-01-01

    Caroli’s disease, which is a rare condition with congenital dilatation of the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli’s dis...

  17. Ultrasonography findings of biliary ascariasis as a rare cause of acalculous cholecystitis

    OpenAIRE

    Şalk, İsmail; Atalar, Mehmet H.

    2014-01-01

    AbstractAscaris lumbricoides is the most common intestinal parasite to infect humans. The incidence of ascariasis is increasing in all part of the world because of world travel and population migration. Ascaris lumbricoides may cause various complications in the gastrointestinal system. Abdominal pain and tenderness with weight loss are the most common clinical presentations. The parasite can cause invagination at the intestinal segments and can enter the bile duct and cause cholangitis or bi...

  18. [Serious Coagulation Dysfunction in a Patient with Gallstone-related Cholecystitis Successfully Treated with Vitamin K].

    Science.gov (United States)

    Shimamoto, Saki; Tanaka, Akiko; Tsuchida, Keiichiro; Hayashi, Kazuko; Sawa, Teiji

    2016-04-01

    An 85-year-old woman with a diagnosis of choledocholithiasis due to common duct stones gradually developed severe coagulation dysfunction over the course of 27 days after hospitalization. Initial clinical findings were fever, general malaise, and obstructive jaundice. She was treated with fasting, and received cephem antibiotics containing N-methyl-thio-tetrazole. Because the common duct stones were not removed endoscopically, cholecystectomy was scheduled. Coagulation on admission was normal, but gradually became impaired. On the scheduled day of the operation, 27 days after hospitalization, coagulation [both prothrombin time (PT) and activated partial thromboplastin time (APTT)] were severely impaired PT, < 10%; PT-international normalized ratio, 6.29; and APTT, 71.6 s. No other abnormalities were identified. Surgery was postponed and antibiotics were discontinued. Simultaneously, administration of vitamin K was initiated. Six days after starting vitamin K, coagulation dysfunction had resolved and the surgery was safely performed under general anesthesia combined with thoracic epidural anesthesia. Care is warranted regarding coagulation dysfunction due to vitamin K deficiency in patients with hepatobiliary disease treated by fasting and antibiotics. PMID:27188119

  19. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Shinto, A. S.; Selvakumar, J. [Amala Institute of Medical Sciences, Amalanagar (India)

    2010-12-15

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

  20. Vólvulo de vesícula con colecistitis: Reporte de un caso Gallbladder volvulus with cholecystitis: Case report

    OpenAIRE

    Mariano Kreplak; Marcelo Zamboni; Lucrecia Quenard

    2009-01-01

    Se reporta el caso de una paciente femenina de 62 años de edad que se presenta con cuadro de abdomen agudo de pocas horas de evolución. Se realizó TC, observándose lesión infraumbilical oblonga, de contenido líquido, de paredes de 3-5 mm, con imágenes de aspecto cálcico. La imagen fue interpretada como vólvulo intestinal o tumor quístico peritoneal. El diagnóstico quirúrgico fue vólvulo vesicular, entidad infrecuente de difícil diagnóstico preoperatorio.We report on a 62-year-old female patie...

  1. Development of gene diagnosis for diabetes and cholecystitis based on gene analysis of CCK-A receptor

    Energy Technology Data Exchange (ETDEWEB)

    Kono, Akira [National Kyushu Cancer Center, Fukuoka (Japan)

    1999-02-01

    Base sequence analysis of CCKAR gene (a gene of A-type receptor for cholecystokinin) from OLETF rat, a model rat for insulin-independent diabetes was made based on the base sequence of wild CCKAR gene, which had been clarified in the previous year. From the pancreas of OLETF rat, DNA was extracted and transduced into {lambda}phage after fragmentation to construct the gene library of OLETF. Then, {lambda}phage DNA clone bound with labelled cDNA of CCKAR gene was analyzed and the gene structure was compared with that of the wild gene. It was demonstrated that CCKAR gene of OLETF had a deletion (6800 b.p.) ranging from the promoter region to the Exon 2, suggesting that CCKAR gene is not functional in OLETF rat. The whole sequence of this mutant gene was registered into Japan DNA Bank (D 50610). Then, F{sub 2} offspring rats were obtained through crossing OLETF (female) and F344 (male) and the time course-changes in the blood glucose level after glucose loading were compared among them. The blood glucose level after glucose loading was significantly higher in the homo-mutant F{sub 2} (CCKAR,-/-) as well as the parent OLETF rat than hetero-mutant F{sub 2} (CCKARm-/+) or the wild rat (CCKAR,+/+). This suggests that CCKAR gene might be involved in the control of blood glucose level and an alteration of the expression level or the functions of CCKAR gene might affect the blood glucose level. (M.N.)

  2. Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    Science.gov (United States)

    Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

    2012-01-01

    The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  3. Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    Science.gov (United States)

    Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

    2012-01-01

    The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  4. Acute acalculous cholecystitis in a patient with primary Epstein-Barr virus infection: a case report and literature review

    Directory of Open Access Journals (Sweden)

    J. Agergaard

    2015-06-01

    In conclusion primary EBV infection should be considered in cases of AAC, especially in young women. In cases associated with EBV infection neither administration of antibiotics nor surgical drainage may be indicated.

  5. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Wilson, E; Gurusamy, K; Gluud, C;

    2010-01-01

    value-of-information analysis estimated the likely return from further investment in research in this area. RESULTS:: ELC is less costly (approximately - pound820 per patient) and results in better quality of life (+0.05 QALYs per patient) than DLC. Given a willingness-to-pay threshold of pound20 000...... better quality of life than DLC. Future research should focus on quality-of-life measures alone. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd....

  6. Development of gene diagnosis for diabetes and cholecystitis based on gene analysis of CCK-A receptor

    International Nuclear Information System (INIS)

    Base sequence analysis of CCKAR gene (a gene of A-type receptor for cholecystokinin) from OLETF rat, a model rat for insulin-independent diabetes was made based on the base sequence of wild CCKAR gene, which had been clarified in the previous year. From the pancreas of OLETF rat, DNA was extracted and transduced into λphage after fragmentation to construct the gene library of OLETF. Then, λphage DNA clone bound with labelled cDNA of CCKAR gene was analyzed and the gene structure was compared with that of the wild gene. It was demonstrated that CCKAR gene of OLETF had a deletion (6800 b.p.) ranging from the promoter region to the Exon 2, suggesting that CCKAR gene is not functional in OLETF rat. The whole sequence of this mutant gene was registered into Japan DNA Bank (D 50610). Then, F2 offspring rats were obtained through crossing OLETF (female) and F344 (male) and the time course-changes in the blood glucose level after glucose loading were compared among them. The blood glucose level after glucose loading was significantly higher in the homo-mutant F2 (CCKAR,-/-) as well as the parent OLETF rat than hetero-mutant F2 (CCKARm-/+) or the wild rat (CCKAR,+/+). This suggests that CCKAR gene might be involved in the control of blood glucose level and an alteration of the expression level or the functions of CCKAR gene might affect the blood glucose level. (M.N.)

  7. Vólvulo de vesícula con colecistitis: Reporte de un caso Gallbladder volvulus with cholecystitis: Case report

    Directory of Open Access Journals (Sweden)

    Mariano Kreplak

    2009-12-01

    Full Text Available Se reporta el caso de una paciente femenina de 62 años de edad que se presenta con cuadro de abdomen agudo de pocas horas de evolución. Se realizó TC, observándose lesión infraumbilical oblonga, de contenido líquido, de paredes de 3-5 mm, con imágenes de aspecto cálcico. La imagen fue interpretada como vólvulo intestinal o tumor quístico peritoneal. El diagnóstico quirúrgico fue vólvulo vesicular, entidad infrecuente de difícil diagnóstico preoperatorio.We report on a 62-year-old female patient who presented with an acute abdomen developed shortly before her visit. CT scan revealed infraumbilical oblong mass, fluid content and thick walls (3-5 mm, with calcium images. The image was interpreted as intestinal volvulus or peritoneal cystic tumor. The surgical diagnosis was gallbladder volvulus, an uncommon entity, which is difficult to diagnose preoperatively.

  8. Acute acalculous cholecystitis (AAC in the pediatric population associated with Epstein–Barr Virus (EBV infection. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fuad Alkhoury

    2015-01-01

    PRESENTATION OF CASE: A 15-year-old female who came to the JDCH ER complaining of 3 days history of mild diffuse abdominal pain associated with two episodes of emesis. She also reports headache as well as a mild cough and low grade subjective fever. Blood test results showed mild leukocytosis with significant elevation in the lymphocytes (59%, High alkaline phosphatase (221 U/I, AST (191 U/I, ALT(221 U/I and bilirubin (Total 1.8 and direct 1.5. Abdominal US showed a contracted gallbladder with wall thickness and pericholecystic fluid. During hospital stay number 2–3 laboratory work up show a trending up in the bilirubin levels. MRCP was ordered and no abdnormalities were found. At this point Hospital stay number 3 EBV acute infection was suspected. Serum serological studies were subsequently diagnostic for this viral disease. Management was conservative and the patient was discharged asymptomatic on hospital day number six.

  9. Gallbladder removal - laparoscopic

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2012:chap 55. Read More Acute cholecystitis Chronic cholecystitis Gallbladder removal - open Gallstones Patient Instructions Bland diet Surgical wound care - open When you have nausea and vomiting ...

  10. 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.)

  11. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

    International Nuclear Information System (INIS)

    Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients' duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: occurrence of duodenogastric reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p<0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients. (author)

  12. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Shih, Wei-Jen; Magoun, S.; Wierzbinski, B.; Ryo, U-Yun [Kentucky Univ., Lexington, KY (United States). Medical Center; Lee, Jong-Kang

    1995-11-01

    Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients` duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: occurrence of duodenogastric reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p<0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients. (author).

  13. Color doppler sonography in thickened gallbladder wall

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. Color doppler sonography in thickened gallbladder wall

    International Nuclear Information System (INIS)

    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

  15. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent

    OpenAIRE

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-01-01

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis aft...

  16. Cholecystoduodenal Fistula:An Intraoperative Diagnosis

    Directory of Open Access Journals (Sweden)

    M.R. Attri, Shahnawaz Ahangar, Rajni Bhardwaj

    2010-01-01

    Full Text Available We report a case of chronic cholecystitis that had no preoperative diagnosis of cholecystoduodenal fistulabut was found during laparoscopic cholecystectomy and was managed successfully.

  17. Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community

    Science.gov (United States)

    2009-05-06

    Ascites; Blunt Abdominal Trauma; Cholelithiasis; Cholecystitis; Cholangitis; Pancreatitis; Hydronephrosis; Abdominal Aortic Aneurysm; Hepatitis; Portal Hypertension; Urolithiasis; Abnormal Uterine Bleeding; Ovarian Mass; Ovarian Torsion

  18. Biliary scintigraphy in children with sickle cell anemia and acute abdominal pain

    International Nuclear Information System (INIS)

    The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant abdominal pain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented. (orig.)

  19. Perforeret akut akalkuløs kolecystitis forårsaget af hepatitis A

    DEFF Research Database (Denmark)

    Cuk, Pedja; Iqbal, Mozammil; Lykke, Jakob

    2014-01-01

    Acute acalculous cholecystitis is a rare condition associated with a high risk of gangrene, empyema and perforation of the gallbladder. In this case report it is described how hepatitis A infection leads to a fulminant perforated acalculous chole-cystitis, which is described sporadically in the l...

  20. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent.

    Science.gov (United States)

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-02-16

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement. PMID:21403817

  1. Weight Loss Surgery: An Option for Teens?

    Science.gov (United States)

    ... Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & ... Late onset​ ​Cholecystitis Dysphagia Gastroesophageal reflux Incisional hernia Malnutrition Pancreatitis Ulcers Renal calculi Internal hernia Small bowel ...

  2. CEA blood test

    Science.gov (United States)

    ... return of colon and other cancers such as medullary thyroid cancer and cancers of the rectum, lung, ... or gallbladder inflammation ( cholecystitis ) Heavy smoking Inflammatory bowel diseases (such as ulcerative colitis or diverticulitis ) Lung infection ...

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

    OpenAIRE

    Shrestha KR; Paudel G; Khaniya S; Agrawal CS; Shakya VC; Adhikary S

    2010-01-01

    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.

  4. Amylase - blood

    Science.gov (United States)

    ... amylase levels may occur due to: Acute pancreatitis Cancer of the pancreas , ovaries, or lungs Cholecystitis Gallbladder attack caused by ... open) Decreased amylase levels may occur due to: Cancer of the pancreas Damage to the pancreas Kidney disease Toxemia of ...

  5. A right diaphragmatic eventration incidentally diagnosed and successfully repaired through an abdominal approach. A case report.

    Science.gov (United States)

    Di Carlo, I; Pulvirenti, E; Toro, A

    2009-01-01

    We report a case of an elderly woman with a large eventration of the right hemidiaphragm, discovered during an episode of acute cholecystitis, with abdominal and pleural effusion, successfully treated by a laparotomic approach. PMID:19499689

  6. Transpapilary drainage of the gallbladder; Report of two cases and literature revision

    International Nuclear Information System (INIS)

    We present two patients with cholelithiasis, repeated bouts of acute cholecystitis and high surgical risk secondary to coexisting illness, in which transpapilary drainage of the gallbladder was done. The literature is reviewed

  7. Polyarteritis Nodosa of the Gallbladder : A Case Report

    International Nuclear Information System (INIS)

    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∼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

  8. Feasibility study of EUS-NOTES as a novel approach for peroral cholecysto-gastrostomy

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, P; Bhutani, M S

    2013-01-01

    EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery.......EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery....

  9. Polyarteritis Nodosa of the Gallbladder : A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    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

  10. Acalculous cholecystitis:A rare presentation of leptospirosis progressing to Weil’s disease

    Institute of Scientific and Technical Information of China (English)

    George Peter; Hegde Narasimha

    2011-01-01

    Leptospirosis is a zoonotic infection with higher incidence in tropics. Leptospirosis, is known for its variable manifestations, and is a clinical challenge for physicians in the tropics. Experienced clinicians, at times can mistake leptospirosis for non-medical conditions. A few reports of leptospirosis presenting as acalculous cholecystitis was found in review of literature. We intent to highlight acalculous cholecystitis as a rare but clinically significant presentation of leptospirosis.

  11. Expression of cystic fibrosis transmembrance conductance regulator mRNA in cholecystic mucosa of 100 patients with gallbladdertones%胆囊结石病人胆囊黏膜组织CFTR mRNA表达与胆囊结石形成关系的研究

    Institute of Scientific and Technical Information of China (English)

    陈锦鹏; 王志伟; 朱铭岩; 沈洪薰; 倪启超; 陈玉泉

    2004-01-01

    囊性穿膜传导调节因子(cystic fibrosis transmembrance conductance regulator,CFFR)是目前的研究热点之一。2000年10月~2002年3月.我们用RT-PCR分析研究100例胆囊结石病人及50例正常对照组胆囊黏膜CFTR mRNA表达.探讨胆囊结石病人胆囊组织CFTR mRNA的表达与胆石成因的关系。

  12. 急性结石性胆囊炎腹腔镜手术时机选择及中转开腹手术的影响因素分析%Analysis of the timing of laparoscopic for acute calculus cholecystitis and factors affecting the conversion to open operation

    Institute of Scientific and Technical Information of China (English)

    王晓军; 王志力; 郑立

    2013-01-01

    目的 探讨急性结石性胆囊炎腹腔镜手术时机的选择及中转开腹的影响因素.方法 对收治的138例急性结石性胆囊炎患者行腹腔镜胆囊切除术.所有患者分为I组(症状出现48 h内手术)、II组 ( 症状出现48 h后手术) 、III组 (保守治疗症状缓解后再择期手术)3组.术后对3组的临床资料进行分析.结果 I、II、III组中转开腹率分别为4.55%(2/44)、21.15%(11/52)、14.29%(6/42),I组开腹率明显低于II、III组(P0.05).单因素分析结果显示症状出现时间、白细胞数目、胆囊壁厚度、胆囊周围渗出、腹肌紧张等5个因素与中转开腹具有相关性(P<0.05).多因素回归分析提示症状出现时间和胆囊周围渗出是影响腹腔镜中转开腹手术的独立危险因素.结论 急性结石性胆囊炎症状出现48 h之内行腹腔镜手术的成功率高,症状出现时间和胆囊周围渗出是影响腹腔镜中转开腹率的独立危险因素.

  13. 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

  14. Percutaneous cholecystostome; 60 cases of experience

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

  15. Cholescintigraphy, ultrasonography and computerized tomography in the evaluation of biliary tract disorders

    International Nuclear Information System (INIS)

    Newer modalities available for the evaluation of hepatobiliary disease include cholescintigraphy, ultrasonography, and computerized tomography. We have examined the relative strengths and weaknesses of each of these noninvasive techniques and developed a rational diagnostic approach for the evaluation of acute cholecystitis, chronic cholecystitis, and cholestasis. The procedure of choice for suspected acute cholecystitis is /sup 99m/Tc-HIDA cholescintigraphy because it is a highly accurate method for obtaining functional information with regard to cystic duct patency. In suspected chronic cholecystitis, the oral cholecystogram is the best screening procedure, followed by ultrasound for confirmation of gallbladder disease as the cause of nonvisualizaion. The role of /sup 99m/Tc-HIDA cholescintigraphy in suspected chronic cholecystitis is limited to those cases where the oral cholecystogram and sonogram yield disparate results, or where a patient is known to have chronic gallbladder disease and super-imposed acute exacerbation is suspected. Ultrasonography is recommended as the initial procedure for evaluation of the patient with cholestasis. It is highly accurate in distinguishing hepatocellular disease from obstructive jaundice, and when dilated biliary radicles are visualized, ultrasonography is frequently capable of identifying the cause of obstruction. If the patient's body habitus or gaseous distention makes ultrasonographic evaluation difficult, then computerized tomography is recommended, followed by endoscopic retrograde cholangiopancreatography or transhepatic cholangiography, when needed

  16. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N; Qvist, N; Højgaard, L; Funch-Jensen, P; Kehlet, H

    1998-01-01

    and dyspepsia 5-10 years after cholecystectomy in 345 (222 women, 123 men) patients cholecystectomized for acute cholecystitis and in a control group of 296 (213 women, 83 men) patients cholecystectomized for uncomplicated symptomatic gallbladder stones. RESULTS: Of 641 questionnaires, 534 (83%) were...... completed. Complaints of abdominal pain and dyspepsia were found with similar frequencies in the acute cholecystitis and gallstone groups. Women had abdominal pain more often than men (42% versus 29%) (P = 0.01). Although more than one-third complained of abdominal pain after cholecystectomy, 93% had...... improved or were cured. CONCLUSION: The outcome after cholecystectomy seems to be independent of the underlying gallbladder disease (acute cholecystitis or elective operations for gallstones)....

  17. Laparoscopic cholecystectomy in situs inversus totalis: a case report

    Directory of Open Access Journals (Sweden)

    Blake Geoffrey

    2005-03-01

    Full Text Available Abstract Background Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally patients present with undiagnosed situs inversus and acute cholecystitis. We discuss one such case and outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. Case presentation A 32 year old female presented to our department with epigastric pain radiating through to the back. A diagnosis of acute cholecystitis in a patient with situs inversus totalis was made following clinical examination and radiological investigation. Laparoscopic cholecystectomy was subsequently performed and the patient made an uneventful recovery. Conclusion Situs inversus presenting with acute cholecystitis is very rare. The surgeon must appreciate that care should be taken to set up the operating theatre in the mirror image of the normal set-up for cholecystectomy, and that right handed surgeons must modify their technique to adapt to the mirror image anatomy.

  18. Laparoscopic cholecystectomy: Rate and predictors for conversion

    Directory of Open Access Journals (Sweden)

    Merdad Adnan

    1999-01-01

    Full Text Available Laparoscopic cholecystectomy (LC was attempted in 847 patients, 823 (97.2% were completed laparoscopically and 24 (2.8% had to be converted to open cholecystectomy (OC. Acute cholecystitis was the commonest reason for conversion (13 out of 24 patients. Patients who had acute cholecystitis are five times at risk for conversion to open than other patients with non-acute cholecystitis (p< 0.00I . Age and sex were not statistically significant predictors for conversion. There were no mortalities and no major bile duct injuries in our series. These data confirms the safety of LC, identify factors which predicts conversion to OC and may be helpful in selecting patients for day care ambulatory LC.

  19. Colecistectomia videolaparoscópica em paciente submetido a transplante cardíaco Laparoscopic cholecystectomy in heart transplant patient

    Directory of Open Access Journals (Sweden)

    Flávio Heuta Ivano

    2000-10-01

    Full Text Available Cardiac transplant has been performed with an increased frequency as the treatment for end-stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Pretransplant patients are well recognized for cardiac events, and posttransplant immunossupressed patients are at a considerable risk for septic complications. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign and it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylatic laparoscopic cholecistectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis and urgent cholecystectomy. In this case report we present a 44 year-old male with acute cholecystitis after cardiac transplantation who was submitted to a safe laparoscopic cholecystectomy one year and seven months later.

  20. Percutaneous transhepatic cholecystostomy

    International Nuclear Information System (INIS)

    Ultrasound-guided percutaneous cholecystostomy was performed in 11 patients. Indications were acute cholecystitis in 7 patients, and obstructive biliary disease in 4 patients. A transhepatic approach was used in all patients. In one patient, bile leakage was noticed during cholecystectomy. No other complications were seen. Three of five patients with an acalculous cholecystitis had a normal post-drainage cholangiogram and the drainage catheter could be removed. A follow-up of 5.5, and 26 months respectively, showed no recurrent disease. Three patients underwent surgery and the remaining five patients were drained until death by their underlying disease. Percutaneous cholecystostomy can be a life-saving and curative procedure in the critically ill patient, in case of acalculous cholecystitis, the only one needed. (orig.)

  1. Percutaneous transhepatic cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Lameris, J.S.; Jeekel, J.; Havelaar, I.J.; Seyen, A.J. van

    1985-01-01

    Ultrasound-guided percutaneous cholecystostomy was performed in 11 patients. Indications were acute cholecystitis in 7 patients, and obstructive biliary disease in 4 patients. A transhepatic approach was used in all patients. In one patient, bile leakage was noticed during cholecystectomy. No other complications were seen. Three of five patients with an acalculous cholecystitis had a normal post-drainage cholangiogram and the drainage catheter could be removed. A follow-up of 5.5, and 26 months respectively, showed no recurrent disease. Three patients underwent surgery and the remaining five patients were drained until death by their underlying disease. Percutaneous cholecystostomy can be a life-saving and curative procedure in the critically ill patient, in case of acalculous cholecystitis, the only one needed.

  2. Hubungan Imunoekspresi NF-kB dengan Sinus Rokitansky Aschoff pada Kolesistitis Kronik

    Directory of Open Access Journals (Sweden)

    Herry Yulianti

    2014-06-01

    Full Text Available Carcinoma of the gallbladder is relatively uncommon but it is a very lethal disease. Gallbladder cancer constitutes 3−4% of all malignant lesions and ranks 5th among the digestive system tumors. Gallblader carcinoma is difficult to detect and diagnose in early stage because it usually has very slight symptoms or asymptomatic. It becomes increasingly necessary to make early diagnosis and identification of high-risk patient,as well as gallstone and history of chronic cholecystitis. Chronic cholecystitis is a chronic inflammation of gallbladder associated with cholelithiasis in more than 90% of cases. Cholelithiasis is one of the important etiological factors in carcinoma of the gallbladder. The histological examination of chronical cholecystitis shows the presence of Rokitansky Aschoff sinuses. Genetic approaches have proven that the components of inflammation such as primary inflammatory cytokines, interleukin-1 (IL-1, tumor necrosis factor (TNF, IL-6 and nuclear factor-kB (NF-kB play the key roles in carcinogenesis. The purpose of this study was to understand the correlation between the immunoexpression of NF-kB and Rokitansky Aschoff sinuses in chronic cholecystitis. The method was cross sectional of 30 cases of chronic cholecystitis from Department of Pathology Anatomy of Dr. Hasan Sadikin General Hospital Bandung/Faculty of Medicine Universitas Padjadjaran in 2010−2011. A section from 4 µm-thick paraffin embedded tissue of chronic cholecystitis was stained with hematoxylin eosin for histopatological evaluation and immunohistochemical using polyclonal NF-kB antibody. Immunoreactive cells was counted in five tumor areas of 400x field by light microscopy. The result showed a significant correlation between the immunoexpression of NFkB and Rokitansky Aschoff sinuses (p=0.000. In conclusion, there is a correlation between immunoexpression of NFkB and Rokitansky Aschoff sinuses because as the immunoexpression of NFkB increase, more Rokitansky

  3. Two year experience with /sup 99m/TC HIDA cholescintigraphy in teaching hospital practice

    International Nuclear Information System (INIS)

    One hundred and thirty-four sequential patients who underwent /sup 99m/TC HIDA cholescintigraphy have been studied. Patients were investigated for suspected acute cholecystitis, chronic cholelithiasis, enterogastric reflux or jaundice, and in the assessment of biliary tract drainage after transplantation of the liver and other operations of the biliary tract. The technique is most valuable in the diagnosis of acute cholecystitis when its accuracy rate is 96 per cent; it is also useful in the assessment of postoperative biliary drainage. It is least helpful in the investigation of jaundice and suspected chronic cholelithiasis

  4. Perforation of the gallbladder diagnosed preoperatively

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, D.G.; Lieberman, L.M.

    1983-04-01

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation.

  5. Perforation of the Gallbladder diagnosed preoperatively

    International Nuclear Information System (INIS)

    A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A sup(99m)Tc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation. (orig.)

  6. Disease: H01213 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available ne disease in an Indian population. J Gastroenterol Hepatol 25:1093-8 (2010) PMID:17562004 Rosmorduc O, Poupon R Low phos...H01213 Gallbladder disease; Cholecystitis; Cholelithiasis Gallbladder disease is one of the most commo...n digestive disorders. Cholecystitis is an inflammation of the gallbladder wall, that is almos...6852 vanBerge-Henegouwen GP, Venneman NG, Portincasa P, Kosters A, van Erpecum KJ, Groen AK Relevance of her...ociated with gallstones. Recently, several common DNA polymorphisms in the ABCG8 gene were discovered that a

  7. Thrombotic microangiopathy involving the gallbladder as an unusual manifestation of systemic lupus erythematosus and antiphospholipid syndrome: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Beatriz De-Leon-Bojorge; Samuel Zaltzman-Girsevich; Arturo Ortega-Salgado; Adelina Prieto-Patron; Ruth Córdoba-Córdoba; Marco Yamazaki-Nakashimada

    2006-01-01

    Gallbladder disease is no more common in patients with systemic lupus erythematosus (SLE) than in the general population. We describe a 17-year-old patient with SLE, who developed nephritis that was well controlled with medications. Initial treatment consisted of azathioprine, aspirin and prednisone with stable control of her symptoms. Two years later she developed a right quadrant abdominal pain,and an abdominal ultrasound revealed microlithiasic cholecystitis. Open cholecystectomy was performed and the histopathological findings revealed vasculitis with thrombotic microangiopathy in the gallbladder. This case presentation illustrates that calculous or acalculous cholecystitis should be considered as a manifestation of active SLE and APS.

  8. ХИРУРГИЧЕСКАЯ ТАКТИКА ЛЕЧЕНИЯ ОСЛОЖНЕННОГО ОСТРОГО ХОЛЕЦИСТИТА ИЗ МИНИ-ДОСТУПА

    OpenAIRE

    ХАДЖ МОХАММЕД Р. М.; Меретуков, Р.

    2006-01-01

    The present article describes a problem of tactics of complicated acute cholecystitis treatment from mini access in 318 patients. Gravels from choledoch are removed with the help of fenestrated forceps from the «Mini -assistant» set. It is expedient to use mini laparotomic cholecystectomy and choledocholithotomy in eldery and old age patients with a severe associated illness.

  9. Clinical significance of presence of the conjugated Bilopaque in the bowel after oral cholecystography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Young; Kim, Jung Sik; Kim, Hong; Kim, Ok Bae; Zeon, Seok Kil; Park, Sam Kyoon [Keimyung University Medical College and Hospital, Taegu (Korea, Republic of)

    1984-09-15

    Oral cholecystography after ingestion of the 3.0 gr. Sodium tyropanoate (Bilopque ) was done in 504 patients from January 1983 to August 1983. Simple supine views of the abdomen of 37 patients, in whom the gallbladder was either nonvisualized or faintly visualized upto 17 hours after Bilopaque administration, were reviewed in search of the presence of conjugated material in the bowel. The results were as follows: 1. The ratio of male to female was nearly 2 : 3 and age distribution was even from 20 years to 79 years. 2. Among 26 cases which showed conjugated Bilopaque in the bowel, cholecystitis with stone was 20 cases (77%) and acalculus cholecystitis was 6 cases (23%). 3. Among 11 case which showed no conjugated Bilopaque in the bowel, hepatitis was 3 caes (28%) and clonorchis sinensis, salmonellosis, pancreatitis, acute gastritis was 2 cases (13%) respectively. 4. All of the 20 cases of cholecystitis with stone showed conjugated Bilopaque in the bowel. 5. Among 6 cases of which conjugated Bilopaque in the bowel, salmonellosis was 1 case (17%) and remaining 5 caes (83%) were acalculus cholecystitis. 6. The result of our study show that the presence of conjugated Bilpaque in the bowel in nonvisualized or faintly visualized gallbladder after oral cholecystography is of definite indicative of cholescystitis. 7. Surgical intervention or ultrasonographic examination of the gallbladder without double dose or second dose oral cholecystography on such cases is recommended.

  10. Clinical significance of presence of the conjugated Bilopaque in the bowel after oral cholecystography

    International Nuclear Information System (INIS)

    Oral cholecystography after ingestion of the 3.0 gr. Sodium tyropanoate (Bilopque ) was done in 504 patients from January 1983 to August 1983. Simple supine views of the abdomen of 37 patients, in whom the gallbladder was either nonvisualized or faintly visualized upto 17 hours after Bilopaque administration, were reviewed in search of the presence of conjugated material in the bowel. The results were as follows: 1. The ratio of male to female was nearly 2 : 3 and age distribution was even from 20 years to 79 years. 2. Among 26 cases which showed conjugated Bilopaque in the bowel, cholecystitis with stone was 20 cases (77%) and acalculus cholecystitis was 6 cases (23%). 3. Among 11 case which showed no conjugated Bilopaque in the bowel, hepatitis was 3 caes (28%) and clonorchis sinensis, salmonellosis, pancreatitis, acute gastritis was 2 cases (13%) respectively. 4. All of the 20 cases of cholecystitis with stone showed conjugated Bilopaque in the bowel. 5. Among 6 cases of which conjugated Bilopaque in the bowel, salmonellosis was 1 case (17%) and remaining 5 caes (83%) were acalculus cholecystitis. 6. The result of our study show that the presence of conjugated Bilpaque in the bowel in nonvisualized or faintly visualized gallbladder after oral cholecystography is of definite indicative of cholescystitis. 7. Surgical intervention or ultrasonographic examination of the gallbladder without double dose or second dose oral cholecystography on such cases is recommended.

  11. The radiological diagnosis of gallbladder disease. An imaging symposium

    Energy Technology Data Exchange (ETDEWEB)

    Berk, R.N.; Ferrucci, J.T. Jr.; Fordtran, J.S.; Cooperberg, P.L.; Weissmann, H.S.

    1981-01-01

    Changes in the radiological diagnosis of gallbladder disease are occurring at a remarkable rate. In this symposium, several recognized authorities place the various diagnostic modalities and their interrelation in modern perspective. The present and future roles of oral cholecystography and intravenous cholangiography, the radiological diagnosis of chronic acalculous cholecystitis, and the use of ultrasonography and cholescintigraphy are analyzed.

  12. System of polarization correlometry of biological liquids layers polycrystalline structure

    Science.gov (United States)

    Ushenko, A. G.; Boychuk, T. M.; Mincer, O. P.; Angelsky, P. O.; Bodnar, N. B.; Oleinichenko, B. P.; Bizer, L. I.

    2013-09-01

    A model of generalized optical anisotropy of human bile is suggested and a method of polarimetric of the module and phase Fourier of the image of the field of laser radiation is analytically substantiated, that is generated by the mechanisms of linear and circular birefringence of polycrystalline networks with a diagnosis and differentiation of cholelithiasis against a background of chronic cholecystitis.

  13. Perkutan kolecystolitotripsi

    DEFF Research Database (Denmark)

    Stage, J G; Rasmussen, S G; Damgaard, B; Kehlet, H

    1991-01-01

    Thirty-two high-risk patients with severe complicating conditions and gall bladder symptoms requiring treatment, including acute cholecystitis in 28 of the patients, were treated with percutaneous cholecystolithotripsy (PTCL). This intervention was carried out under general, regional or local...

  14. In vitro and in vivo accuracy of sonographic gallbladder volume determinations

    DEFF Research Database (Denmark)

    Andersen, I B; Monrad, H; Grønvall, S; Højgaard, L

    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 the...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  16. Cholecystectomy During the Weekend Increases Patients' Length of Hospital Stay

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian; Rosenberg, Jacob

    2015-01-01

    30 days between week time and weekend time. A longer postoperative length of stay was observed for patients operated onFridays and Saturdays even though surgical complication rates were alike between weekdays. Patients with acute cholecystitis had a longer length of stay on Saturdays. CONCLUSION: We...

  17. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  18. Budd-Chiari syndrome: diagnosis with ultrasound and nuclear medicine calcium colloid liver scan following non-diagnostic contrasted CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Mulholland, J.P.; Fong, S.M.; Kafaghi, F.A.; Fong, W. [Royal Brisbane Hospital, Herston, QLD (Australia)

    1997-02-01

    Budd-Chiari syndrome is a rare condition characterized by thrombosis within the hepatic veins and inferior vena cava. A case of Budd-Chiari syndrome is presented in a patient who experienced acutely 3 days following laparoscopic cholecystectomy for a calculous cholecystitis. A discussion of pathology and findings on calcium colloid scintigram, CT scan and Doppler ultrasound is provided. 5 refs., 4 figs.

  19. IgG4 disease: The great masquerader.

    Science.gov (United States)

    Yadav, Divya; Liu, Xiuli; Chahal, Prabhleen

    2016-06-01

    Systemic IgG4 disease can have a wide spectrum of clinical presentation, which can mimic several other disease entities. In this report, we describe a series of two patients with IgG4-related disease who were referred to us initially with the diagnosis of acute cholecystitis and the second patient with metastatic pancreatic adenocarcinoma with peritoneal metastasis respectively. PMID:26164258

  20. Dynamics of functional indices of the liver in cholecystography

    International Nuclear Information System (INIS)

    During cholecytography with Boyden's cholekinetic breakfast patients with chronic cholecystitis showed disorders of the motor function of the gallbladder and also a pronounced dynamics of some most specific functional indices of the liver allowing a more accurate diagnosis of the presence of concomitant reactive hepatitis and adequate control of the efficacy of prophylactic and therapeutic measures

  1. Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

    Energy Technology Data Exchange (ETDEWEB)

    Hersey, N., E-mail: naomi.hersey@sth.nhs.uk [Sheffield Teaching Hospitals NHS Trust, Department of Radiology, Northern General Hospital (United Kingdom); Goode, S. D., E-mail: s.goode@sheffield.sc.uk [Sheffield Teaching Hospitals NHS Trust, Sheffield Vascular Institute (United Kingdom); Peck, R. J., E-mail: robert.peck@sth.nhs.uk; Lee, F., E-mail: fred.lee@sth.nhs.uk [Sheffield Teaching Hospitals NHS Trust, Department of Radiology, Northern General Hospital (United Kingdom)

    2015-08-15

    PurposeThere have been few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.Materials and MethodsThirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal and transhepatic gallbladder puncture. The cystic duct was cannulated with a hydrophilic guidewire which was subsequently passed through the common bile duct and into the duodenum. An 8Fr 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder.ResultsTen patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91 %. We experienced a 13 % complication rate with 3 % mortality rate at 30 days.ConclusionCystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage as a definitive mid-term treatment option.

  2. Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis

    OpenAIRE

    Elhence, Poonam; Bansal, Rani; Agrawal, Nivesh

    2012-01-01

    Heterotopic pancreatic tissue in the gallbladder is a very uncommon lesion, which is an incidental finding in most cases. We report here, a case of an 18-year-old, post puerperal female, suffering from right upper quadrant abdominal pain with a clinical diagnosis of chronic cholecystitis, in whom heterotopic pancreatic tissue was found in the gall bladder.

  3. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

    International Nuclear Information System (INIS)

    Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis. (orig.)

  4. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

    Energy Technology Data Exchange (ETDEWEB)

    Prince, Jeffrey S. [Department of Radiology, UCSD Medical Center, 200 West Arbor Dr., Mail Code 8756, San Diego, CA 92103-8756 (United States); Senac, Melvin O. [Department of Radiology, Children' s Hospital and Health Center, 3020 Children' s Way, San Diego, CA 92123-4282 (United States)

    2003-09-01

    Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis. (orig.)

  5. Functional properties of laser effects on morphology of liver, gall bladder and bile ducts in cholelithiasis

    Directory of Open Access Journals (Sweden)

    Bakhtior Shamirzaev

    2012-05-01

    Full Text Available In 85 patients with calculous cholecystitis the preoperative preparation before laparoscopic cholecystectomy included irradiation of the area of gall bladder and epigastric puncture with low power magneto-infrared laser. The investigations performed revealed significant reduction of the liver and gall bladder changes both on the light optic and electron microscopic levels due to effects of low power laser irradiation.

  6. Opisthorchis viverrini: The carcinogenic human liver fluke

    OpenAIRE

    Natthawut Kaewpitoon, Soraya J Kaewpitoon, Prasit Pengsaa, Banchob Sripa

    2008-01-01

    Opisthorchiasis caused by Opisthorchis viverrini remains a major public health problem in many parts of Southeast Asia, including Thailand, Lao PDR, Vietnam and Cambodia. The infection is associated with a number of hepatobiliary diseases, including cholangitis, obstructive jaundice, hepatomegaly, cholecystitis and cholelithiasis. Multi-factorial etiology of cholangiocarcinoma, mechanical damage, parasite secretions, and immunopathology may enhance cholangiocarcinogenesis. Moreover, both expe...

  7. Bile peritonitis associated with gastric dilation-volvulus in a dog

    OpenAIRE

    Hewitt, Saundra A.; Brisson, Brigitte A.; Holmberg, David L.

    2005-01-01

    This report describes a case of septic peritonitis and gall bladder rupture in German shepherd dog that developed 7 d after surgical treatment for gastric dilation-volvulus. Histological examination confirmed gall bladder necrosis, secondary to an acute ischemic event. Postoperative acute necrotizing cholecystitis has not been a previously reported complication in dogs.

  8. Amylase - urine

    Science.gov (United States)

    ... be a sign of: Acute pancreatitis Alcohol consumption Cancer of the pancreas , ovaries, or lungs Cholecystitis Ectopic or ruptured tubal ... levels may be due to: Damage to the pancreas Kidney disease Pancreatic cancer Toxemia of pregnancy Images Female urinary tract Male ...

  9. Treating Biliary System Postoperational Complications by Syndrome Differentiation Using Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ The operation of the biliary system is usually employed for liver,gallbladder or pancreatic diseases.Most benign cases are cholelithiasisinduced cholecystitis and choledochitis,while malignant ones mainly include gallbladder cancers,cholangiocarcinoma or carcinoma of the head of the pancreas.

  10. Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis)

    Energy Technology Data Exchange (ETDEWEB)

    Akata, D.; Oezmen, M.N.; Kaya, A.; Akhan, O. [Dept. of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    1999-02-01

    Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess. (orig.) (orig.) With 3 figs., 8 refs.

  11. Colecistite aguda por ascaris lumbricoides Acute cholecystites for ascaris lumbricoides

    Directory of Open Access Journals (Sweden)

    Amauri Clemente da Rocha

    2006-08-01

    Full Text Available Biliary’s ascariasis is the most often ectopic site of this helminthiasis, but invasion of the worms into the gallbladder is quite rare. The autors report a case of a patient with clinical symptoms, compatible with cholecystitis induced by the worm, as shown by ultrasonography. Treatament was cholecystectomy and antihelmintic drug therapy with a good outcome.

  12. Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis)

    International Nuclear Information System (INIS)

    Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess. (orig.) (orig.)

  13. Biliary ascariasis in a bile duct stones-removed female patient

    OpenAIRE

    2013-01-01

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic s...

  14. Prognostic Indicators as Provided by the EPIC ClearView

    Science.gov (United States)

    2011-11-18

    Coronary Artery Disease; Congestive Heart Failure; Valvular Heart Disease; Atrial Fibrillation; Hypertension; Pyelonephritis; Acute Renal Failure; Renal Failure; Viral Hepatitis; Alcoholic Hepatitis; Steatohepatitis; Cirrhosis; Asthma; COPD; Bronchitis; Emphysema; Pneumonia; Inflammatory Bowel Disease; Crohn's Disease; Ulcerative Colitis; Diverticulitis; Peptic Ulcer Disease; Irritable Bowel Syndrome; Cholecystitis; Pancreatitis; Malabsorption Disorders; Celiac Sprue; Diabetes

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

    OpenAIRE

    Maria Pappa; Glykeria Petrocheilou; Alexandra Gavala; Dimitrios Karakitsos; Efimia Evodia; Pavlos Myrianthefs; Ioanna Vlachou; George Baltopoulos

    2012-01-01

    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 (gallbladd...

  16. Colecistite aguda por ascaris lumbricoides Acute cholecystites for ascaris lumbricoides

    OpenAIRE

    Amauri Clemente da Rocha; Severino Lourenço da Silva Júnior; Rodrigo Fernando Lourenço de Amorim

    2006-01-01

    Biliary’s ascariasis is the most often ectopic site of this helminthiasis, but invasion of the worms into the gallbladder is quite rare. The autors report a case of a patient with clinical symptoms, compatible with cholecystitis induced by the worm, as shown by ultrasonography. Treatament was cholecystectomy and antihelmintic drug therapy with a good outcome.

  17. Tuberculosis of the Gallbladder

    OpenAIRE

    2000-01-01

    Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as acalculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.

  18. Prophylactic Embolization of the Cystic Artery Prior to Radioembolization of Liver Malignancies—An Evaluation of Necessity

    Energy Technology Data Exchange (ETDEWEB)

    Powerski, Maciej, E-mail: maciej.powerski@med.ovgu.de; Busse, Anke, E-mail: anke.busse@med.ovgu.de; Seidensticker, Max, E-mail: max.seidensticker@med.ovgu.de; Fischbach, Frank, E-mail: frank.fischbach@med.ovgu.de; Seidensticker, Ricarda, E-mail: ricarda.seidensticker@med.ovgu.de; Strach, Katharina, E-mail: katharina.strach@med.ovgu.de; Dudeck, Oliver, E-mail: oliver.dudeck@med.ovgu.de; Ricke, Jens, E-mail: jens.ricke@med.ovgu.de; Pech, Maciej, E-mail: maciej.pech@med.ovgu.de [Otto-von-Guericke University, Department of Radiology and Nuclear Medicine (Germany)

    2015-06-15

    PurposePrior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA).Materials and MethodsRetrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up.ResultsAt none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment.ConclusionComparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE.

  19. Costs of conservative treatment of patients with cholangitis and cholesystitis

    Directory of Open Access Journals (Sweden)

    Mikić Sandra Stefan

    2014-01-01

    Full Text Available Introduction. There are no guidelines for treating bacterial infections in our country. Antibacterial drugs are selected empirically, which is not always in accordance with the recommended therapy coming from the countries that have their own pharmacotherapy protocols. This study reviews the differences between the standard conservative treatment of cholangitis/cholecystitis and treatment implemented in accordance with current pharmacotherapy guidelines of other countries. The assessment of the therapeutic efficacy of antibacterial drugs implemented in the treatment of cholangitis/cholecystitis and economic viability of that implementation was one of the aims of this study, and another one was comparison of the efficiency and cost of medical treatment using physician’s therapy of choice and treatment according to pharmacotherapy guidelines. Material and Methods. The study was carried out over a threeyear period at the Department of Infectious Diseases of the Clinical Center of Vojvodina. It included 72 patients with the diagnosis of cholangitis/cholecystitis who were divided into two groups. The control group was treated according to the physician’s therapy of choice, while the test group was treated in accordance with pharmacotherapy guidelines. The efficiency and cost of medical treatment were determined for both groups. Results. The comparison of the efficiency and costs of medical treatment of cholangitis/cholecystitis before and after introducing pharmacotherapy guidelines showed no significant differences in the efficiency of administered therapies. However, the cost of medical treatment carried out in accordance with pharmacotherapy guidelines showed a decrease of 17.24%. Conclusion. Medical treatment using physician’s antibacterial therapy of choice and the one which is in accordance with pharmacotherapy guidelines for treating cholangitis/cholecystitis show no differences in terms of efficiency. However, medical treatment proved

  20. The effect of different dosing regimens of motesanib on the gallbladder: a randomized phase 1b study in patients with advanced solid tumors

    International Nuclear Information System (INIS)

    Gallbladder toxicity, including cholecystitis, has been reported with motesanib, an orally administered small-molecule antagonist of VEGFRs 1, 2 and 3; PDGFR; and Kit. We assessed effects of motesanib on gallbladder size and function. Patients with advanced metastatic solid tumors ineligible for or progressing on standard-of-care therapies with no history of cholecystitis or biliary disease were randomized 2:1:1 to receive motesanib 125 mg once daily (Arm A); 75 mg twice daily (BID), 14-days-on/7-days-off (Arm B); or 75 mg BID, 5-days-on/2-days-off (Arm C). Primary endpoints were mean change from baseline in gallbladder size (volume by ultrasound; independent review) and function (ejection fraction by CCK-HIDA; investigator assessment). Forty-nine patients received ≥1 dose of motesanib (Arms A/B/C, n = 25/12/12). Across all patients, gallbladder volume increased by a mean 22.2 cc (from 38.6 cc at baseline) and ejection fraction decreased by a mean 19.2% (from 61.3% at baseline) during treatment. Changes were similar across arms and appeared reversible after treatment discontinuation. Three patients had cholecystitis (grades 1, 2, 3, n = 1 each) that resolved after treatment discontinuation, one patient developed grade 3 acute cholecystitis requiring cholecystectomy, and two patients had other notable grade 1 gallbladder disorders (gallbladder wall thickening, gallbladder dysfunction) (all in Arm A). Two patients developed de novo gallstones during treatment. Twelve patients had right upper quadrant pain (Arms A/B/C, n = 8/1/3). The incidence of biliary “sludge” in Arms A/B/C was 39%/36%/27%. Motesanib treatment was associated with increased gallbladder volume, decreased ejection fraction, biliary sludge, gallstone formation, and infrequent cholecystitis. ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT00448786?term

  1. Action and mechanism of Fas and Fas ligand in immune escape of gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Li-Ning Xu; Sheng-Quan Zou; Jian-Ming Wang

    2005-01-01

    AIM: To study the role of Fas and Fas ligand (FasL) in biological behaviors of gallbladder carcinoma, and their correlated action and mechanism in tumor escape.METHODS: Streptavidin-biotin-peroxidase immunohistochemistry technique was used to study the expression of Fas and FasL protein in 26 gallbladder carcinoma tissues,18 gallbladder adenoma tissues, 3 gallbladder dysplasia tissues and 20 chronic cholecystitis tissues. Apoptosis of the infiltrating lymphocytes in these tissues was studied by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) method. Expression of both proteins and apoptosis of the tumor infiltrating lymphocytes in cancer tissues of primary foci was compared with clinicopathological features of gallbladder carcinoma.RESULTS: The positive rates of Fas were not significantly different among carcinoma, adenoma, dysplasia and chronic cholecystitis. The positive rate of FasL in carcinoma was significantly higher than that in chronic cholecystitis (x2 = 4.89, P<0.05). The apoptotic index (AI) in carcinoma was significantly higher than that in adenoma (t'= 4.19, P<0.01) and chronic cholecystitis (t'= 8.06, P<0.01). The AI was significantly lower in well-differentiated carcinoma and Nevin Ⅰ-Ⅲ carcinoma than that in poorly-differentiated carcinoma (t'= 2.63, P<0.05) and Nevin Ⅳ-Ⅴ carcinoma(t'= 3.33, P<0.01). The confidence interval (CI) ofinfiltrating lymphocytes in adenoma, chronic cholecystitis, well-differentiated carcinoma and Nevin Ⅰ-Ⅲ carcinoma wasvery significantly lower than that in carcinoma (t' = 6.99,P<0.01), adenoma (t' = 3.66, P<0.01), poorly-differentiated carcinoma (t' = 5.31, P<0.01) and Nevin Ⅳ-Ⅴ carcinoma(t' = 3.76, P<0.01), respectively. The CI of apoptosis of infiltrating lymphocytes in well-differentiated carcinoma was significantly lower than that in poorly-differentiated carcinoma (t = 2.52, P<0.05), and was not significantly lower in Nevin Ⅰ-Ⅲ carcinoma than

  2. Reliability of pre- and intraoperative tests for biliary lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  3. Reliability of pre- and intraoperative tests for biliary lithiasis.

    Science.gov (United States)

    Escallon, A; Rosales, W; Aldrete, J S

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable. PMID:3888131

  4. Adenomyomatosis of the gall bladder: the NUH experience.

    Science.gov (United States)

    Chan-Wilde, C; Chew, R; Foong, W C; Wee, A

    1990-05-01

    Adenomyomatosis (AD) is a degenerative disorder of the gall bladder wall which can be complicated by chronic inflammation and calculi. The true incidence of this disorder in South East Asians is not known. Nine Chinese patients with AD were discovered amongst 200 consecutive right upper quadrant ultrasound examinations. Four of them had cholecystectomy and were diagnosed as cholecystitis by the pathologist. Adenomyomatosis can be suspected on ultrasonography, but should be confirmed by oral cholecystography (OCG). There is great disparity in the ultrasound, OCG, surgical and histopathological diagnosis of this condition. This may be due to the fact that only complicated cases of AD come to surgery, where the presence of chronic cholecystitis or calculi detracts from recognising or overshadows the presence of AD. It is not known whether uncomplicated AD has any clinical significance and whether it, if given sufficient time, will lead to inflammation of the gall bladder. PMID:2203297

  5. Reliability of pre- and intraoperative tests for biliary lithiasis

    International Nuclear Information System (INIS)

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable

  6. IDIOPATHIC OMENTAL INFARCTION : A RARE CAUSE OF ACUTE PAIN ABDOMEN

    Directory of Open Access Journals (Sweden)

    Narendra Nath

    2015-02-01

    Full Text Available Omental torsion leading on to omental infarction is an unusual cause of acute abdominal pain in adults. Often the condition mimics common causes of acute abdomen like acute cholecystitis, acute appendicitis or acute pancreatitis. A review of literature reveals that this enigmatic condition has been managed both non - operatively and by surgery in the past. We report the case of a 46 - year - old man who presented with a 4 - day history of severe right - sided abdominal pain mimicking acute cholecystitis. Abdominal CT scan revealed a right upper quadrant mass with a whirl - like appearance, suspicious for omental infarction. He was started on conservative management with analgesics and antibiotics. He improved symptomatically and was discharged

  7. 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.

  8. Rare presentation of gall bladder tuberculosis in a non immuno-compromised patient

    Directory of Open Access Journals (Sweden)

    Pawan Kumar

    2015-06-01

    Full Text Available The gall bladder is least common intraabdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery.

  9. Kolecystektomi i Danmark 1989-2003

    DEFF Research Database (Denmark)

    Ainsworth, Alan Patrick; Adamsen, Sven; Rosenberg, Jacob

    2005-01-01

    Registry, which covers all public hospitals in Denmark. All cholecystectomies performed from 1989 to 2003 in the various hospitals were registered. Open and laparoscopic operations were registered separately. In addition, the number of patients who were operated on for acute cholecystitis from 1996 to 2003...... was registered. RESULTS: An increase in the cholecystectomy rate was observed, from 67/100,000 inhabitants in 1989 to 143/100,000 inhabitants in 2003 (p < 0.05). The increase was due mainly to the number of laparoscopic procedures, which comprised 81% of all cholecystectomies in 2003. The proportion...... of patients who were operated on for acute cholecystitis decreased from 14% in 1996 to 12% in 2003 (p < 0.05). DISCUSSION: The increasing cholecystectomy rate in Denmark from 1989 to 2003 is probably due to the fact that more patients are having surgery for painful gallbladder stones....

  10. Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients.

    Science.gov (United States)

    Cicala, M; Guarino, M P; Vavassori, P; Alloni, R; Emerenziani, S; Arullani, A; Pallone, F

    2001-11-01

    Impaired gallbladder motility may contribute to gallstone pathogenesis by providing time for nucleation and aggregation of cholesterol crystals. Simultaneous scintigraphic-ultrasonographic techniques have been proposed to assess alternating phases of gallbladder emptying and filling. To evaluate patterns of gallbladder motility and of postprandial bile flow by means of a single ultrasonographic technique, 12 healthy volunteers and 20 gallstone patients underwent minute-by-minute gallbladder ultrasonography for 3 h postprandially. Mathematical analysis of volume measurements was used to estimate hepatic and cholecystic bile flux through the gallbladder. Compared to controls, gallstone patients showed greater amounts of unexchanged cholecystic-to-hepatic bile (11% vs. 1%, p scintigraphic-sonographic studies in comparable groups of subjects. This study provides new ultrasonographic variables, which better express gallbladder bile retention in gallstone patients and strongly discriminate gallstone patients from controls. PMID:11750742

  11. Ultrasonographic diagnosis of gallbladder carcinoma: diagnostic difficulties and pitfalls

    International Nuclear Information System (INIS)

    Ultrasonographic findings of 60 patients with histologically verified primary gallbladder carcinoma were analyzed with special emphasis in diagnostic difficulties and pitfalls, sonographic diagnosis was correct in 40 patients, thus the sensitivity was 66.7%. Sonography of 20 incorrectly diagnosed cases were interpretated as benign biliary disease in 15(complicated cholecystitis in 9, gallbladder or bile duct stone in 6) and malignant disease in 5 with incorrect diagnosis of primary site. Thickened wall type was the most frequent type of false negative cases. The causes of sonographic diagnostic difficulty or pitfalls were 1) poor criteria of benign vs malignant wall thickening because of frequent association of complicated cholecystitis in gallbladder carcinoma,2) Overlook of small gallbladder lesions in cases with common bile duct disease including stone.3) inadequate study or technical problem especially in cases of localized carcinoma involving the fungus, neck or anterior wall. Knowledge of these diagnostic pitfalls may result in more accurate diagnosis of gallbladder carcinoma

  12. [Biliary tract diseases in persons suffering as a result of the accident at the Chernobyl Atomic Electric Power Station].

    Science.gov (United States)

    Komarenko, D I; Soboleva, L P; Kadiuk, E N; Glukhen'kiĭ, E V; Nosach, E V

    1999-07-01

    A retrospective analysis was performed of case histories and of results of sonographic investigations in liquidators of the Chernobyl accident suffering from chronic abnormalities of the biliary ducts. Patients with cholecystitis were studied for the biochemical composition of their bile. The incidence of the gallbladder disorders (chronic cholecystitis, angiocholitis, dyskinesias of the biliary ducts) has not changed much over the last 10 years having elapsed since the accident. The biochemical composition of bile was found to have been changed to a greater extent in the liquidators of the Chernobyl accident than it was in those having avoided danger of exposure to ionizing radiation. Mechanisms of origination of cholelithiasis are discussed on the basis of investigations designed to study biochemical properties of bile and findings secured with the aid of the ultrasound techniques. PMID:10822667

  13. Impact of cholescintigraphy and ultrasound in the management of gallbladder disease

    International Nuclear Information System (INIS)

    Major objectives of this study were to determine the functional changes that occur in chronic calculous cholecystitis (CCC) and chronic acalculous cholecystitis (CAC), and establish objective parameters of biliary pain. Total of 800 patients, who underwent serial cholecystectomy from March 1999 to May 2002 were chosen for retrospective analysis. They were divided into function and morphology groups. The function group underwent cholecystokinin cholescintigraphy and ultrasound imaging, and morphology group had only ultrasound imaging. Basal hepatic bile flow, gallbladder ejection fraction (EF), ejection period (EP), and ejection rate (ER) were measured. Functional parameters of CCC and CAC were compared with each other and also with data from 22 control subjects. Sensitivity, specificity, and accuracy, and positive predictive and negative predictive values of ultrasound for gallstone were calculated. Patients with acute or subacute cholecystitis had obstruction of the cystic duct. Bile entry into the gallbladder was normal in both CAC and CCC. Cholecystokinin administration induced cystic duct spasm causing significant reduction in EF (16±13% and 21±17%, p< 0.001) and ER (2±1%/min. and 2±1%/min., P<0.0001) in both CCC and CAC when compared to control subjects (EF of 54+17% and ER of 5.1+3.7%/min). Ultrasound overall sensitivity of 88%, accuracy of 86%, and specificity of 77% for gallstones were much lower than previously published values. It was concluded that obstruction of the cystic duct is the common feature for both acute and subacute cholecystitis. Spasm of the cystic duct on exposure to cholecystokinin causes low EF and low ER, resulting in bile stasis in both CCC and CAC. Reliance on morphology imaging alone with ultrasound may result in inappropriate gallbladder therapy either due to over diagnosis (false-positive for gallstone) or under diagnosis (false-negative in cystic duct spasm). Addition of quantitative cholescintigraphy provides objective

  14. Analysis of Cases of Nonvisualized Gallbladder by Ultrasonography *

    OpenAIRE

    Chung, Jae Bock; Yim, Dae Soon; Chon, Chae Yoon; Moon, Young Myoung; Kang, Jin Kyung; Park, In Suh; Choi, Heung Jai

    1987-01-01

    To define the significance of nonvisualization of the gallbladder by ultrasonography, we studied follow-up data on 31 cases in which the gallbladder could not be identified despite adequate fasting. Thirty one cases of gallbladder disease included 15 cases of chronic cholecystitis due to cholelithiasis (13 cases) and choledocholithiasis (2 cases), 4 cases of cholelithiasis which were not surgerized, and 3 cases of cancer. There were 4 cases of diagnostic error in which gallbladder nonvisualiz...

  15. Evaluation of biliary disease by scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ram, M.D.; Hagihara, P.F.; Kim, E.E.; Coupal, J.; Griffen, W.O.

    1981-01-01

    The value of biliary scintigraphy was studied in 180 patients with suspected biliary tract disease. Most of the patients were investigated additionally by conventional techniques such as cholecystography, cholangiography and ultrasonography. It is concluded that biliary scintigraphy is a simple and safe technique for visualization of the biliary tract. It is particularly useful in the evaluation of acute cholecystitis, in patients with iodine sensitivity obstructive from nonobstructive jaundice.

  16. Kocuria varians infection associated with brain abscess: A case report

    OpenAIRE

    Tsai Tai-Hsin; Chou Yu-lin; Cheng Yu-Hsin; Su Shou-hsin; Tsai Cheng-Yu; Lieu Ann-Shung

    2010-01-01

    Abstract Background Kocuria, established by Stackebrandt et al., previously was classified into Micrococcus. Only two species, K. rosea and K. kristinae are reported to be associated as pathogenic and found with catheter-related bacteremia and acute cholecystitis. Case presentation We herein report the first case of brain abscess caused by Kocuria varians, a gram-positive microorganism, in a 52-year-old man. Hematogenous spread is the probable pathogenesis. Conclusions This report presents a ...

  17. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

    OpenAIRE

    Lovekesh Kumar; Mahendra Singh; Ashish Saxena; Yuvraj Kolhe; Karande, Snehal K.; Narendra Singh; Venkatesh, P.; Rambabu Meena

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked ...

  18. Emphysematous liver abscess in diabetic patient: two cases report

    International Nuclear Information System (INIS)

    There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor prognosis in spite of immediate and successful percutaneous drainage procedure

  19. Laparoskopisk subtotal kolecystektomi ved kompliceret galdestenssygdom

    DEFF Research Database (Denmark)

    Semenisina, Galina; Rosenberg, Jacob; Gögenur, Ismail

    2010-01-01

    In laparoscopic cholecystectomy conversion to open surgery occurs. Patients who would otherwise need conversion can benefit from laparoscopic subtotal cholecystectomy (LSC). We present a review of studies in which outcome after LSC has been investigated. The results show reduced conversion rates,......, shorter hospital stay, minimal complications and mortality rates. Acute cholecystitis, cirrhosis, Mirrizi syndrome type I are the indications for LSC. Randomized prospective trials are needed to investigate safety and long-term effects....

  20. Emphysematous liver abscess in diabetic patient: two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyun Chul; Koo, Ja Hong; Kim, Sung Tae; Kim, Yong Soo; Koh, Byung Hee; Cho, On Koo [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1995-07-15

    There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor prognosis in spite of immediate and successful percutaneous drainage procedure.

  1. Multifocal peritoneal splenosis in Tc-99m-labeled heat-denatured red blood cell scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Min Ki; Hwang, Kyung Hoon; Choe, Won Sick [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2006-06-15

    A 44-year-old man with a past medical history of splenectomy came to hospital because of epigastric pain abdominopelvic computed tomography(CT) showed a soft tissue mass and multifocal variable-sized nodules as well as finding suggestive of cholecystitis. Subsequently, he underwent Tc-99m-labeled heat- denatured red blood cell(RBC) scintigraphy to evaluate the mass and nodules. The scintigraphy confirmed multifocal peritoneal splenosis in the abdominopelvic cavity.

  2. 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.

  3. Bouveret's syndrome: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Tueney, D.; Cimsit, C. [Dept. of Radiology, Marmara University Hospital, Istanbul (Turkey)

    2000-11-01

    Intestinal obstruction secondary to gallstones is seen in the older population and the level of obstruction is usually at the level of the terminal ileum. Obstruction at the level of the gastric outlet is called Bouveret's syndrome. A case with perforated cholecystitis and duodenal obstruction due to a gallstone is presented. The CT findings are presented along with the clinical findings and literature review. (orig.)

  4. Medical image of the week: uvula hematoma secondary to endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Natt B

    2013-09-01

    Full Text Available A 53 year old male with no significant past medical history admitted for acute cholecystitis, underwent an uneventful laparoscopic cholecystectomy. Per anesthesia report, intubation was difficult. A few hours after extubation, he complained of dyspnea and a choking sensation. Examination showed a hematoma of the uvula with elongation and abnormal position of the uvula anterior to the soft palate. The patient was given a dose of intravenous steroids and anti-histamine with resolution of his symptoms over time.

  5. Gallstone ileus: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Delabrousse, E.; Bartholomot, B.; Sohm, O.; Kastler, B. [Dept. of Radiology A, CHU Jean Minjoz, University of Besancon (France); Wallerand, H. [Dept. of Surgery, CHU Jean Minjoz, University of Besancon (France)

    2000-06-01

    Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus. We report a case in which gallstone ileus was initially diagnosed by CT. (orig.)

  6. Acute Interstitial Nephritis and Membranous Nephropathy in the Context of IgG4-Related Disease

    OpenAIRE

    Stylianou, Kostas; Maragkaki, Eleftheria; Tzanakakis, Michael; Stratakis, Stavros; Gakiopoulou, Hariklia; Daphnis, Eugene

    2014-01-01

    We present the case of a patient with IgG4-related disease, which manifested in an asynchronous manner as vitiligo, cholecystitis, sialadenitis, lymphadenopathy, facial palsy and kidney dysfunction. The patient underwent a renal biopsy, and a presumptive diagnosis of lupus nephritis was made due to compatible clinical and immunological findings. The biopsy revealed IgG4-related kidney disease with severe interstitial nephritis and membranous nephropathy. Corticosteroids treatment restored all...

  7. Biliary fistula and Bouveret's syndrome. the same but different two case descriptions and a literature review

    International Nuclear Information System (INIS)

    Biliary fistula is an infrequently occurring disease in which gall stones pass from the gall bladder to the duodenum causing intestinal obstruction. In most cases the stones' impact is at the end of the small intestine. When the stones impact in the duodenum it is called Bouveret's syndrome. We present a case study of a patient with acute cholecystitis and another case study of Bouveret's syndrome, together with a summary symptoms, diagnostic techniques, and treatment.

  8. [Acute gastrointestinal involvement in dengue disease by serotype 4: a case report and literature review].

    Science.gov (United States)

    Marín, Johan; Vilcarromero, Stalin; Forshey, Brett M; Celis-Salinas, Juan C; Ramal-Asayag, Cesar; Morrison, Amy C; Laguna-Torres, Alberto; Casapía, Martín; Halsey, Eric S

    2013-10-01

    Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management. PMID:24248170

  9. Heterotopic Pancreatic Tissue Obstructing the Gallbladder Neck: A Case Report

    OpenAIRE

    Justin L Weppner; Wilson, Matthew R.; Robert Ricca; Paul A Lucha Jr

    2009-01-01

    Context Heterotopic pancreatic tissue is defined as pancreatic tissue outside the boundaries of the pancreas that has neither anatomic nor vascular continuity with the pancreas. Heterotopic pancreatic tissue in the gallbladder is uncommon and has rarely been reported to cause symptoms. We report a case of heterotopic pancreatic tissue obstructing the gallbladder neck resulting in cholecystitis. Case report A 26-year-old female presented with right upper quadrant abdominal pain and fever. On p...

  10. On the optimization of clinicosonographic and biochemical diagnostics of gall-bladder disease

    Directory of Open Access Journals (Sweden)

    N.V. Yekimova

    2010-09-01

    Full Text Available Determination of serum lipidic spectrum (increase of total cholesterol, atherogenic rate for dynamic control of possible transformation in cholelithiasis is necessary to be included in examination of patients with cholecystitis. Changes in serum lipidic level (increase of total cholesterol, rate of total cholesterol to cholesterol of lipoproteins of high density and decrease of lipoproteins of high density in healthy people promote forming risk group of gall-bladder cholestherosis

  11. Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy

    OpenAIRE

    Mamdani, M M; Tu, K; van Walraven, C.; Austin, P. C; Naylor, C D

    2000-01-01

    BACKGROUND: Several studies have indicated that estrogen may prime inflammatory and nociceptive pathways, leading to symptoms that mimic cholecystitis. We set out to confirm the relation between recent estrogen use and cholecystectomy in postmenopausal women and to test the novel hypothesis that a similar relation exists for appendectomy. METHODS: We developed a retrospective cohort using prescribing and surgical procedure information from health administrative databases for approximately 800...

  12. Rare combination of familial adenomatous polyposis and gallbladder polyps

    OpenAIRE

    MORI, YASUHISA; Sato, Norihiro; Matayoshi, Nobutaka; Tamura, Toshihisa; Minagawa, Noritaka; Shibao, Kazunori; Higure, Aiichiro; Nakamoto, Mitsuhiro; Taguchi, Masashi; Yamaguchi, Koji

    2014-01-01

    Familial adenomatous polyposis is associated with a high incidence of malignancies in the upper gastrointestinal tract (particularly ampullary adenocarcinomas). However, few reports have described a correlation between familial adenomatous polyposis and gallbladder neoplasms. We present a case of a 60-year-old woman with familial adenomatous polyposis who presented with an elevated mass in the neck of the gallbladder (measuring 16 mm × 8 mm in diameter) and multiple small cholecystic polyps. ...

  13. MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24~77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30~150min),blood loss was 10ml(3~50ml),and postoperative stay was 3 days(1~5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

  14. MR cholangio pancreatography: clinical applications; Colangiopancreatografia por ressonancia magnetica: aplicacoes clinicas

    Energy Technology Data Exchange (ETDEWEB)

    D`Ippolito, Giuseppe; Galvao Filho, Mario; Jesus, Paulo Eduardo Marinho de; Wolosker, Angela; Borri, Maria Lucia [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Centro Diagnostico

    1998-05-01

    MR cholangio-pancreatography (MRCP) has been replacing diagnostic conventional cholangio-pancreatography. MRCP is a new, noninvasive and rapidly evolving technique for imaging diseases of the biliary tree and pancreatic ducts. Images are obtained without administration of oral or intravenous contrast. Our objective is to demonstrate the main clinical applications of MPCP, its limits and advantages over other methods. In our series of 60 patients we have detected choledocholithiasis, sclerosing cholecystitis, chronic pancreatitis, pancreatic and ampullary tumors. (author) 16 refs., 14 figs.

  15. Perforated duodenal diverticulum caused by Bezoar: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2013-11-15

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

  16. Pneumobilia After Penetrating Trauma Abdominal Wall with no Injury to the Biliary Tree- A Case Report

    OpenAIRE

    Sandhu, Sartaj Singh; Sampley, Sunil K.; Chhabra, Kapil

    2012-01-01

    Pneumobilia denotes an abnormal connection between the gastrointestinal and the biliary tracts. In the absence of surgically created anastomosis between the bowel and the bile duct, the common causes for pneumobilia are gallstone obstruction, endoscopic interventions or emphysematous cholecystitis. We present the case of a young male with traumatic pneumobilia with gastric perforation and a tear in the mesentery of the small gut following penetrating trauma in the form of stab in the abdomen.

  17. Aberrant right hepatic artery; A case report

    International Nuclear Information System (INIS)

    We present a rare case of aberrant hepatic artery in a 40-year-old male with a history of chronic cholecystitis. During laparoscopic surgery, the artery found to pass anterior to the body the gallbladder and bifurcating anterior to the gallbladder body. The surgery was un eventful. We present this anomaly of the rare condition of aberrant right hepatic artery which should be in mind during laparoscopic cholecystectomy, because inadverant injury could lead to massive bleeding and increase co morbidities. (author)

  18. Laparoscopic cholecystectomy: a clinical practice audit

    International Nuclear Information System (INIS)

    To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Study Design: Prospective study. Place and Duration of Study: Surgical department Military Hospital from Jul 2011-Dec 2013. Material and Methods: A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone pancreatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Results: Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 ± 10.456 years. 44.7% patients presented with the clinical features of acute cholecystitis, 540 (52.94%) with chronic cholecystitis and 23 (2.28%) with acute pancreatitis. Mean operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 (3.6%) patients were converted to open cholecystectomy. Post-operative complications occur in only 122 (12%) patients. 938 (92%) patients were discharged within 48 hours. of surgery. Conclusion: Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non

  19. Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-

    OpenAIRE

    Baş, Sema Şanal; Özlü, Onur

    2012-01-01

    A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the fi...

  20. Bacteriological examination of gallbladder contents

    OpenAIRE

    Petaković Goran; Korica Milan; Gavrilović Sava

    2002-01-01

    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, th...

  1. Drug-induced liver injury due to “natural products” used for weight loss: A case report

    OpenAIRE

    Tarantino, Giovanni; Pezzullo, Martina Gilda; Dario di Minno, Matteo Nicola; Milone, Francesco; Pezzullo, Luigi Sossio; Milone, Marco; Capone, Domenico

    2009-01-01

    Taking herbal-extracts to lose weight is an underestimated health hazard. Often, these products contain active agents that can cause acute liver damage. In this case report, a 22-year-old female patient, who presented with a feature of cholestatic syndrome, was so sure that the “natural products” were not dangerous that she did not inform her physicians that she had taken them, making their task that much more challenging. Clinical presentation mimicked acute cholecystitis and the patient und...

  2. Gastrointestinal Complications and Cardiac Surgery

    OpenAIRE

    Allen, Sara J.

    2014-01-01

    Gastrointestinal (GI) complications are an uncommon but potentially devastating complication of cardiac surgery. The reported incidence varies between .3% and 5.5% with an associated mortality of .3–87%. A wide range of GI complications are reported with bleeding, mesenteric ischemia, pancreatitis, cholecystitis, and ileus the most common. Ischemia is thought to be the main cause of GI complications with hypoperfusion during cardiac surgery as well as systemic inflammation, hypothermia, drug ...

  3. Ascariasis Presenting as Acute Abdomen—A Case Report

    OpenAIRE

    Nag, Hirdaya H.; Ji, Ram

    2012-01-01

    Infection with Ascaris lumbricoides is common in tropical and subtropical regions of the world. Prevalence of ascariasis is related to poverty, poor hygiene and poor fecal sanitation. This helminth usually lives harmlessly in small intestine but can also cause intestinal obstruction or perforation peritonitis which is common in childhood. Ascaris can also migrate through ampulla of vater to produce cholangitis, pancreatitis,cholecystitis and rarely hepatic abscess. Ascaris induced hepatic abs...

  4. Colon Cancer Metastatic to the Biliary Tree.

    Science.gov (United States)

    Strauss, Alexandra T; Clayton, Steven B; Markow, Michael; Mamel, Jay

    2016-04-01

    Metastasis of colon adenocarcinoma is commonly found in the lung, liver, or peritoneum. Common bile duct (CBD) tumors related to adenomas from familial adenomatous polyposis metastasizing from outside of the gastrointestinal tract have been reported. We report a case of biliary colic due to metastatic colon adenocarcinoma to the CBD. Obstructive jaundice with signs of acalculous cholecystitis on imaging in a patient with a history of colon cancer should raise suspicion for metastasis to CBD. PMID:27144209

  5. Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage

    OpenAIRE

    Lee, Ming-Tsung; Hsi, Sheng-Chuan; Hu, Philip; Liu, Kuang-Yi

    2007-01-01

    A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics...

  6. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial

    OpenAIRE

    Wiggers, Jimme K; Coelen, Robert J.S.; Rauws, Erik A. J.; van Delden, Otto M.; van Eijck, Casper H. J.; Jonge, Jeroen; Porte, Robert J.; Buis, Carlijn I; Cornelis H. C. Dejong; Molenaar, I. Quintus; Besselink, Marc G.H.; Busch, Olivier R.C.; Dijkgraaf, Marcel G. W.; van Gulik, Thomas M.

    2015-01-01

    Background Liver surgery in perihilar cholangiocarcinoma (PHC) is associated with high postoperative morbidity because the tumor typically causes biliary obstruction. Preoperative biliary drainage is used to create a safer environment prior to liver surgery, but biliary drainage may be harmful when severe drainage-related complications deteriorate the patients’ condition or increase the risk of postoperative morbidity. Biliary drainage can cause cholangitis/cholecystitis, pancreatitis, hemorr...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Freeman, L.M.; Sugarman, L.A.; Weissmann, H.S.

    1981-07-01

    Cholecystokinin (CCK) and its C-terminal octapeptide analog, Sincalide, have been utilized in two separate roles for the evaluation of gallbladder disease. These are: (1) prior to cholescintigraphy to evacuate the gallbladder and optimized subsequent filling with radiotracers, and (2) to study contractile function of visualizing gallbladders on cholecystography and cholescintigraphy. As a preparation for 99mTc-IDA studies, it clearly facilitates earlier gallbladder filling in patients with chronic cholecystitis, thereby ruling out complete cystic duct obstruction. The problem lies in the fact that the use of CCK as a premedication markedly decreases the sensitivity of the study to detect chronic cholecystitis, since the findings become indistinguishable from patients with normal gallbladders. For this reason, the authors prefer to obtain delayed images, since chronic cholecystitis is frequently associated with gallbladder filling beyond the first hour. The role of CCK in detecting abnormal gallbladder function in the normally visualizing gallbladder also is controversial. Other studies as well as the author's experience suggests that as much as one-forth of positive cases may be associated with normal gallbladders at surgery and often even on microscopic examination. However, most importantly, the great majority of these patients are relieved of their symptoms following surgery. It appears reasonable that CCK or Sincalide cholecystography or cholescintigraphy may be detecting functional abnormalities before anatomic changes occur and can, therefore, serve as a useful examination in selecting symptomatic patients who may benefit from cholecystectomy.

  9. Cholecystokinin cholescintigraphic findings in the cystic duct syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Fink-Bennett, D.; DeRidder, P.; Kolozsi, W.; Gordon, R.; Rapp, J.

    1985-10-01

    Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.

  10. Role of cholecystokinetic agents in 99mTc-IDA cholescintigraphy

    International Nuclear Information System (INIS)

    Cholecystokinin (CCK) and its C-terminal octapeptide analog, Sincalide, have been utilized in two separate roles for the evaluation of gallbladder disease. These are: (1) prior to cholescintigraphy to evacuate the gallbladder and optimized subsequent filling with radiotracers, and (2) to study contractile function of visualizing gallbladders on cholecystography and cholescintigraphy. As a preparation for 99mTc-IDA studies, it clearly facilitates earlier gallbladder filling in patients with chronic cholecystitis, thereby ruling out complete cystic duct obstruction. The problem lies in the fact that the use of CCK as a premedication markedly decreases the sensitivity of the study to detect chronic cholecystitis, since the findings become indistinguishable from patients with normal gallbladders. For this reason, the authors prefer to obtain delayed images, since chronic cholecystitis is frequently associated with gallbladder filling beyond the first hour. The role of CCK in detecting abnormal gallbladder function in the normally visualizing gallbladder also is controversial. Other studies as well as the author's experience suggests that as much as one-forth of positive cases may be associated with normal gallbladders at surgery and often even on microscopic examination. However, most importantly, the great majority of these patients are relieved of their symptoms following surgery. It appears reasonable that CCK or Sincalide cholecystography or cholescintigraphy may be detecting functional abnormalities before anatomic changes occur and can, therefore, serve as a useful examination in selecting symptomatic patients who may benefit from cholecystectomy

  11. Cholecystokinin (CCK) functional cholescintigraphic findings in patients with a partial cystic duct obstruction - the cystic duct syndrome (CDS)

    International Nuclear Information System (INIS)

    Fourteen patients (pts.) with a CDS underwent CCK functional cholescintigraphy (FC). All pts. presented with persistent post-prandial right upper quadrant pain and biliary colic. None had an abnormal OCG, gallbladder (GB) ultrasound exam or upper G.I. series. All had macro- or microscopically abnormal cystic ducts (5 fibrotic, 7 elongated and narrow, 2 kinked) with (12) or without (2) concomitant chronic cholecystitis. Each pt. (NPO after 12 A.M.) received 5 mCi of technetium (TC)-99m Hepatolite. When the GB max. filled, .02 ug/kg CCK was administered (3 min.) I.V. Background corrected GBEFs were determined q.5 min. x 4 by ratioing the pre-CCK GB cts. minus post-CCK GB cts. to pre-CCK GB cts. GB EFRs were: 3 (12%), 2 (17%), and 1 each 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5% and 22%. No pt. with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low ejection fraction response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both

  12. Role of Liver Function Enzymes in Diagnosis of Choledocholithiasis in Biliary Colic Patients

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    Mohammad Hussein Mirshamsi

    2011-10-01

    Full Text Available Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP was performed for patients with suspicious to biliary colic and common bile duct (CBD stones. Ultrasonography, Aspartate Aminotransferases (AST, Alanine Aminotransferases (ALT, Alkaline Phosphatase (ALP and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00 and elevated serum level of ALT (OR: 2; P=0.04 were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP.

  13. COLECISTECTOMÍA LAPAROSCÓPICA EN COLECISTITIS AGUDA. FACTORES DE RIESGO PARA LA CONVERSIÓN A CIRUGÍA ABIERTA

    Directory of Open Access Journals (Sweden)

    Jorge Ramón Lucena Olavarrieta

    2008-01-01

    Full Text Available Laparoscopic cholecystectomy for acute cholecystitis is associated with higher rate of conversion to laparotomy. The value of several factors that might influence the percentage of conversion is analyzed. In a retrospective analysis of a database, the medical records of patients who underwent laparoscopic cholecystectomy from July 1991 to august 1999 were reviewed. Patients who had acute cholecystitis and had undergone interval laparoscopic cholecystectomy were included in this study.Out of 1984 cholecystectomies, the 10,13% were operated on for acute cholecystectomy. In the 82,3% underwent successful laparoscopic cholecystectomy, and 17,7% needed conversion to open cholecystectomy. Patients age (p = 0,031, total white cell count (p= 0,014, total bilirubin (p= 0,002, alkaline phosphatase (p=0,003 and presence of common bile duct stone (p= 0,001 were found to be independently associated with conversionLaparoscopic cholecystectomy can be performed safely for acute cholecystitis. Predictors of conversion will be helpful when planning the laparoscopic approach and for counseling patients preoperatively.

  14. 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.)

  15. Distinguishing benign from malignant gallbladder wall thickening using FDG-PET

    International Nuclear Information System (INIS)

    Because thickening of the gallbladder wall is observed not only in patients with gallbladder cancer but also in those with benign diseases such as chronic cholecystitis and gallbladder adenomyosis, it is difficult to distinguish between benign and malignant gallbladder wall thickening by conventional techniques of diagnostic imaging such as computed tomography (CT), magnetic resonance imaging (MRI), and abdominal ultrasonography (US). In the present study, we attempted to distinguish between benign and malignant gallbladder wall thickening by means of fluorine-18-fluorodeoxyglucose (FDG)-Positron emission tomography (PET). FDG-PET was performed in 12 patients with gallbladder wall thickening detected by CT or US, to determine whether it was benign or malignant. Emission scans were taken, beginning 45 minutes after intravenous administration of FDG, and standardized uptake value (SUV) was calculated as an indicator of glucose metabolism. Of the 12 patients, 4 showed positive uptake of FDG in the gallbladder wall. Of these 4 patients, 3 had gallbladder cancer. The remaining one, who had chronic cholecystitis, had false-positive findings. The other 8 patients had negative uptake of FDG in the gallbladder wall. Two of these 8 underwent surgical resection, which yielded a diagnosis of chronic cholecystitis. The other 6 patients exhibited no sign of gallbladder malignancy and have been followed without active treatment. FDG-PET appears able to distinguish between benign and malignant gallbladder wall thickening. (author)

  16. Heterotopic Pancreatic Tissue Obstructing the Gallbladder Neck: A Case Report

    Directory of Open Access Journals (Sweden)

    Justin L Weppner

    2009-09-01

    Full Text Available Context Heterotopic pancreatic tissue is defined as pancreatic tissue outside the boundaries of the pancreas that has neither anatomic nor vascular continuity with the pancreas. Heterotopic pancreatic tissue in the gallbladder is uncommon and has rarely been reported to cause symptoms. We report a case of heterotopic pancreatic tissue obstructing the gallbladder neck resulting in cholecystitis. Case report A 26-year-old female presented with right upper quadrant abdominal pain and fever. On physical examination the right upper quadrant was tender to palpation with a positive Murphy’s sign. Laboratory tests were significant for elevated aspartate aminotransferase and alanine aminotransferase. Transabdominal sonography showed gallbladder wall thickening, a positive sonographic Murphy’s sign, and an apparent large non-mobile stone at the gallbladder neck. Pathologic examination revealed cholecystitis but instead of a large stone there was a tan-yellow necrotic mass at the gallbladder neck. Microscopically, the mass consisted of heterotopic pancreatic tissue containing exocrine pancreatic acini, ducts, and islets of Langerhans. The final diagnosis was acute cholecystitis secondary to obstruction by heterotopic pancreatic tissue. Conclusion Although heterotopic pancreatic tissue is usually an incidental finding on pathologic exam, one should not exclude it in the differential diagnosis of symptomatic gallbladder disease of indefinite etiology.

  17. Scaffold with a natural mesh-like architecture: isolation, structural, and in vitro characterization.

    Science.gov (United States)

    Burugapalli, Krishna; Thapasimuttu, Anilkumar; Chan, Jeffrey C Y; Yao, Li; Brody, Sarah; Kelly, Jack L; Pandit, Abhay

    2007-03-01

    An intact extracellular matrix (ECM) with a mesh-like architecture has been identified in the peri-muscular sub-serosal connective tissue (PSCT) of cholecyst (gallbladder). The PSCT layer of cholecyst wall is isolated by mechanical delamination of other layers and decellularized with a treatment with peracetic acid and ethanol solution (PES) in water to obtain the final matrix, which is referred to as cholecyst-derived ECM (CEM). CEM is cross-linked with different concentrations of glutaraldehyde (GA) to demonstrate that the susceptibility of CEM to degradation can be controlled. Quantitative and qualitative macromolecular composition assessments revealed that collagen is the primary structural component of CEM. Elastin is also present. In addition, the ultra-structural studies on CEM reveal the presence of a three-dimensional fibrous mesh-like network structure with similar nanoscale architecture on both mucosal and serosal surfaces. In vitro cell culture studies show that CEM provides a supporting structure for the attachment and proliferation of murine fibroblasts (3T3) and human umbilical vein endothelial cells (HUVEC). CEM is also shown to support the attachment and differentiation of rat adrenal pheochromocytoma cells (PC12). PMID:17309297

  18. Sonographic diagnosis of gallbladder cancer: analysis of mis-diagnosed cases

    International Nuclear Information System (INIS)

    Ultrasonography is the most valuable diagnostic tool in the evaluation of gallbladder (GB) diseases. Although sonographic findings in GB cancer have been well described, the diagnostic accuracy has not been clearly analyzed. Our purpose of this report was to discuss diagnostic difficulties and analyze causes of misdiagnosis of GB cancer based on our recent experience and so may result in more accurate diagnosis of GB cancer. We analyzed 13misdiagnosed cases out of 24 cases of GB cancer with special emphasis on diagnostic difficulties and causes of misidagnosis. The most common type of misdiagnosed GB cancer was thickened wall type which was found in 10 cases. Preoperative sonographic diagnosis of these cases was empyema in 4 cases, cholecystitis in 3, and non-specific GB wall thickening in 1. In 2 cases, any lesion could not be detected at ultrasonography. Two cases with intraluminal type of GB cancer were misdiagnosed ; one being misdiagnosed as cholecystitis with stone, and the other being completely missed. Three cases that were completely missed consist of 2 with focal wall thickening and 1 involving GB neck. In conclusion, sonographic diagnosis of GB cancer is difficult, because the wall thickening type, that mimicks the cholecystitis, is frequent. Thorough and careful investigation of GB is mandatory for eliminating misdiagnosis

  19. Gallbladder aspirate from a dog.

    Science.gov (United States)

    Neel, Jennifer A; Tarigo, Jaime; Grindem, Carol B

    2006-12-01

    A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid. PMID:17123257

  20. Risk factors for conversion to conventional laparoscopic cholecystectomy in single incision laparoscopic cholecystectomy

    Science.gov (United States)

    Kim, Sung Gon; Moon, Ju Ik; Lee, Sang Eok; Sung, Nak Song; Chun, Ki Won; Lee, Hye Yoon; Yoon, Dae Sung; Choi, Won Jun

    2016-01-01

    Purpose The aim of this study was to investigate the risk factors for conversion to conventional laparoscopic cholecystectomy (CLC) in single incision laparoscopic cholecystectomy (SILC) along with the proposal for procedure selection guidelines in treating patients with benign gallbladder (GB) diseases. Methods SILC was performed in 697 cases between April 2010 and July 2014. Seventeen cases (2.4%) underwent conversion to conventional LC. We compared these 2 groups and analyzed the risk factors for conversion to CLC. Results In univariate analysis, American Society of Anesthesiologist score > 3, preoperative percutaneous transhepatic GB drainage status and pathology (acute cholecystitis or GB empyema) were significant risk factors for conversion (P = 0.010, P = 0.019 and P multivariate analysis, pathology (acute cholecystitis or GB empyema) was significant risk factors for conversion to CLC in SILC (P < 0.001). Conclusion Although SILC is a feasible method for most patients with benign GB disease, CLC has to be considered in patients with acute cholecystitis or GB empyema because it is likely to result in inadequate visualization of the Calot's triangle and greater bleeding risk.

  1. Cholecystokinin cholescintigraphic findings in the cystic duct syndrome

    International Nuclear Information System (INIS)

    Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both

  2. Scaffold with a natural mesh-like architecture: isolation, structural, and in vitro characterization.

    LENUS (Irish Health Repository)

    Burugapalli, Krishna

    2007-03-01

    An intact extracellular matrix (ECM) with a mesh-like architecture has been identified in the peri-muscular sub-serosal connective tissue (PSCT) of cholecyst (gallbladder). The PSCT layer of cholecyst wall is isolated by mechanical delamination of other layers and decellularized with a treatment with peracetic acid and ethanol solution (PES) in water to obtain the final matrix, which is referred to as cholecyst-derived ECM (CEM). CEM is cross-linked with different concentrations of glutaraldehyde (GA) to demonstrate that the susceptibility of CEM to degradation can be controlled. Quantitative and qualitative macromolecular composition assessments revealed that collagen is the primary structural component of CEM. Elastin is also present. In addition, the ultra-structural studies on CEM reveal the presence of a three-dimensional fibrous mesh-like network structure with similar nanoscale architecture on both mucosal and serosal surfaces. In vitro cell culture studies show that CEM provides a supporting structure for the attachment and proliferation of murine fibroblasts (3T3) and human umbilical vein endothelial cells (HUVEC). CEM is also shown to support the attachment and differentiation of rat adrenal pheochromocytoma cells (PC12).

  3. Two-port laparoscopic cholecystectomy with modified suture retraction of the fundus: A practical approach

    Directory of Open Access Journals (Sweden)

    Ming G Tian

    2013-01-01

    Full Text Available Context: Although transumbilical single incision laparoscopic cholecystectomy (SILC has been demonstrated to be superior cosmetic, it is only limited to simple cases at present. In complex cases, the standard four- or three-port LC is still the treatment of choice. Aim: To summarize the clinical effect of a modified technique in two-port LC. Settings and Design: A consecutive series of patients with benign gallbladder diseases admitted to the provincial teaching hospital who underwent LC in the past 4 years were included. A modified two-port LC was the first choice except for those requiring laparoscopic common bile duct exploration (LCBDE. Materials and Methods: The operation was done with suture retraction of the fundus by a needle-like retractor. The patients′ data, including the operative time, time consumed by gallbladder retraction, operative bleeding, conversion rate, rate of adding trocars, and postoperative complications were recorded. Statistical Analysis: Data were expressed as percentage and mean with standard deviation. Results: Total 107 patients with chronic calculous cholecystitis (N = 61, acute calculous cholecystitis (N = 43, and cholecystic polyps (N = 3 received two-port LC. The procedure was successful in 99 out of 107 cases (success rate, 92.5%, and a third trocar was added in the remaining 8 cases (7.5% due to severe pathological changes. The operative time was 47.2 (±13.21 min. There was no conversion to open surgery. Conclusion: Two-port LC using a needle-like retractor for suture retraction of the gallbladder fundus is a practical approach when considering the safety, convenience, and indications as well as relatively minimal invasion.

  4. Percutaneous cholecystostomy at the community hospital: value evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  5. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    International Nuclear Information System (INIS)

    Purpose. Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. Methods. A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. Results. Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. Conclusion. No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis

  6. Laparoscopic Cholecystectomy by Sectorisation of Port Sites

    International Nuclear Information System (INIS)

    Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)

  7. Results obtained with ultrasound and X-ray cholecystography in the diagnosis of the gall bladder

    International Nuclear Information System (INIS)

    In 205 patients examination of the gall bladder was carried out by cholecystography (per os or iv./) and by gray-scale echography. By comparative evaluations the iv. cholecystography proved to be the most accurate method (97.5%). Per os cholecystography and echocholecystography exhibited similar results (96% and 95.6% resp.). In the cases of acute cholecystitis, pancreatitis and jaundice echography is proposed, whereas in chronic biliary diseases peroral cholecystography is advised as the first radiological examination. If X-ray examination uncovers a non-filling gall bladder, echography may provide direct proof of cholelithiasis. (L.E.)

  8. Technetium-99m pyridoxylideneglutamate (P. G. ) cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Stadalnik, R.C.; Matolo, N.M.; Jansholt, A.L.; Krohn, K.A.; DeNardo, G.L.; Wolfman, E.F Jr.

    1976-12-01

    Technetium-99m P.G. cholescintigraphy was performed in 27 human volunteers and 81 patients referred for hepatobiliary tract disease. The gallbladder, biliary system, and gastrointestinal tract were well visualized in the normal patients and volunteers. The gallbladder was not visualized in 22 patients with histologically proved cholecystitis with cystic duct obstruction. Nine patients with complete extrahepatic obstruction of the common bile duct were correctly diagnosed. Hepatocellular disease and incomplete obstruction, with and without jaundice, were diagnosed with this technique. Oral cholecystography is superior to this method for the detection of cholelithiasis in nonjaundiced patients.

  9. Kocuria varians infection associated with brain abscess: A case report

    Directory of Open Access Journals (Sweden)

    Tsai Tai-Hsin

    2010-04-01

    Full Text Available Abstract Background Kocuria, established by Stackebrandt et al., previously was classified into Micrococcus. Only two species, K. rosea and K. kristinae are reported to be associated as pathogenic and found with catheter-related bacteremia and acute cholecystitis. Case presentation We herein report the first case of brain abscess caused by Kocuria varians, a gram-positive microorganism, in a 52-year-old man. Hematogenous spread is the probable pathogenesis. Conclusions This report presents a case of Kocuria varians brain abscess successfully treated with surgical excision combined with antimicrobial therapy. In addition, Vitek 2 system has been used to identify and differentiate between coagulase-negative staphylococcus.

  10. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Philip Rothman, Josephine; Burcharth, Jakob; Pommergaard, Hans-Christian; Viereck, Søren; Rosenberg, Jacob

    2016-01-01

    to open surgery. METHODS: PubMed and Embase were searched systematically in March 2014. Observational studies evaluating preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery in patients with gallstone disease were included. The outcome variables extracted were......BACKGROUND: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystectomy......, and acute cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  11. Traditional Uighur Medicine Karapxa decoction, inhibits liver xanthine oxidase and reduces serum uric acid concentrations in hyperuricemic mice and scavenges free radicals in vitro

    OpenAIRE

    Amat, Nurmuhammat; Umar, Anwar; Hoxur, Parida; Anaydulla, Mihrigul; Imam, Guzalnur; Aziz, Ranagul; Upur, Halmurat; Kijjoa, Anake; Moore, Nicholas

    2015-01-01

    Background Karapxa decoction (KD) is a Traditional Uighur Medicine used for hepatitis, cholecystitis, gastralgia, oedema, gout and arthralgia. Because of its purported effect in gout, its effects were tested in hyperuricemic mice models induced by yeast extract paste or potassium oxonate, as well as its capacity to scavenge free radicals in vitro. Methods Hyperuricemia was induced in mice by yeast extract paste or potassium oxonate. KD was given orally for 14 days at 200, 400 and 800 mg/kg/da...

  12. Infectious abdominal emergencies; Urgences abdominales d`origine infectieuse

    Energy Technology Data Exchange (ETDEWEB)

    Porcel, A.; Arrive, L.; Mehdi, M.; Monnier-Cholley, L.; Ayadi, K.; Tubiana, J.M. [Centre Hospitalier Universitaire Saint-Antoine, 75 - Paris (France)

    1996-12-31

    Infectious disease is a common cause of acute abdomen. The diagnosis is based on clinical examination and basic laboratory tests. However, medical imaging routinely performed according to the clinical findings is frequently useful. Hepatic and splenic abscesses are correctly demonstrated by ultrasonography and computed tomography. Ultrasonography is the reference standard for the diagnosis of acute cholecystitis. The US examination is also performed for the diagnosis of appendicitis and its complications. Ultrasonography and barium enema are commonly performed for the evaluation of sigmoid diverticulitis. Computed tomography is the reference standard to determine medical or surgical procedures. (authors). 20 refs., 15 figs.

  13. The use of intraoperative cholangiogram during laparoscopic double cholecystectomy

    Directory of Open Access Journals (Sweden)

    Gustavo E. Guajardo-Salinas

    2010-09-01

    Full Text Available ouble gallbladder is a rare finding in patients with symptomatic cholelithiasis or acute cholecystitis. The incidence has been described as 1 in every 4000-5000 patients during autopsy. To identify the gallbladder (GB duplication prior to surgical removal of the GB is of upmost importance. It is not unusual to identify this diagnosis intraoperatively, but by using US, ERCP or MRCP more than 50% of the cases are diagnosed preoperatively. The use of intraoperative cholangiogram helps to identify the anatomy and confirm the diagnosis during laparoscopic cholecystectomy in patients with gallbladder duplication.

  14. Left-sided gall bladder: Report of two cases

    Directory of Open Access Journals (Sweden)

    Chrungoo R

    2007-01-01

    Full Text Available Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.

  15. Recent Advances in the Concept and Pathogenesis of IgG4-Related Disease in the Hepato-Bilio-Pancreatic System

    OpenAIRE

    Okazaki, Kazuichi; Yanagawa, Masahito; Mitsuyama, Toshiyuki; Uchida, Kazushige

    2014-01-01

    Recent studies have proposed nomenclatures of type 1 autoimmune pancreatitis (AIP) (IgG4-related pancreatitis), IgG4-related sclerosing cholangitis (IgG4-SC), IgG4-related cholecystitis, and IgG4-related hepatopathy as IgG4-related disease (IgG4-RD) in the hepato-bilio-pancreatic system. In IgG4-related hepatopathy, a novel concept of IgG4-related autoimmune hepatitis (AIH) with the same histopathological features as AIH has been proposed. Among organs involved in IgG4-RD, associations with p...

  16. Infectious abdominal emergencies

    International Nuclear Information System (INIS)

    Infectious disease is a common cause of acute abdomen. The diagnosis is based on clinical examination and basic laboratory tests. However, medical imaging routinely performed according to the clinical findings is frequently useful. Hepatic and splenic abscesses are correctly demonstrated by ultrasonography and computed tomography. Ultrasonography is the reference standard for the diagnosis of acute cholecystitis. The US examination is also performed for the diagnosis of appendicitis and its complications. Ultrasonography and barium enema are commonly performed for the evaluation of sigmoid diverticulitis. Computed tomography is the reference standard to determine medical or surgical procedures. (authors). 20 refs., 15 figs

  17. Opisthorchiasis in Thailand: Review and current status

    Institute of Scientific and Technical Information of China (English)

    Natthawut Kaewpitoon; Soraya J Kaewpitoon; Prasit Pengsaa

    2008-01-01

    Opisthorchiasis caused by Opisthorchis viverrini (O.viverrini)remains a major public health problem in many parts of Southeast Asia including Thailand, Lao PDR,Vietnam and Cambodia. The infection is associated with a number of hepatobiliary diseases, including cholangitis,obstructive jaundice, hepatornegaly, cholecystitis, cholelithiasis and cholangiocarcinoma. The liver fluke infection was induced by eating raw or uncooked fish products that is the tradition and popular in the northeastern and northern region, particularly in rural areas of Thailand.Health education programs to prevent and control opisthorchiasis are still required in high-risk areas.

  18. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy.

    Science.gov (United States)

    Kumar, Lovekesh; Singh, Mahendra; Saxena, Ashish; Kolhe, Yuvraj; Karande, Snehal K; Singh, Narendra; Venkatesh, P; Meena, Rambabu

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50-100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy. PMID:26167314

  19. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

    Directory of Open Access Journals (Sweden)

    Lovekesh Kumar

    2015-01-01

    Full Text Available Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy.

  20. HIDA and ultrasound scans in the diagnosis of acute gall bladder disease

    International Nuclear Information System (INIS)

    97 patients with suspected acute gall bladder disease were subjected to cholescintigraphy (HIDA) and ultrasonography (US) to evaluate their diagnostic accuracy in detecting acute cholecystitis (AC). Three patients with non-biliary disease had normal HIDA and sonography scans, while the remaining 94 were operated on within 48 hours of admission to the hospital. Of these 62 (66%) were proved to have AC at operation and on histopathological examination. HIDA scans correctly diagnosed AC in 57 of them (92%), while sonography revealed dilated and oedematous gall bladders, and thus diagnosed AC in 30 patients (48%). (orig.)

  1. Cholecystoenteric Fistule and Laparoscopic Repair

    Directory of Open Access Journals (Sweden)

    Temel Bulut

    2014-03-01

    Full Text Available Gallbladder stones are an endemic disease of hepatobiliary system.Whereas, cholecystoenteric fistules which develop by depending on gallbladder stone are rarely seen complications. A diagnosis is usually established during an operation. As is seen in our case too, in view of acute-stoned cholecystitis, laparoscopy has been carried out and a diagnosis of cholecystoduodenal fistule has been established during laparoscopy. Our case to whom laparoscopic duodenography and cholecystectomy has been applied is a rarely seen disease in literature. So, we aimed at sharing this information.

  2. [Minimally-invasive surgery: even less invasive? Oncological surgery: multidisciplinary first].

    Science.gov (United States)

    Zingg, T; Demartines, N

    2010-01-27

    Despite advertising for NOTES in 2009, single trocart laparoscopic surgery is about to become a new standard in selected indications. As other important topics, the limits of oncological surgery are extended due to a systematic multidisciplinary approach. To discuss every publication would be difficult and our review will focus on a selected number of papers of importance for daily practice. As examples, the management of acute calculous cholecystitis, gastro-esophageal reflux, inguinal and incisional hernia repair as well as colorectal surgery are presented. PMID:20214193

  3. Obstructive choledocholithiasis requiring intervention in a three week old neonate: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lindsay E. Peters

    2016-01-01

    Full Text Available The discovery of cholelithiasis in neonates is often incidental, however obstructing common bile duct stones are rare. Herein we report the case of a 3 week old neonate who presented with obstructive choledocholithiasis. The patient was treated conservatively with antibiotics and ursodeoxycholic acid but did not improve. He was therefore taken to surgery for cholecystectomy and stone extraction. The operation was successful and his transaminases and bilirubin levels declined. Trials of conservative management can be attempted in asymptomatic infants with choledocholithiasis. However, failure of the stone to pass or ongoing signs of cholecystitis should be met with operative intervention to remove the obstruction.

  4. Bacteriological examination of gallbladder contents

    Directory of Open Access Journals (Sweden)

    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

  5. Our experience of biliary ascariasis in children

    OpenAIRE

    Wani M; Chechak Bashir; Reshi Farooq; Pandita Sanjay; Rather Muddasar; Sheikh Tariq; Ganie Ishfaq

    2006-01-01

    Ascariasis is highly endemic in Kashmir valley as temperate climate and wet soil provide excellent conditions for its development. We studied 198 cases (11%) of biliary ascariasis out of 1,800 patients of worm infestation from December 2001 to December 2004 in the age group of 4-15 years. In our study, we found biliary ascariasis to be more common in female children, and most common clinical presentation was biliary colic in 143 patients, cholangitis in 28, cholecystitis in 15, liver a...

  6. Imaging findings in the rare catastrophic variant of the primary antiphospholipid syndrome

    International Nuclear Information System (INIS)

    We report imaging findings in a case of the rare catastrophic variant of antiphospholipid syndrome (CAPS) characterized by widespread microvascular occlusions, which may lead to multiple organ failure. We present a case of a 66-year-old woman with bone marrow necrosis, acute acalculous cholecystitis (AAC), focal liver necrosis, subtle patchy splenic infarctions, and bilateral adrenal infarction. The demonstration of multiple microvascular organ involvement (three or more) is crucial for the diagnosis of the catastrophic variant of APS. This can be performed radiologically intra-vitam. Imaging can even reveal subclinical microinfarctions, which are often only diagnosed at autopsy. (orig.)

  7. Imaging findings in the rare catastrophic variant of the primary antiphospholipid syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Thuerl, Christina; Altehoefer, Carsten; Laubenberger, Joerg [Freiburg Univ. (Germany). Abt. Radiologie; Spyridonidis, Alexandros [Freiburg Univ. (DE). Abt. Innere Medizin 1 (Haematologie und Onkologie)

    2002-03-01

    We report imaging findings in a case of the rare catastrophic variant of antiphospholipid syndrome (CAPS) characterized by widespread microvascular occlusions, which may lead to multiple organ failure. We present a case of a 66-year-old woman with bone marrow necrosis, acute acalculous cholecystitis (AAC), focal liver necrosis, subtle patchy splenic infarctions, and bilateral adrenal infarction. The demonstration of multiple microvascular organ involvement (three or more) is crucial for the diagnosis of the catastrophic variant of APS. This can be performed radiologically intra-vitam. Imaging can even reveal subclinical microinfarctions, which are often only diagnosed at autopsy. (orig.)

  8. Bilothorax as a complication of percutaneous transhepatic biliary drainage.

    Science.gov (United States)

    Sano, Atsushi; Yotsumoto, Takuma

    2016-01-01

    We report two cases of bilothorax that occurred as a complication of percutaneous transhepatic biliary drainage. In an 86-year-old woman who had undergone percutaneous transhepatic biliary drainage for obstructive jaundice, bilothorax occurred after accidental removal of the tube. She recovered with chest drainage only. An 83-year-old man who had undergone percutaneous transhepatic biliary drainage for cholecystitis developed bilothorax with infection. He recovered with thoracoscopic curettage. Although bilothorax is a rare complication of percutaneous transhepatic biliary drainage, appropriate diagnosis and prompt treatment is important, especially when bilothorax is accompanied by infection. PMID:26294694

  9. Massive right hemothorax as the source of hemorrhagic shock after laparoscopic cholecystectomy - case report of a rare intraoperative complication

    Directory of Open Access Journals (Sweden)

    Federico Biolchini

    2011-05-01

    Full Text Available Abstract A 62-year old man was referred to our institution in hemorrhagic shock after a laparoscopic cholecystectomy for acute cholecystitis, performed at an outside hospital. A chest X-ray revealed a right-sided massive pleural effusion. Urgent surgical exploration was performed through a video-assisted mini-thoracotomy which revealed active bleeding from a pleural adherence. Successful hemostasis was achieved intraoperatively and the patient had an uneventful recovery. In absence of intra-abdominal hemorrhage, a hemothorax should be considered as a potential source of major bleeding in patients who develop symptoms of hypovolemia after laparoscopic surgery.

  10. [Sonographic imaging of Ascaris lumbricoides].

    Science.gov (United States)

    Barzilai, M; Khamaysi, N

    1996-10-01

    The round worm, Ascaris lumbricoides, is one of the largest of the parasites that infest the human bowel. The worms usually develop in the jejunum and can reach several thousand in number, causing bowel obstruction, volvulus, intussusception, appendicitis and even bowel perforation with penetration into the peritoneal cavity. They tend to invade the bile and pancreatic ducts and may cause acute cholecystitis and pancreatitis. Ascaris lumbricoides can be detected by sonography. This imaging modality can be helpful in diagnosing the presence of the worms and in evaluating response to treatment. We present an 18-month-old girl in whom bowel worms were detected by sonography. PMID:8940520

  11. [Pathology of biliary tract IN elderly patients with the system approach. Principles of therapy].

    Science.gov (United States)

    Pal'tsev, A I; Eremina, A A; Gorbunova, E N; Torgashov, M N

    2011-01-01

    The biliary tract pathology gains the increasing distribution.So cholelitiasis in different camps is registered from 7.8 to 38%. In Russia the given indicator from 3 to 12%. Special importance cholelitiasis and chronic cholecystitis without cholelitiasis get at persons of the advanced age, connected as with morfofunkcional'nymi changes in an organism of senior citizens, and with a wrong way of life. All it demands the differentiated approach to treatment of this group of patients and includes change of a way of life, a dietotherapy, farmako- and physiotherapeutic treatment. PMID:21916202

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

    Directory of Open Access Journals (Sweden)

    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.

  13. [Prevalence and risk factors of gastroduodenal and biliary system diseases in infants and preschool children].

    Science.gov (United States)

    Malanicheva, T G; Ziatdinova, N V; Denisova, S N

    2013-01-01

    To study the prevalence and risk factors of digestive diseases in children performed continuous screening questionnaire 786 children from 1.5 to 7 years. Were Revealed that 47.1 +/- 3.5% of children have symptoms of diseases of the gastrointestinal tract and biliary system. This symptoms occur in children aged 4 to 7 years in 2.3 times more frequently than in children from 1.5 to 3 years. In-depth study was revealed that the frequency of biliary dyskinesia (BD) was 33 +/- 3.3%, chronic gastritis (CG) and gastroduodenitis (CGD)--6.2 +/- 1.8%, chronic cholecystitis--4.2 +/- 1.4%, functional disorders of the stomach (FSD)--2.8 +/- 1.2%, and peptic duodenal ulcer (DU)--0.3 + 0.4%. In the structure of digestive diseases in children from 1.5 to 7 years on the 1st place are BD--70% on the 2nd--CG and CGD--14.7% on the 3rd chronic cholecystitis--8.9%, on the 4th FSD-5.9% and 5th place DU-0.5%. For dispensary observation in the children's clinic with digestive diseases consist of only 7.9 +/- 1.9% of children, which is 5.9 times lower than according to the active diagnostics data. The leading medical and social risk factors and their complex influence on the formation of digestive disorders in infants and preschool children. PMID:24933954

  14. Diagnosis of hepatobiliary disease by Technetium-99m-HIDA and BIDA cholecystography in 210 patients treated at ''Soroka Medical Center'' between 1977 - 1979

    International Nuclear Information System (INIS)

    Cholescintigraphy experience with Tc99m-HIDA and BIDA in 210 patients with gallbladder disease treated at the Soroka Medical Center between the years 1977 - 1979 is described. In this work the utility of the method in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice up to 26 mg% of Bilirubin is demosntrated. Four patients were diagnosed as suffering from Atresia of biliary duct. The most common findings in our series are: all normal gallbladders exhibited filling; absence of visualization indicated gallbladder disease and/or cystic duct obstruction; visualization of the gallbladder after a fatty meal-induced emptying excluded an obstructed cystic duct and acute cholecystitis; a definite diagnosis of hepato-cellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemia. No diagnostic failures due to too low concentration of the tracer in the biliary tract, were observed. Radiation exposure is somewhat greater than in cholecystography and cholangiography. Cholescintigraphy is a suitable complementary or alternative investigation to intravenous cholangiography, especially when poor excretion of the contrast medium or adverse reaction impair the result of the latter. In some of our cases this method proved to be the first choice non invasive procedure, especially in cases with high serum bilirubin up to 26 mg%. (B.G.)

  15. Imaging diagnosis of biliary tract lesions (with a report of 486 cases)

    International Nuclear Information System (INIS)

    Objective: To evaluate the various imaging modalities in the diagnosis of biliary tract lesions. Methods: The imaging findings of 486 cases of biliary tract lesions proved surgically and pathologically were retrospectively reviewed. The advantage and the limitation of each examination were analyzed. Results: Twenty six cases with negative stone in gallbladder were demonstrated in conventional cholecystography. The anatomical morphology and the pathogenesis were well shown on direct cholangiography. The positive accuracy of ultrasonography (US) and CT for biliary duct calculus was 91.3% and 90.3%, respectively. Sanded stone were missed on CT in 13 cases. The consistent rate of US diagnosis of chronic cholecystitis and gallbladder polyps was 100% and 93.3%, respectively. The 'bile duct tree' at MRCP helped the diagnosis of the cholangiocarcinoma arising at the portal hepatics. Conclusion: The negative stone in gallbladder can be demonstrated by conventional cholecystography. Direct cholangiography can provide important evidence for the qualitative diagnosis. US and CT are superior to other modalities in detecting biliary duct calculus. US is the best imaging modality for chronic cholecystitis and polypoid lesion of gallbladder. 3D MRCP is an ideal imaging for severe bile duct obstruction

  16. MICROBIOLOGICAL PROFILE OF BILE IN CHOLELITHIASIS AND THEIR IMPLICATION IN CAUSING POST OPERATIVE WOUND INFECTIONS

    Directory of Open Access Journals (Sweden)

    Shahi

    2014-12-01

    Full Text Available BACKGROUND: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. MATERIALS AND METHODS: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. RESULTS: Bactibilia was found in 43/100 (43% of patients. Polymicrobial flora was found in 7% of bile samples. Escherichia coli, citrobacter, Klebsiella pneumoniae and pseudomonas were the predominant organisms isolated. Post-operative wound infection was found in ten (10% patients who had bactibilia. Amikacin, gentamicin, ceftriaxone sulbatum, pipracillin tazobactum, imipenem were among most effective in prophylactic regimen. CONCLUSION: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing cholecystectomy should receive prophylactic antibiotic to prevent post-operative wound infections.

  17. Inflammatory diseases of the gall bladder and biliary system. Part I: Imaging - cholelithasis - inflammation of the gall bladder; Entzuendliche Erkrankungen der Gallenblase und der Gallenwege. Teil I: Bildgebende Verfahren - Cholelithiasis - Entzuendungen der Gallenblase

    Energy Technology Data Exchange (ETDEWEB)

    Helmberger, H. [Krankenhaus Dritter Orden Muenchen-Nymphenburg (Germany). Abteilung fuer Diagnostische und Interventionelle Radiologie/Nuklearmedizin; Kammer, B. [Haunersches Kinderspital der Ludwig-Maximilians-Universitaet Muenchen (Germany). Abteilung Paediatrische Radiologie

    2005-05-01

    Cholelithiasis is the most common affliction of the gallbladder and biliary tract. Including its complications, gallstone disease represents the basis for cholecystitis and cholangitis in the majority of cases. Inflammatory diseases of the biliary system are divided into acute and chronic forms originating from the gallbladder as well as from the biliary tract. Although acute calculous cholecystitis is the most common form, gangrenous, and emphysematous inflammation of the gallbladder as well as gallbladder empyema are included in this group of diseases. In the chronic forms, calculous and acalculous inflammation is also differentiated. Recent developments in cross-sectional imaging in sonography, computed tomography, and magnetic resonance imaging offer numerous tools for depicting the biliary system with high diagnostic accuracy. Invasive imaging modalities of the biliary system are mainly used for therapeutic aspects. (orig.) [German] Die Cholelithiasis ist die haeufigste Erkrankung von Gallenblase und Gallenwegen. Zusammen mit seinen Komplikationen stellt das Gallensteinleiden zugleich in der Mehrzahl der Faelle die Ursache entzuendlicher Erkrankungen des Gallesystems dar. Dabei wird zwischen akuten und chronischen Formen sowohl der Gallenblase als auch der Gallenwege unterschieden. Zu den akuten Cholezystitiden zaehlen neben der begleitenden Entzuendung beim Gallensteinleiden auch die gangraenoese und emphysematoese Cholezystitis sowie das Gallenblasenempyem. Auch bei den chronischen Formen werden Entzuendungen ohne und mit Steinleiden differenziert. Mit den modernen Schnittbildverfahren Sonographie, Computertomographie und Magnetresonanztomographie stehen zahlreiche Moeglichkeiten der Bildgebung des Gallensystems mit hoher diagnostischer Aussagekraft zur Verfuegung. Die Verfahren der direkten Darstellung des Gallesystems kommen hauptsaechlich im Rahmen der Therapie zum Einsatz. (orig.)

  18. 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.)

  19. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Randen, Adrienne van; Stoker, Jaap [Academic Medical Centre, Department of Radiology (suite G1-227), Amsterdam (Netherlands); Lameris, Wytze; Boermeester, Marja A. [Academic Medical Center, Department of Surgery, Amsterdam (Netherlands); Es, H.W. van; Heesewijk, Hans P.M. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Ramshorst, Bert van [St Antonius Hospital, Department of Surgery, Nieuwegein (Netherlands); Hove, Wim ten [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Bouma, Willem H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, Maarten S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, Esteban M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Bossuyt, Patrick M. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam (Netherlands)

    2011-07-15

    Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p < 0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience. (orig.)

  20. Are histological alterations observed in the gallbladder precancerous lesions?

    Directory of Open Access Journals (Sweden)

    Adriana Lúcia Agnelli Meirelles-Costa

    2010-01-01

    Full Text Available INTRODUCTION: Gallbladder cancer, which is characterized by rapid progression and a poor prognosis, is a complex disease to treat. Unfortunately, little is known currently about its etiology or pathogenesis. A better understanding of its carcinogenesis and determining risk factors that lead to its development could help improve the available treatment options. METHOD: Based on this better understanding, the histological alterations (such as acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis, polyps, pyloric metaplasia, intestinal metaplasia, dysplasia, cancer and others in gallbladders from 1,689 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis were analyzed. The association of these gallbladder histological alterations with clinical data was studied. RESULTS: Gender analysis revealed a greater incidence of inflammatory changes in males, while dysplasia and cancer were only found in women. The incidence of cholesterolosis was greater in the patients 60 years of age and under, and the incidence of adenomyomatosis and gangrene was greater in the elderly patients. A progressive increase in the average age was observed as alterations progressed through pyloric metaplasia, intestinal metaplasia, dysplasia and then cancer, suggesting that the metaplasia-dysplasia-carcinoma sequence may occur in gallbladder cancer. Gallbladder histological alterations were also observed in asymptomatic patients. CONCLUSION: The results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required.

  1. 儿童胆道系统感染的诊断与治疗%Diagnosis and treatment of biliary infection in children

    Institute of Scientific and Technical Information of China (English)

    黄志华; 刘圣烜; 董琛

    2011-01-01

    儿童胆道系统感染包括急、慢性胆囊炎和胆管炎.急性胆囊炎主要表现为右上腹疼痛,呈持续性胀痛,Murphy征阳性,伴恶心、呕吐,部分患儿有高热、寒战、黄疸,重症者发生昏迷.急性胆管炎发病急骤,以腹痛、寒战、高热和黄疸三联征为临床特征,少数患儿以感染性休克为主要表现,病死率高.本文介绍儿童胆道系统感染的诊断与治疗.%Biliary infection in children includes acute and chronic cholecystitis and cholangitis.The main dinical manifestations of acute cholecystitis are right upper-quadrant abdominal pain which is persistent with nausea and vomiting,Murphy's sign positive.Some of patients have high fever,chills,jaundice,and some severe patients have coma.Acute cholangitis has rapid onset.The most common manifestations are abdominal pain,fever,chills and jaundice which are known as Charcot's triad.A few children's main manifestation is septic shock which has a high mortality.This article described the diagnosis and treatment of biliary inflammation in children.

  2. 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.

  3. Fecal loading in the cecum as a new radiological sign of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Andy Petroianu; Luiz Ronaldo Alberti; Renata Indelicato Zac

    2005-01-01

    AIM: Although the radiological features of acute appendicitis have been well documented, the value of plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis with images of fecal loading in the cecum.METHODS: Plain abdominal radiographs of 400 patients operated upon for acute appendicitis (n = 100), acute cholecystitis (n = 100), right acute pelvic inflammatory disease (n = 100) and right nephrolithiasis (n = 100)were assessed. The presence of fecal loading was recorded and the sensitivity and specificity of this sign for acute appendicitis were calculated.RESULTS: The presence of fecal loading in the cecum occurred in 97 patients with acute appendicitis, 13 patients with acute cholecystitis, 12 patients with acute inflammatory pelvic disease and 19 patients with nephrolithiasis. The sensitivity of this sign for appendicitis was 97% and its specificity to this disease was 85.3%. Its positive predictive value for appendicitis was 68.7%; however, its negative predictive value for appendicitis was 98.8%.CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign of acute appendicitis, and the absence of this sign probably excludes this disease.This is the first description of fecal loading as a radiological sign for acute appendicitis.

  4. Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

    Science.gov (United States)

    Udachan, Tejaswini V; Sasnur, Prasad; Baloorkar, Ramakanth; Sindgikar, Vikram; Narasangi, Basavaraj

    2015-01-01

    Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection. PMID:26816942

  5. Torsion of the gallbladder: a case report

    Directory of Open Access Journals (Sweden)

    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.

  6. 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.

  7. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain

    International Nuclear Information System (INIS)

    Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p < 0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience. (orig.)

  8. Bilateral synchronous breast carcinomas followed by a metastasis to the gallbladder: a case report

    Directory of Open Access Journals (Sweden)

    Dardamanis Dimitrios

    2007-09-01

    Full Text Available Abstract Background Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare. Case presentation A 59-year-old woman presented with bilateral synchronous breast lesions. A palpable, retroareolar solid lesion of diameter equal to 5 cm was present in the right breast, and a newly developed, non-palpable lesion with microcalcifications (diameter equal to 0.7 cm was present in the upper outer quadrant of the left breast. Modified radical mastectomy was performed on the right breast and lumpectomy after hook-wire localization was performed on the left breast, combined with lymph node dissection in both sides. The pathological examination revealed invasive lobular carcinoma grade II in the right breast and invasive ductal carcinoma grade I in the left breast. Chemotherapy, radiation therapy, trastuzumab and letrozole were appropriately administered. At her 18-month follow-up, the patient was free of symptoms; the imaging tests (chest CT, abdominal U/S, bone scan, biochemical tests, blood cell count and tumor markers were also normal. At the 20th month after surgery however, the patient developed symptoms of cholecystitis and underwent cholecystectomy. The histopathological examination revealed metastasis of the lobular carcinoma to the gallbladder. Conclusion This extremely rare case confirms on a single patient the results of large series having demonstrated the preferential metastasis of lobular breast cancer to the gallbladder. Symptoms of cholecystitis should not be neglected in such patients, as they might indicate metastasis to the gallbladder.

  9. Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Takehide Asano; Hodaka Amano; Masahiro Yoshida; Naoyuki Toyota; Keita Wada; Kenichiro Kato; Tadahiro Takada; Junichi Fukushima; Fukuo Kondo; Hajime Takikawa

    2009-01-01

    Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice.Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pyloruspreserving pancreatoduodenectomy and liver biopsy.On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sclerosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis (PSC). Bile duct wall thickening in patients (PSC). Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia.

  10. Risk of Post-ERCP Pancreatitis after placement of Covered versus Uncovered Self-Expandable Biliary Metal Stents: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2008-09-01

    Full Text Available Background Self-expandable metal stents are commonly used in the management of malignant biliary obstruction due to higher patency rates compared to plastic stents. Development of covered self-expandable metal stents has led to extended stent patency compared to uncovered self-expandable metal stents. However, there are concerns that deployment of covered self-expandable metal stents may be associated with higher risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis, acute cholecystitis and stent migration. Objective We performed this meta-analysis to assess the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events (acute cholecystitis and stent migration with biliary covered self-expandable metal stents compared to uncovered self-expandable metal stents. We also assessed the proportion of stent patency at 6 and 12 months between the two groups. Methods We searched MedLine, EMBASE, Cochrane database, ISI Web of Science and Scopus from January 1989 through June, 2014, to identify randomized controlled trials and observational studies that provided data on the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events following the placement of covered self-expandable metal stents versus uncovered self-expandable metal stents in patients with biliary obstruction. The Mantel–Haenszel method was used to pool data of post-endoscopic retrograde cholangio- pancreatography pancreatitis, acute cholecystitis, stent migration and proportion of stent patency over 6 and 12 months into fixed or random effect model of meta-analyses. Odds ratio was used to generate an overall effect estimate of the outcome. Results Eight studies (6 randomized controlled trials and 2 observational studies with a total of 1078 patients were included in the meta-analysis. The pooled odds ratio with 95% confidence intervals for risk of post-endoscopic retrograde cholangio

  11. Sonographic Analysis of the Collapsed Gall Bladder

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sang Suk; Choi, Jae Young; Choi, Seok Jin; Eun, Chung Ki [Pusan Paik Hospital, College of Medicine Inje University, Busan (Korea, Republic of); Nam, Kyung Jin; Lee, Jeong Mi [Donga University Collge of Medicine, Busan (Korea, Republic of)

    1996-06-15

    This study was done to find answers for further following questions in cases of the collapsed gallbladder (GB) : What is the probability of the presence of stone when stony echo is visible in GB area? What is the probability of the presence of stone when only acoustic shadow is visible from GB area? What are the associated GB pathologies except stone or cholecystitis in previously mentioned situations and is it possible to differentiate them? What are the underlying pathologies of GB collapse without stony echo or acoustic shadow and is it possible to differentiate them sonographic ally? What are the rate and causes of re-expansion of the collapsed GB on follow-up study? Prospective study was done in 157 cases of collapsed GB with no visible or nearly no visible bile filled lumen in recent 3 years. Sonographic analysis for GB lesions was done in 61 confirmed cases. Changing pattern of GB lumen on follow-up study and their underlying pathologies were analyzed in 28 cases. Initial sonographic examination was done with 3 or 3.5 MHz transducer. No other transducer was used in cases showing stony echo or acoustic shadow in GB area, but additional examination was done with 5 or 7-4 MHz transducer in cases without stony echo or acoustic shadow. Among 31 cases, which showed stony echo, stone was found in 30 cases and milk of calcium bile in one case. Stone was present in all of the 11 cases which showed only acoustic shadow from the collapsed GB without stony echo. GB cancer was accompanied in 2 cases among upper 42 cases, and its possibility could be suspected sonographic ally. Underlying pathologies of the 19cases without stony echo or acoustic shadow were as follows : GB stone (3), cholecystitis (6), GB cancer (1), bile plug syndrome (1), hepatitis (5), and ascites (3). And sonographic differentiation of the underlying causes for the collapse was possible in only 1 case of GB cancer. Among 28 cases of the follow-up study, 20 cases showed re-expansion of the GB lumen and

  12. Association of cyclin D1, p16 and retinoblastoma protein expressions with prognosis and metastasis of gallbladder carcinoma

    Institute of Scientific and Technical Information of China (English)

    Hong-Bing Ma; Hai-Tao Hu; Zheng-Li Di; Zuo-Ren Wang; Jing-Sen Shi; Xi-Jing Wang; Yi Li

    2005-01-01

    AIM: To investigate the role of cydin D1, p16 and retinoblastoma in cancerous process of gallbladder carcinomas and to assess the relation between cyclin D1, p16, Rb and the biological characteristics of gallbladder carcinoma.METHODS: Forty-one gallbladder carcinoma, 7 gallbladder adenoma and 14 chronic cholecystitis specimens were immunohistochemically and histopathologically investigated for the relation of cyclin D1, p16 and Rb with Nevin staging and pathologic grading.RESULTS: The expression rates of abnormal cyclin D1 in gallbladder carcinoma (68.3%)and gallbladder adenoma(57.1%) were significantly higher than those in chronic cholecystitis (7.1%) (P<0.05). No significant difference was found both among the pathological grades G1, G2 and G3and among Nevin stagings S1-S2, S3 and S4-S5 of gallbladder carcinoma. The positive rates of p16 (48.8%) and Rb(58.5%) in gallbladder carcinoma were significantly lower compared to those in adenoma (100.0%) and cholecystitis(100.0%) (P<0.05). The positive rates of p16 and Rb in Nevin stagings S1-S2 (80.0% and 90.0%) and S3 (46.2%and 61.5%) gallbladder carcinomas were significantly higher than those in S4-S5 (33.3% and 38.8%) (P<0.05),and those in pathologic grades G1 (54.5% and 81.8%) and G2 (50.0% and 62.5%) gallbladder carcinoma were significantly higher than those in G3 (28.6% and 35.7%)(P<0.05). The protein expression of p16 and Rb had a negative-correlation in gallbladder carcinoma (r = -0.2993,P<0.05), and this negative-correlation was correlated with Nevin staging (P<0.05). Moreover, the protein expression of p16 and cyclin D1 had a negative-correlation in gallbladder carcinoma (r = -0.9417, P<0.05).CONCLUSION: Cyclin D1 may play a role in the early stage of gallbladder carcinoma. Mutation of p16 and Rb genes might be correlated with progression of gallbladder carcinoma.Analysis of p16 and Rb can estimate the prognosis of gallbladder carcinoma. Expression of p16 and Rb may be correlated with Nevin

  13. Application of imaging modalities in diagnosis of hepatic disorders in dogs

    International Nuclear Information System (INIS)

    The study was undertaken on 18 dogs, of varied age, breed and sex, which were divided into two groups. The group-I consisted of 6 clinically healthy dogs, whereas group-II consisted of 12 dogs brought with liver disorders. The clinical, haematobiochemical, radiographic, sonographic and laparoscopic examinations were carried out in both group of animals. Results showed more liver disorders in older female animals. Haematobiochemical analysis revealed non-significant differences between the groups. Radiographic evaluation of the liver is unreliable. Ultrasonography revealed alteration in liver texture, thick hyperechoic walled gall bladder, mixed echogenic patches and anechoic cyst in the liver. By laparoscopic examination, disorders of liver like, hepatomegaly with hepatic cyst, cholecystitis, hepatitis, nodular cirrhosis, multifocal abscesses, fatty degeneration, icteric changes alongwith leafening of liver lobes could be diagnosed

  14. Effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the gallbladder and bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Fiegler, W.; Schoerner, W.; Felix, R.

    1984-09-01

    The effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the biliary tract is described. Ultrasound should be the first examination in clinical suspicion of cholelithiasis and has a higher accuracy than oral cholecystography. Computed tomography is very expensive and should be carried out in suspected gallbladder carcinoma, cholecystitis with abscess formation, tumour in the porta hepatis and pancreatic head and in sonographically unclear cases. Nuclear magnetic resonance can determine the ability of the gallbladder to concentrate bile. Ultrasound can distinguish with high accuracy between obstructive and inflammatory jaundice. In clinical suspicion of bile duct lesions an infusion cholangiogram must be carried out, if bilirubin is lower than 5 mg%; if bilirubin is higher, an ERC or PTC should be performed. If in biliary obstruction a suspicion of tumour in porta hepatis or head of the pancreas is present, computed tomography should be effected.

  15. Gallstones: new insights into an old story

    Science.gov (United States)

    Tiderington, Evan; Lee, Sum P.; Ko, Cynthia W.

    2016-01-01

    Gallstones, particularly cholesterol gallstones, are common in Western populations and may cause symptoms such as biliary colic or complications such as acute cholecystitis or gallstone pancreatitis. Recent studies have allowed for a better understanding of the risk of symptoms or complications in patients with gallstones. In addition, newer data suggest an association of gallstones with overall mortality, cardiovascular disease, gastrointestinal cancers, and non-alcoholic fatty liver disease. Knowledge of appropriate indications and timing of cholecystectomy, particularly for mild biliary pancreatitis, has gradually accumulated. Lastly, there are exciting possibilities for novel agents to treat or prevent cholesterol stone disease. This review covers new advances in our understanding of the natural history, clinical associations, and management of gallstone disease. PMID:27508070

  16. Gallbladder disease in patients with primary sclerosing cholangitis

    International Nuclear Information System (INIS)

    The author retrospectively reviewed the records of 121 patients with known primary sclerosing cholangitis. CT scans, US scans, and cholangiograms were reviewed and correlated with surgical or autopsy findings, when available. Gallstones were found in 16 of 55 patients at surgery/autopsy. Acalculous cholecystitis was found in 31 patients, cholesterolosis in three, adenoma in three, and carcinoma in three. In 66 nonoperatively treated patients, gallstones were demonstrated by US in an additional 13 (overall prevalence = 29/121, or 24%). Thickening of the gallbladder wall without stones was demonstrated in 20 patients. Gallbladder abnormalities occur more often in patients with primary sclerosing cholangitis than is generally believed, and include a variety of neoplastic and inflammatory entities

  17. Transient heterogeneous enhancement on dual-phase helical CT of liver

    Energy Technology Data Exchange (ETDEWEB)

    Ishibashi, Tadashi; Hama, Hikaru; Oikawa, Hideki; Yamada, Takayuki; Abe, Hiroyuki; Saitoh, Haruo; Sakamoto, Kiyohiko [Tohoku Univ., Sendai (Japan). School of Medicine; Satoh, Akihiro

    1996-08-01

    Transient heterogeneous enhancement was seen on the arterial phase of dual-phase helical CT of the liver. The shape of the enhancement was appeared wedged or patchy. These phenomena without liver tumor were observed in 23 (2.3%) of 1012 patients with suspected hepatobiliary disease. Plain CT showed no attenuation difference in the liver. Twenty-two of these 23 cases were diagnosed as scarred liver, A-P shunt caused by liver biopsy, acute cholecystitis, liver abscess, liver cirrhosis, or advanced pancreas head cancer. The diagnosis of one case was uncertain. These phenomena were thought to be caused by a regional direct increase in hepatic arterial flow due to arterial-portal (A-P) shunt, or hypervascular tumor; or a compensatory increase in hepatic arterial flow as a result of decreased portal venous flow caused by tumor invasion or severe liver cirrhosis. (author)

  18. Imaging findings of biliary and nonbiliary complications following laparoscopic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin-Young; Kim, Joo Hee; Lim, Joon Seok; Oh, Young Taik; Kim, Ki Whang [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Kim, Myeong-Jin [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Brain Korea 21 Project for Medical Science, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Yonsei University College of Medicine, Institute of Gastroenterology, Seoul (Korea); Park, Mi-Suk [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea)

    2006-09-15

    Laparoscopic techniques are evolving for a wide range of surgical procedures although they were initially confined to cholecystectomy and exploratory laparoscopy. Recently, surgical procedures performed with a laparoscope include splenectomy, adrenalectomy, gastrectomy, and myomectomy. In this article, we review the spectrum of complications and illustrate imaging features of biliary and nonbiliary complications after various laparoscopic surgeries. Biliary complications following laparoscopic cholecystectomy include bile ductal obstruction, bile leak with bile duct injury, dropped stones in the peritoneal cavity, retained CBD stone, and port-site metastasis. Nonbiliary complications are anastomotic leakage after partial gastrectomy, gangrenous cholecystitis after gastrectomy, hematoma at the anastomotic site following gastrectomy, gastric infarction after gastrectomy, port-site metastasis after gastrectomy, hematoma after splenectomy, renal infarction after adrenalectomy, and active bleeding after myomectomy of the uterus. (orig.)

  19. Isolated Polypoid Ganglioneuroma of Gall Bladder - A Case Report

    Directory of Open Access Journals (Sweden)

    Vandana U.G.

    2011-07-01

    Full Text Available A ganglioneuroma is a very rare neoplasm in the gastrointestinal tract and a benign neoplasm of sympathetic nervous system. They predominantly affect the colon and rectum and are rare to arise in gall bladder. Gastrointestinal ganglioneuromas occur as rare isolated (solitary polypoid lesions or more commonly as ganglioneuromatous polyposis and diffuse ganglioneuromatosis. Isolated polypoid lesions are clinically asymptomatic and incidentally detected during endoscopy or surgery. We report a case of a 42-year-female who presented clinically with features of chronic cholecystitis and was operated. There was no association of any hereditary disease. Incidentally the cholecystectomy specimen showed a small sessile polypoid lesion. Histopathological examination showed the lesion to be polypoid ganglioneuroma arising in gall bladder. The isolated polypoid ganglioneuroma is invariably benign. They do not have increased risk of von Recklinghausen’s disease or multiple endocrine neoplasia IIB and show no evidence of recurrence with excellent prognosis after total excision.

  20. 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.

  1. Antireflux metal stent with an antimigration system for distal malignant biliary obstruction: a feasibility pilot study.

    Science.gov (United States)

    Hamada, Tsuyoshi; Isayama, Hiroyuki; Nakai, Yousuke; Togawa, Osamu; Kogure, Hirofumi; Takahara, Naminatsu; Mohri, Dai; Sasaki, Takashi; Matsubara, Saburo; Yamamoto, Natsuyo; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2015-06-01

    An antireflux metal stent (ARMS) for distal malignant biliary obstruction has been reported to be useful, but the effectiveness of a flared-end structure to prevent migration on ARMS remains unclear. To evaluate the feasibility of a newly designed ARMS with both ends flared, 8 patients with covered metal stent occlusion due to sludge or food impaction were enrolled. ARMS were placed successfully after endoscopic removal of the occluded stents in all patients, and no procedure-related complication was observed. The median time to recurrent biliary obstruction was 71 days. ARMS occlusion occurred in 3 (38%) patients (sludge in 2 patients and hemobilia in 1). ARMS migration occurred in 1 (13%) patient. As a late complication, cholecystitis occurred in 1 (13%) patient. In conclusion, our newly designed ARMS with an antimigration system was technically feasible and safe, and a further investigation is warranted to evaluate the effectiveness of the current antimigration system. PMID:25856131

  2. Investigation of the motor activity of the gall bladder using cholescintigraphy

    International Nuclear Information System (INIS)

    The motor activity of the gall bladder was studied using cholescintigraphy with sup(99m)Tc-HIDA in 57 patients with chronic cholecystitis and chronic heaptitis and in 9 controls. A comparative analysis of the curves activity-time based upon the elements of images of the external contour and the entire zone of the gall bladder, made it possible to reveal differences in the type of reaction of the gall bladder to the use of cholagogic stimulators (cholecystokinin i.v. and cholagogic breakfast). A method of the processing of the results made it possible to determine the number of contraction phases of the gall bladder during its emptying as well as the true latent period and the period of primary reactions of the beliferous apparatus after taking a food stimulus

  3. Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; Grigoris Chatzimavroudis; Ioannis Pilpilidis; George Paroutoglou; Jannis Kountouras; Christos Zavos

    2008-01-01

    A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis.His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy,and total parenteral nutrition(TPN)for 15 d.Seven weeks after cholecystectomy,he presented with cholangitis.Endoscopic retrograde ch0Iangiopancreatography(ERCP)demonstrated extrahepatic filling defects.Despite endoscopic extraction of a biliary cast,cholestasis remained unchanged.Oral administration of ursodeoxycholic acid(UDCA),750 mg/d,resulted in normalization of liver function tests.We,therefore,propose for the first time,combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.(C)2008 The WJG Press.All righis reserved.

  4. A retrospective study of post-operative gall bladder pathology with special reference to incidental carcinoma of the gall bladder

    Directory of Open Access Journals (Sweden)

    Jagannath Dev Sharma

    2014-06-01

    Methods: This retrospective study was carried out at a multi-specialty hospital in eastern India from the pathology records for the period from August 2005 to July 2008. The records were analyzed for gender, age group distribution, and pathological types with different histology. Results: Out of 863 records, chronic cholecystitis 51.2% was the most common histology and malignancy was seen in 2.7% (23/863 both pre-operative and post-operative diagnosis. In the neoplastic group incidental carcinoma was diagnosed in 1.9% (17/23 of cases Conclusion: Histopathological examination of gallbladder specimen helps to identify non-neoplastic conditions with its complications and also, for the detection of incidental carcinoma. Thorough sampling of all gallbladder specimens is a must to detect focal neoplastic changes. [Int J Res Med Sci 2014; 2(3.000: 1050-1053

  5. Heterotopic Pancreatic Tissue Located in the Gallbladder Wall. A Case Report

    Directory of Open Access Journals (Sweden)

    Hasan Gucer

    2011-03-01

    Full Text Available Context Heterotopia of the pancreas can be defined as the presence of pancreatic tissue in an abnormal location without any continuity with the main body of the pancreas. Heterotopic pancreatic tissue located in the gallbladder is a rare entity. Despite being a congenital condition, it takes years for heterotopic pancreas to become symptomatic. Case report An 80-year-old male patient presented to our hospital with a two-week history of abdominal pain, nausea and vomiting aggravated after meals. Abdominal ultrasonography revealed minimal wall edema and small grain-sized gallstones in the gallbladder. The patient was hospitalized and laparoscopic cholecystectomy was performed for acute cholecystitis. Pathologic examination showed a 6 mm nodular mass of pancreatic tissue in the gallbladder wall, comprised mainly of ductal and acinic structures and a few endocrine cells. Conclusion We found this case of pancreatic heterotopia worth reporting because of its rare incidence.

  6. Scintigraphic demonstration of bile reflux after gastro-intestinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, K.F.; Creutzig, H.; Lieth, U. von der; Hundeshagen, H.

    1983-04-01

    Bile reflux may occur after a variety of reconstructive procedures in the gastro-intestinal tract and biliary system. The present paper deals with reflux into the duodenum, jejunum, stomach, oesophagus and into blind loops. The demonstration of reflux by sup(99m)Tc labelled IDA acid derivatives, and a possible quantitative approach, are discussed. The advantages of isotope methods are: 1. Direct demonstration of bile reflux without any intervention in the physiological process and with little trouble to the patient. 2. The ability to use the method for various reconstructive procedures and 3. the additional information obtained which may help in the differential diagnosis of blind loops, biliary obstruction, cholecystitis or liver metastases if there has been a gastrectomy for a malignant tumour. In combination with a second administration of a radio-isotope tracer, one may be able to demonstrate abnormalities in the motility of the stomach or gut, or pyloric stenosis or gastro-oesophageal reflux.

  7. Getting Out of a PCCL: Percutaneous Cholecystolithotomy as a Salvage Treatment Option for Gallstone Removal in Patients Deemed Unfit for Standard Surgical Approaches.

    Science.gov (United States)

    Calaway, Adam C; Borofsky, Michael S; Dauw, Casey A; Lingeman, James E

    2016-01-01

    Definitive management of acute cholecystitis or symptomatic cholelithiasis in exceedingly high-risk patients remains a clinical dilemma. In certain cases, treatment through a percutaneous approach following standard techniques and principles similar to those of percutaneous nephrolithotomy may be considered. However, one potential challenge, particularly among a high-risk population, is the possible necessity to stay on obligate anticoagulation for pre-existing medical reasons. To date, there have been no prior reports documenting the role of this procedure in patients on systemic anticoagulation, particularly clopidogrel. Here we report a case of a percutaneous cholecystolithotomy performed on an elderly patient unable to stop dual antiplatelet therapy (aspirin and clopidogrel) secondary to recent drug eluting stent placement for myocardial infarction. PMID:27579410

  8. [Depressive syndrome in gastroenterology: diagnosis and treatment].

    Science.gov (United States)

    Tsimmerman, Ia S; Tsimmerman, I Ia

    2007-01-01

    The article presents modern data on depressive syndrome, its prevalence and possible reasons for its growth, the role of psychoemotional stress in the development of anxiety depression (AD), as well as psychosomatic diseases and syndromes and modern views on the mechanisms of their formation. The authors discuss methods of revealing and diagnostic criteria of AD and psychosomatic diseases, including those that develop against the background of masked depression. Associations between depressive syndrome and the development of gastroenterological diseases and psychosomatic syndromes such as peptic ulcer, functional dyspepsia, irritated bowel syndromes, chronic cholecystitis, and chronic duodenal obstruction syndrome are discussed in detail. Special attention is paid to treatment of AD in gastroenterological patients using psycho- and hypnotherapy as well as psychotropic drugs such as antidepressives, anxiolytics, neuroleptics, and nootropic agents. PMID:17665598

  9. 99mTc-trimethyl-BrIDA scintigraphy in HIV-related cholangiopathy

    International Nuclear Information System (INIS)

    A HIV-infected 37-year-old man with diffuse mid-abdominal pain and elevated liver enzymes was sequentially studied by sonography, computed tomography (CT), 99mTc-trimethyl-BrlDA scintigraphy and endoscopic retrograde cholangiopancreaticography (ERCP). CT and sonography did not lead to a final diagnosis. Cholescintigraphy showed signs of cholecystitis and sclerosing cholangitis with intra- and extrahepatic bile duct dilatation. These findings could be confirmed by ERCP, rendering HIV-associated cholepathy probable. Cytomegalovirus infection was demonstrated by polymerase chain reaction from bile fluid and the presence of cryptosporidia infection in a histology specimen isolated by ERCP. Therefore, biliary scintigraphy seems promising for screening for HIV-associated cholangio- and cholecystopathy, being less invasive and less bothering for the patient than ERCP. (orig.)

  10. Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report

    Directory of Open Access Journals (Sweden)

    Sugizaki Katsuyoshi

    2010-05-01

    Full Text Available Abstract Background Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder. Case Presentation A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently. Conclusion Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.

  11. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine Moll; Bardram, Linda

    2011-01-01

    20,307 cholecystectomies from a national prospective database that combines administrative data with clinical data. This report states the quality of cholecystectomy in Denmark, establishes benchmarks, and identifies significant risk factors. Methods The Danish Cholecystectomy Database was queried...... for data from 2006 to 2009. The outcome measures included conversion rate, hospital length of stay (LOS), readmission, additional procedures, and 30-day mortality. Patient characteristics and operative findings were analyzed as risk factors using stepwise backward logistic regression. Results The...... a low conversion rate and a high frequency of short admissions without readmission. Acute cholecystitis and open procedure are important risk factors for poorer outcomes.The results of this study analyzing a large, unbiased population can be used to benchmark outcomes of cholecystectomy....

  12. Diagnosis on multi-slice spiral CT in acute pancreatitis and complications

    International Nuclear Information System (INIS)

    Objective: To analyze multi-slice CT features and to assess the diagnostic value of CT in acute pancreatitis. Methods: CT was performed on 21 patients with acute pancreatitis in the unenhanced, arterial (28 seconds after intravenous contrast injection), venous (60 seconds) phases. The morphology and contrast enhancement enhancement patterns were analyzed. Results: Of 21 patients, pancreatic necrosis was found in 9 and acute edematous pancreatitis in 12. Associated findings included bile duct stones or cholecystitis (13), liver abscess (1), systemic lupus erythematosis (1), abdominal trauma (2), and pancreatic divisum (1). Complications included pseudoaneurysm (1), venous thrombosis (1), ascites (7), pleural effusion (4) and right lower lobe lung atelectasis (1). Conclusion: Tri-phasic multi-slice spiral CT can accurately distinguish acute edematous pancreatitis from acute hemorrhagic necrotic pancreatitis. CT allows comprehensive evaluation of the cause and complication of acute pancreatitis. (authors)

  13. COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY IN RESPECT OF POSTOPERATIVE RECOVERY AND HOSPITAL STAY

    Directory of Open Access Journals (Sweden)

    Ajay

    2014-01-01

    Full Text Available Gall stones are one of the major causes of morbidity and mortality all over the world. Differences in primary outcomes like mortality and complication proportions [particularly bile duct injuries] are important reasons to choose one of the two operative te chniques open or laparoscopic Cholecystectomy. The study consists of 100 patients with a diagnosis of calculus cholecystitis that underwent Cholecystectomy. Laparoscopic cholecystectomy is a considerable advancement in the treatment of gall bladder disease , technically the dissection of the cystic artery and cystic duct is very precise and bleeding is easily controlled with less per operative blood loss. LC is associated with less chances of wound infection and there is no risk of wound dehiscence. The only disadvantage of the laparoscopic Cholecystectomy over the open procedure is the duration of operating time which is significantly longer.

  14. Two potentially zoonotic parasites infecting Philippine brown deer (Cervus mariannus desmarest, 1822 in Leyte Island

    Directory of Open Access Journals (Sweden)

    Harvie Potot Portugaliza

    2015-12-01

    Full Text Available This case report describes the necropsy findings of two potentially zoonotic parasites infecting the Philippine brown deer (Cervus mariannus in Leyte Island, Philippines. A female deer aging approximately 5-year was presented for necropsy to the Diagnostic Laboratory at the College of Veterinary Medicine, Visayas State University. Gross pathology was recorded and the selected organs having lesion were collected for histopathological studies. Results showed severe necrotizing lesions in the nasal and palatal areas, infestation of calliphorid maggots, hepatic fibrosis, cholangitis, cholecystitis, lung atelectasis and duodenitis. Heavy ruminal fluke infection was also observed. Two potentially zoonotic parasites namely Fasciola gigantica and Sarcocystis spp. were identified. The Philippine brown deer appears to have a role in transmission and amplification of zoonotic parasites, and can also be threatened by diseases caused by the parasites.

  15. Effects of ingestion of cold and hot water on the course of thermal changes in the stomach and intestine

    Science.gov (United States)

    Batinkov, Y. L.

    1979-01-01

    With the use of a thermocouple and mirror galvanometer, calibrated before the experiment and after each test, it was found that the normal temperature in the esophagus is 0.1-0.4 C higher than in the oral cavity, the temperature in the duodenum is somewhat less than in the stomach, but higher with cholecystitis, duodenitis or gastritis, the temperature in the normal stomach equals or is somewhat higher than in the esophagus, and that the temperature of distended stomachs frequently is lower than in the esophagus. It was found that hot water is retained in the stomach longer than cold water, and that both hot and cold water are allowed to pass into the duodenum when the water temperature becomes approximately equal to that of the surrounding organs.

  16. The DKA that wasn't: a case of euglycemic diabetic ketoacidosis due to empagliflozin.

    Science.gov (United States)

    Candelario, Nellowe; Wykretowicz, Jedrzej

    2016-07-01

    Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication used to treat diabetes. At present, the Food and Drug Administration (FDA) has only approved three medications (canagliflozin, dapagliflozin and empagliflozin) in this drug class for the management of Type 2 diabetes. In May 2015, the FDA issued a warning of ketoacidosis with use of this drug class. Risk factors for the development of ketoacidosis among patients who take SGLT-2 inhibitors include decrease carbohydrate intake/starvation, acute illness and decrease in insulin dose. When identified, immediate cessation of the medication and administration of glucose must be done, and in some instances, starting an insulin drip might be necessary. We present a case of a patient with diabetes mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute cholecystitis. The hospital course was complicated by euglycemic diabetic ketoacidosis after being kept nothing per orem before a contemplated cholecystectomy. PMID:27471597

  17. [Adenomatous polyposis of the gallbladder and Gardner's syndrome. A rare association].

    Science.gov (United States)

    Brevet, Marie; Brehant, Olivier; Dumont, Frédéric; Regimbeau, Jean-Marc; Dupas, Jean-Louis; Chatelain, Denis

    2007-04-01

    We report one case of adenomatous polyposis of the gallbladder in a 57 year-old woman with Gardner's syndrome presenting with cholangitis. On gross examination the gallbladder contained two calculi and numerous flat or polypoid adenomas less than 1 cm in size. On microscopic examination, the adenomas showed low and high grade intraepithelial neoplasia. Only 10 cases of gallbladder adenomas have been reported in the literature in patients presenting with familial adenomatous polyposis (FAP). Cholecystectomy is usually performed for cholecystitis or cholangitis. These adenomatous gallbladder lesions are discovered late, often when the patient is older than 40. Pathogenesis of gallbladder adenomas is still unclear. It is difficult to assess the risk of malignancy: only 6 cases of gallbladder adenocarcinomas have been reported in patients with FAP. PMID:17483782

  18. Accessory liver lobe of the gallbladder in adults.

    Science.gov (United States)

    Handra-Luca, Adriana

    2016-09-01

    The accessory liver lobe (ALL) of the gallbladder wall is rare, mentioned by Meckel since 1822. We present two cases of ALL occurring in two adult women. The ALLs were diagnosed at microscopic examination of cholecystectomy specimens for lithiasic cholecystitis and were located at the gallbladder body level. They measured 0.5 and 1.1 cm and were pediculated from the gallbladder serosa. Luschka duct complexes were seen in the adjacent subserosa in one of the cases. The main clinical relevance of ALL of the gallbladder resides in the differential diagnosis with a lymph node and in the risk of peroperative hemorragia or bile leakage by sectioning of the connecting blood vessels and/or bile duct. Intraparietal ALL may interfere with dysmotility, possibly resulting in bile stagnation and stone formation. PMID:27147442

  19. Ileal perforation associated with dengue in the paediatric age group: an uncommon presentation.

    Science.gov (United States)

    Kumar, Piyush; Gupta, Archika; Pandey, Anand; Kureel, Shiv Narain

    2016-01-01

    Acute abdomen in dengue, a common arboviral disease found in tropical and subtropical countries, is not uncommon and can occasionally present as acute surgical emergency requiring urgent surgical intervention. The spectrum of acute abdomen presenting as surgical emergency in dengue infection that raises suspicion of an abdominal catastrophe includes acute appendicitis, acute cholecystitis, appendicitis and, rarely, intestinal perforation. All cases of intestinal perforation including appendicular, gastric and jejunal perforation have been reported in adult patients during the course of dengue infection. However, intestinal perforation during the course of dengue infection in the paediatric age group has never been reported. We report two cases of ileal perforation in children occurring during the course of dengue infection. PMID:27485879

  20. Diagnóstico endoscópico de una fístula colecistogástrica

    OpenAIRE

    Ramón Baños-Madrid; Hortensia Salama-Benarroch; Enrique Olmos-Brieba; Fernando Carballo-Álvarez

    2007-01-01

    Resumen La fístula colecistogástrica es el resultado de una comunicación anómala entre el árbol biliar y el tracto gastrointestinal. Se presenta el caso de un varón de 57 años, sin historial médico relevante, que consulta en urgencias por dolor abdominal y fiebre. El estudio endoscópico demostró una fístula gastrobiliar. Se realizó una laparotomía y se confirmó una fístula colecistogástrica. Se efectúo colecistectomía y reparación de la fístula y el paciente evolucionó bien.Abstract Cholecyst...

  1. System of polarization correlometry of polycrystalline layers of urine in the differentiation stage of diabetes

    Science.gov (United States)

    Ushenko, Yu. O.; Pashkovskaya, N. V.; Marchuk, Y. F.; Dubolazov, O. V.; Savich, V. O.

    2015-08-01

    The work consists of investigation results of diagnostic efficiency of a new azimuthally stable Muellermatrix method of analysis of laser autofluorescence coordinate distributions of biological liquid layers. A new model of generalized optical anisotropy of biological tissues protein networks is proposed in order to define the processes of laser autofluorescence. The influence of complex mechanisms of both phase anisotropy (linear birefringence and optical activity) and linear (circular) dichroism is taken into account. The interconnections between the azimuthally stable Mueller-matrix elements characterizing laser autofluorescence and different mechanisms of optical anisotropy are determined. The statistic analysis of coordinate distributions of such Mueller-matrix rotation invariants is proposed. Thereupon the quantitative criteria (statistic moments of the 1st to the 4th order) of differentiation of human urine polycrystalline layers for the sake of diagnosing and differentiating cholelithiasis with underlying chronic cholecystitis (group 1) and diabetes mellitus of degree II (group 2) are estimated.

  2. Parasitic disease of the liver and biliary tree

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulrahman

    1997-01-01

    Full Text Available Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. Bile iry tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliary tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobiliary parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography (ERCP is safe and effective in diagnosis and management of biliary tree parasites.

  3. Imaging of ascariasis

    International Nuclear Information System (INIS)

    Full text: Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. During the intestinal phase of the disease, the adult worms usually remain clinically silent, sometimes causing a variety of non-specific abdominal symptoms. When present in large numbers, the worms may get intertwined into a bolus, causing intestinal obstruction, volvulus or even perforation. Occasionally, the adult Ascaris worm may migrate into the Vater's ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Imaging plays a significant role in showing the presence of worms and possible complications in intestinal as well as hepatobiliary ascariasis. This pictorial essay aims to illustrate various imaging features of ascariasis and its associated complications

  4. 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.

  5. Intrahepatic type II gall bladder perforation by a gall stone in a CAPD patient

    Directory of Open Access Journals (Sweden)

    Göbel T

    2011-05-01

    Full Text Available Abstract Introduction Perforation of the gall bladder represents a rare, but life-threatening complication of cholecystitis. Clinical presentation may vary between severe peritonism in acute perforation and absence of symptoms in subacute or chronic progression of perforation. Abdominal imaging like ultrasound or CT-scan are important tools for immediate diagnose of gall bladder perforation. Case presentation We report a case of a 30-year old female patient with end-stage kidney disease treated by continuous ambulatory peritoneal dialysis (CAPD who was admitted to the emergency room with fever and mild abdominal pain. A type II gall bladder perforation by a solitary gall stone with development of a liver abscess was detected by abdominal ultrasound. Conclusion Gall bladder perforations are rare but have to be considered in patients with abdominal pain and fever. Abdominal ultrasound is a reliable tool to establish diagnosis.

  6. 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.

  7. Drug-induced liver injury due to "natural products" used for weight loss: A case report

    Institute of Scientific and Technical Information of China (English)

    Giovanni Tarantino; Martina Gilda Pezzullo; Matteo Nicola Dario di Minno; Francesco Milone; Luigi Sossio Pezzullo; Marco Milone; Domenico Capone

    2009-01-01

    Taking herbal - extracts to lose weightis an underestimated health hazard. Often, these products contain active agents that can cause acute liver damage. In this case report, a 22-year-old female patient, who presented with a feature of cholestatic syndrome, was so sure that the "natural products" were not dangerous that she did not inform her physicians that she had taken them, making their task that much more challenging. Clinical presentation mimicked acute cholecyst it is and the pat ient underwent a cholecystectomy. Surgery was without any consequences and complications, although it did not completely cure the illness. She later admitted to having taken herbal remedies and this led to the correct diagnosis of phytotherapy-related hepatotoxicity and a successful therapeutic approach. The true incidence of phytotherapy-related hepatotoxicity and its pathogenic mechanisms are largely unknown. It is important to increase the awareness of both clinicians and patients about the potential dangers of herbal remedies.

  8. Relationship of total parenteral nutrition to the Tc-99m imino-diacetic acid (IDA) hepatobiliary study

    International Nuclear Information System (INIS)

    Total parental nutrition (TPN) is a cause of gallbladder nonvisualization, but this has not been a consistent finding. The authors performed hepatobiliary scintigraphy in 18 patients with a normal gallbladder on US and no symptoms of cholecystitis. In 12 patients the gallbladder was visualized in 1 hour. Cases of cancer, peptic ulcer disease, and trauma were found both in patients in whom the gallbladder was visualized and in patients in whom it was not visualized. There was no significant difference between these two groups with respect to age, duration of fast, or alkaline phosphatase, SGOT, SGPT, bilirubin, and amylase levels. The serum albumin was lower in patients in whom the gallbladder was not visualized

  9. Cholangitis and Choledocholithiasis After Repair of Duodenal Atresia: A Case Report

    Directory of Open Access Journals (Sweden)

    Atia Zaka-ur-Rab

    2011-04-01

    Full Text Available Cholelithiasis is a rare but known complication of surgery for duodenal atresia. Occurrence of choledocholithiasis as sequelae of duodenoduodenostomy is still rarer. Biliary stasis resulting from compression of common bile duct due to periductal fibrosis may predispose to gallstone formation. We are reporting a case of choledocholithiasis in a 6 year old child as a late post-operative complication of duodenoduodenostomy (for duodenal atresia in the neonatal period. To the best of our knowledge this is the first case of its kind reported in English literature. Cholecystectomy followed by choledocholithotomy was done and the patient had an uneventful recovery. Upper abdominal pain in any patient with a history of surgery for duodenal atresia in the past warrants a thorough evaluation for any biliary tract anomaly, cholecystitis, cholangitis, cholelithiasis or choledocholithiasis.

  10. Xanthogranulomatous cholangitis causing obstructive jaundice: A case report

    Institute of Scientific and Technical Information of China (English)

    Susumu Kawate; Susumu Ohwada; Hayato Ikota; Kunihiro Hamada; Kenji Kashiwabara; Yasuo Morishita

    2006-01-01

    This article reports the case of a 34-year-old woman with xanthogranulomatous cholangitis who developed obstructive jaundice. Microscopically, the bile duct was surrounded and narrowed by a xanthogranulomatous lesion, but no xanthogranulomatous cholecystitis was seen. Although percutaneous cholangiograms done via the transhepatic biliary drainage showed smooth narrowing of the upper to middle bile duct, the cytology of bile was diagnosed as class V adenocarcinoma.Therefore, right extended hepatectomy and extrahepatic bile duct resection were performed. The differentiation of benign and malignant strictures at the hepatic hilum is often difficult. Xanthogranulomatous cholangitis is one possible diagnosis of a bile duct stricture. Precise review of all the preoperative information is required to make a correct diagnosis.

  11. Eclectic use of cholecystostomy in biliary tract procedures

    International Nuclear Information System (INIS)

    Twenty-seven patients underwent percutaneous aspiration or catheterization of gallbladder for the diagnosis or treatment of biliary tract disease, including 12 cases of cholecystitis, nine malignancies, two cases of choledocholithiasis, and one case of biliary structure. In three patients the cholangiograms were normal. Cholestostomy catheters were placed in 25 patients, including those with normal cholangiograms; the catheters were withdrawn from these patients after the procedure. In all other patients with obstruction the catheters were left in place for drainage, stone chemolysis, or assistance with ductal opacification during percutaneous biliary dilation. There were two minor and no major complications. In addition to its uses in gallbladder disease, percutaneous cholecystostomy is a safe, less painful alternative to percutaneous transhepatic cholangiography. In conjunction with transhepatic drainage for malignancy, it allows control of biliary opacification and optimal selection of the site of ductal puncture

  12. Research Progress of Therapeutic Endoscopy in the Treatment of Pancreaticobiliary Disease

    Institute of Scientific and Technical Information of China (English)

    CAI Lei; CHENG Yuan; CAI Li-quan; PAN Ming-xin; GAO Yi

    2014-01-01

    Pancreaticobiliary diseases, which include cholecystitis, choledocholithiasis, cholangitis, malignant biliary stricture, pancreatic pseudocyst and pancreatic cancer, have increasing morbidity and mortality year by year and severely threaten human lives, for which there are many therapeutic methods in clinic. The promotion of endoscopic otomy and the development of new devices have greatly improved the successful rate of endoscopic retrograde cholangiopancreatology (ERCP). Additionally, with the development of non-invasive diagnostic technique for pancreatic disease like magnetic resonance cholangiopancreatography, ERCP can also be widely used in the treatment of pancreatic diseases. Therefore, this study mainly reviewed the application of ERCP in the treatment of pancreaticobiliary diseases, hoping to improve the survival rate of patients and provide basis for the clinical treatment.

  13. The 'Jack Stone' or 'Mercedes Benz' sign--anew theory to explain the presence of gas within fissures in gallstones.

    Science.gov (United States)

    Wright, F W

    1977-07-01

    Gas within clefts of fissures in gallstones is not a very common finding, but when it occurs is, characteristic and indicates the presence of one or more calculi. It closely resembles the appearance of a 'Jack Stone' but has previously been termed the 'Mercedes Benz' sign. Only a few cases have previously been recognised in the U.K. Most reported cases have been associated with biliary colic or cholecystitis. Various theories have been put forward to explain the presence of gas, but the author believes that the gas is released from solution by negative pressure within cholesterol stones undergoing internal fissuring due to their crystalline structure, i.e. the gas is released from solution from the small amount of fluid trapped in the calculus, in the same way that gas may be 'pulled' out of solution in a joint, a degenerate intervertebral disc or the fibro-cartilage of the symphysis pubis. PMID:872516

  14. The clinical significance of gall-bladder non-visualization in cholescintigraphy of patients with choledochal cysts

    Energy Technology Data Exchange (ETDEWEB)

    Kao Panfu [Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei (Taiwan, Province of China); Huang Miauju [Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei (Taiwan, Province of China); Tzen Kaiyuan [Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei (Taiwan, Province of China); You Dongling [Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei (Taiwan, Province of China); Liaw Yunfan [Liver Unit, Chang Gung Memorial Hospital, Taipei (Taiwan, Province of China)

    1996-11-01

    Intravenous radionuclide cholescintigraphy (IVRC) provides a very specific picture for choledochal cysts. However, the clinical significance of the non-visualization of the gall-bladder (GB) activity in these cases is unclear. In this study, we reviewed 27 patients with choledochal cysts who underwent IVRC within 7 days prior to operation and correlated the GB findings on IVRC with the histopathological results. In 18 of the 27 patients (66.7%), there was non-visualization of the GB at 4 h post injection. Among these, two had histopathological features of acute cholecystitis (AC), 11 had chronic cholecystitis (CC), and five had normal GBs. In the other nine patients with visualization of the GB, there were five cases of CC and four normal GBs. If we apply the finding of non-visualization of the GB at 4 h post injection as the criterion for the diagnosis of AC, the diagnostic accuracy was only 40.7% (11/27). We concluded that: (1) GB disease (AC and CC) was common (66.7%: 7.4% and 59.3% respectively) in choledochal cyst patients. (2) Non-visualization of the GB on IVRC did not necessarily indicate AC in choledochal cyst cases, and the diagnostic accuracy was low. (3) GB disease is not the only cause of GB non-visualization on IVRC. A huge choledochal cyst causing a mass or reservoir effect may be a cause of GB compression and result in non-visualization of the GB. (orig.). With 3 figs., 3 tabs.

  15. Safety of superselective transcatheter arterial chemoembolization through cystic artery for treatment of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Jae Ho; Yoon, Hyun Ki; Song, Ho Young; Lee, Duck Hee; Hwang, Jae Chul; Kim, Bong Soo; Kim, Jae Won; Sung, Kyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-01-01

    To report on the safety and efficacy of superselective transcatheter arterial chemoembolization(TACE) of tumor feeding branches originating from the cystic artery for the treatment of hepatocellular carcinoma(HCC). From, May 1955 to, September 1999, eleven HCC patients aged between 38 and 82 (mean, 57.4) years with tumor-feeding branches originating from the cystic artery underwent TACE. In eight, for whom superselection of these branches was possible, TACE was done with the use of Gelform and a mixture of Lipiodol and cisplatin, while for three, for whom superselection was impossible, a mixture of Lipiodol and cisplatin only was used. Immediately after TACE, remnant tumor staining was angiographically evaluated, and tumor response was determined by follow-up CT at one month. After procedure, the development of cholecystitis was clinically. Post-FACE angiography showed remnant tumor staining in one patients who underwent embolization with Gelform and the mixture fo Lipiodol and cisplatin, and in one for whom the mix ture of Lipodol and cisplationly was used. Among the eight for whom Gelfoam and the mixture of Lipiodol and cisplatin was used, one-month follow up CT showed compact Lipiodol uptake in five, partial Lipiodol uptake in three, no change in tumor size in six, increased tumor size in one, and decreased tumor size in one. Among the three for whom the mixture of Lipiodol and cisplatin only was used,one-month follow-up CT showed neither Lipiodol uptake nor change in tumor size in one patient, partial Lipiodol uptake and increased tumor size in one, and compact Lipiodol uptake and decreased tumor size in one. Cholecystitis developed in only one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, but was cured by conservative treatment. Superselective TACE of tumor feeding branches originating from the cystic artery seems to be a safe and effective method for the treatment of hepatocellular carcinoma.

  16. Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

    Energy Technology Data Exchange (ETDEWEB)

    Theysohn, Jens M., E-mail: jens.theysohn@uni-due.de [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany); Mueller, Stefan [University Hospital Essen, Department of Nuclear Medicine (Germany); Schlaak, Joerg F.; Ertle, Judith [University Hospital Essen, Department of Gastroenterology and Hepatology (Germany); Schlosser, Thomas W. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany); Bockisch, Andreas [University Hospital Essen, Department of Nuclear Medicine (Germany); Lauenstein, Thomas C. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany)

    2013-08-01

    PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin ({sup 99}mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, or a positive Murphy sign, were assessed during patient follow-up.ResultsA significant {sup 99}mTc-HSA accumulation in the gallbladder wall (higher {sup 99}mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position.

  17. Hepatobiliary Complications of Sickle Cell Disease among Children Admitted to Al Wahda Teaching Hospital, Aden, Yemen

    Directory of Open Access Journals (Sweden)

    Hana A. Qhalib

    2014-10-01

    Full Text Available Objectives: This study aimed to describe the pattern of hepatobiliary complications among patients with sickle cell disease (SCD and to assess their correlation with age, gender and other risk factors. Methods: This cross-sectional study assessed 106 patients with SCD who were admitted to Al Wahda Teaching Hospital in Aden, Yemen, between January and June 2009. A full history, thorough examination, essential laboratory investigations (including a complete blood count, liver function test and viral markers test and an abdominal ultrasound were performed on all patients. The clinicopathological characteristics of the hepatobiliary complications were analysed for their correlation to different risk factors such as age and gender. Results: It was found that 46.2% of the patients with SCD had hepatobiliary complications. Of these, 36.7% had viral hepatitis, 26.0% had cholecystitis and 20% had gallstones. A total of 60.4% of the affected patients were male. The mean levels of alanine aminotransferase (59.4 and 56.0 U/L and aspartate transaminase (40.1 and 38.3 U/L were significantly elevated in patients with viral hepatitis and cholecystitis, respectively. Hepatitis B virus surface antigen showed higher positivity (10.4% than anti-hepatitis A and anti-hepatitis C antibodies. Hepatobiliary complications increased significantly with age and were notably higher among those who were often admitted to hospital and/or underwent frequent blood transfusions. Conclusion: This study suggests that hepatobiliary complications are common among SCD patients and the likelihood of developing such complications increases as patients age. Thus, regular clinical follow-ups, abdominal ultrasound studies and periodic liver function tests, as well as serological tests for viral hepatitis, are strongly recommended. These can help in the early detection of these complications and allow opportunities for their management and prevention.

  18. Metabonomic study of human serum in gallbladder cancer by 1H NMR spectroscopy

    International Nuclear Information System (INIS)

    Gallbladder carcinoma (GBC) is one of the most lethal malignancies of upper gastrointestinal tract and it has the highest mortality rate in Chile and India. It has a very high incidence rates in northern India therefore it is also called as an Indian disease. There are several factors which play important role in development of gallbladder cancer including long-standing stones in gallbladder and alterations in composition of bile. Studies on gallstones and gallbladder tissues revealed that benign group can easily be discriminated from malignant group. Many proteomic studies have been performed for different cancers and several responsible serum protein markers have been identified but there is no such metabonomics study that shows the presence of any biomarker associated with gallbladder carcinoma. Identification of such biomarker would help immensely in the diagnostic of GBC. For this study we have collected blood samples (70; including patients from Chronic Cholecystitis (CC), XanthoGranulomatous Cholecystitis (XGC) and Gallbladder Cancer (GBC)) post-operatively (immediately after surgery) from patient undergoing cholecystectomy in Department of Surgical Gastroenterology, SGPGIMS. Control samples were also collected from 20 volunteers after 12 hrs of fasting. 4 ml of blood sample was collected and was allowed to clot in plastic tube for 30 min at room temperature in incubator. The serum was collected by centrifugation and samples were stored at -80 deg C till NMR experiments. 400 μL of serum was used for recording NMR spectra. NMR spectra were recorded at Bruker Avance 800 MHz spectrometer using CPMG pulse sequence with water presaturation. Control serum shows presence of various amino acids and low molecular weight metabolites. Detailed multivariate analysis along with markers found in serum associated with GBC will be presented. (author)

  19. Hepatobiliary scintigraphy in children.

    Science.gov (United States)

    Nadel, H R

    1996-01-01

    Hepatobiliary scintigraphy using iminodiacetic (IDA) radiopharmaceuticals provides clinically useful information on the function of the biliary tract in a variety of pathological processes in children, including neonatal jaundice, gallbladder dysfunction, trauma, and liver transplantation. Phenobarbital premedication (5 mg/kg per day for a minimum of 5 days in divided doses) is used in infants who are being examined for neonatal jaundice to increase the accuracy of 99mTc-IDA scintigraphy in differentiating extrahepatic biliary atresia from neonatal hepatitis. Biliary atresia can be ruled out in an infant if a patent biliary tree is shown with passage of activity into the bowel. If no radiopharmaceutical is noted in the bowel on imaging up to 24 hours, distinction between severe hepatocellular disease and biliary atresia cannot be made. The literature reports 91% accuracy, 97% sensitivity, and 82% specificity for hepatobiliary imaging in the diagnosis of biliary atresia. The impairment of both intrahepatic and extrahepatic biliary drainage is an important cause of liver disease in cystic fibrosis. Hepatobiliary scintigraphy in cystic fibrosis has shown characteristic patterns of dilatation of mainly the left hepatic duct, narrowing of the distal common bile duct, gallbladder dysfunction, and delayed bowel transit. Cholecystitis in children may be acalculous. Sensitivity and specificity for the scintigraphic diagnosis of acute acalculous cholecystitis is reported to range from 68% to 93% and 38% to 93%, respectively. Cholescintigraphy in a suspected bile leak provides information generally not available with other techniques, except for direct cholangiography. If the amount of intraperitoneal accumulation of the tracer is greater than that entering the gastrointestinal tract, surgery is usually indicated. Hepatobiliary imaging in children who have undergone liver transplantation will assess graft vascularity, parenchymal function, biliary drainage, presence of a leak

  20. Diseases of the hepatobiliary system as a cause of acute abdomen; Erkrankungen des hepatobiliaeren Systems als Ursache des akuten Abdomens

    Energy Technology Data Exchange (ETDEWEB)

    Schima, W.; Eisenhuber-Stadler, E. [Krankenhaus Goettlicher Heiland, Abteilung fuer Radiologie und bildgebende Diagnostik, Wien (Austria); Koelblinger, C.; Kulinna-Cosentini, C.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2010-03-15

    Diseases of the liver and biliary system are common causes of acute abdominal pain and gallstone disease predisposes to cholecystitis and cholangiolithiasis. Sonography is the method of choice for the assessment of cholecystitis, whereas magnetic resonance cholangiopancreaticography (MRCP) is the standard technique to detect stones in the common bile duct. Multi-detector computed tomography (MDCT) is ideal for detection of associated complications, including abscess formation and gall stone ileus. Pyogenic, amebic and fungal liver abscesses are reliably diagnosed with MDCT which can also be used for interventional radiologic therapy of liver abscesses by percutaneous aspiration or drainage procedures. The second most common cause of liver rupture after blunt trauma is spontaneous rupture of hypervascular liver tumors (i.e., HCC, adenoma, angiosarcoma) and due to medical procedures. Multi-phase contrast-enhanced MDCT can reliably detect active bleeding to guide further therapy in these cases. (orig.) [German] Die Cholezystitis ist eine der haeufigsten Ursachen fuer ein akutes Abdomen. Waehrend die Sonographie die Methode der Wahl zum Nachweis einer Cholezystolithiasis und Cholezystitis ist, steht bei der Entwicklung von Komplikationen die Multidetektorcomputertomographie (MDCT) diagnostisch im Vordergrund. Die Magnetresonanzcholangiopankreatikographie (MRCP) hat einen hohen Stellenwert bei der Abklaerung der Cholangiolithiasis, v. a. bei der Differenzialdiagnose zu anderen Ursachen einer Cholestase. Die Diagnose bakterieller, Amoeben- oder fungaler Leberabszesse kann mittels Sonographie oder MDCT rasch gestellt werden, wobei diese Methoden auch fuer die interventionelle radiologische Therapie von Leberabszessen (Punktion oder Drainage) gut geeignet sind. Die mehrphasige, kontrastmittelverstaerkte MDCT ist die Methode der Wahl fuer den Nachweis von Leberinfarkten oder -rupturen, da bei diesen Erkrankungen bzw. Verletzungsfolgen die Darstellung der

  1. On the use of Disease Staging for clinical management: analysis of untimely admissions in the Abruzzo Region, Italy

    Directory of Open Access Journals (Sweden)

    Lamberto Manzoli

    2004-12-01

    Full Text Available

    Background and aims. The process of decentralization which recently occurred within the Italian National Health Service has transferred substantial responsibility and authority for health care administration to the individual regions. The project is aimed at developing regional benchmarks that can be used as a part of an ongoing system for analysis of resource use and quality of care in the Abruzzo Region of Italy.

    Methods. All 286 924 hospital admissions for the year 2001 in the region were analysed. Three diseases were chosen for in-depth review: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. There were a total of 9391 admissions for these diagnoses. Severity, length of hospital stay and hospital mortality were analysed using Disease Staging methodology. In addition, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely and late.

    Results. The rate of medically unnecessary admissions for diabetes mellitus was 72% throughout the region, and the percentage of late hospitalisations for cholelithiasis/cholecystitis was 43%. For both diseases, there were significant variations across Local Health Units in the proportion of late and early admissions. The rate of timely hospitalisations for bacterial pneumonia was higher than 86%.

    Conclusion. The analysis of discharge abstract data using Disease Staging revealed that in the Abruzzo region there are problems of inappropriate hospital admission, both early and late, for all diseases examined excepted bacterial pneumonia.

    Data confirmed the validity of Disease Staging to compare the performance of diverse hospitals in terms of length of stay and in-hospital mortality.

  2. 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. PMID:27457076

  3. OUTCOME FOLLOWING OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Anmol

    2014-12-01

    Full Text Available : Laparoscopic cholecystectomy has rapidly become established as the popular alternative to open cholecystectomy, but it should have a safety profile similar to or better than that of open procedure. The aim of this study was to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of procedure, complications, postoperative pain, analgesic requirement, antibiotic requirement, resumption of normal diet and period of hospital stay.50 patients with symptoms and signs of acute acalculous/calculous cholecystitis, selected randomly, were included in this study. Clinical profile, investigations, treatments, outcomes were analyzed. The highest age incidence was in the 5th decade, more common in females. Pain in the RUQ of abdomen was the most common symptom. Ultrasonography showed gallbladder stones in almost all patients. The duration of LC (120min was more than for OC (90min. The conversion rate of LC to OC was 8%. Post- operative morbidity was more in case of LC. The antibiotic and analgesic requirements were less in LC group. The resumption of normal diet was 2 days earlier in LC compared to OC group, and the hospital stay was 4 days less in LC group. The result showed the incidence of acute calculous/acalculous cholecystitis more in females, 5th decade, presented more commonly with pain abdomen. Ultrasonography was the most common investigation. Laparoscopic cholecystectomy reduces the number of antibiotic and analgesic requirement, hospital days, pain disability, wound infection, and with better cosmesis, except for the prolonged operative time, which can be minimized in due course of time as the learning curve progresses.

  4. Prevention strategies of biliary tract injury of LC (600 cases report)%腹腔镜胆囊切除术胆管损伤的预防对策(附600例分析)

    Institute of Scientific and Technical Information of China (English)

    王广义; 刘亚辉; 刘瑾琨; 王磊; 陈光; 刘铮; 张文良; 李楠; 王有德; 谭毓铨

    2001-01-01

    目的总结连续开展腹腔镜胆囊切除术(LC)600例无胆管损伤等严重并发症的成功经验。方法回顾分析本组成功实施LC 600例的临床资料,其中胆囊结石466例,急性胆囊炎23例,胆囊息肉85例,胆囊结石合并息肉15例,慢性胆囊炎11例。结果完成588例,中转手术12例,600例全部治愈,无胆管损伤等严重并发症发生。结论严格的技术培训,采用钝性锐性分离相结合法谨慎解剖Calot三角,适时中转手术是成功避免LC术中胆管损伤等严重并发症的关键。%Objective To summarize the successful experience of LC 600 cases without biliary tract injury and other severe complications.Methods Retrospective analysis was made on 600 patients underwent LC successfully including 466 cases of gallbladder gallstone, 23 cases of acute cholecystitis, 85 cases of gallbladder polyps, 15 cases of gallbladder gallstone with polyps, 11 cases of chronic cholecystitis.Results LC was performed on 588 cases, 12 cases converted to open cholecystectomy. All patients were cured without biliary tract injury and other severe complications.Conclusion It is key point for preventing biliary tract injury to keep strict technique training,to disect carefully the calot triangle by dull and sharp dissection, and to convert to open cholecystectomy timely.

  5. Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

    International Nuclear Information System (INIS)

    PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin (99mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, or a positive Murphy sign, were assessed during patient follow-up.ResultsA significant 99mTc-HSA accumulation in the gallbladder wall (higher 99mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position

  6. Trends in etiologies of chronic pancreatitis within 20 years: analysis of 636 cases

    Institute of Scientific and Technical Information of China (English)

    LI Jing-nan; LAI Ya-min; QIAN Jia-ming; GUO Tao; L(U) Hong; TANG Xiao-yan

    2011-01-01

    Background The prevalence of chronic pancreatitis has increased during recent years in Asia-Pacific areas as well as in China.The etiologies vary in different regions and periods.This study aimed to investigate the changing etiologies of chronic pancreatitis within 20 years at Peking Union Medical College Hospital in China.Methods Retrospective analysis of the etiologies of 636 cases of chronic pancreatitis at Peking Union Medical College Hospital from 1990 to 2010 was performed.Patients were divided into two groups according to two time periods (1990-2000 and 2001-2010).Statistical analysis was performed using the chi-square test.Results The morbidity rate of chronic pancreatitis in China has recently increased.The main etiology changed from biliary diseases in the 1990s (decreased from 36.8% to 28.1%) to alcohol abuse after the year 2000 (increased from 26.5% to 36.8%).The main etiology of biliary diseases is stones in the cholecyst or bile duct,and the percentage of cholecystitis cases has increased.Autoimmune disease,including autoimmune pancreatitis,has increased quickly and currently accounts for 7.3% of cases because a greater number of autoimmune pancreatitis cases are being diagnosed.Approximately 9.5% of chronic pancreatitis cases are caused by multiple factors such as alcohol abuse and bile duct stones.Other factors include cholecystectomy and acute pancreatitis.Conclusions The main etiology of chronic pancreatitis has changed from biliary disease to alcohol abuse in recent years.Autoimmune factors have also obviously increased.

  7. Interesting scan appearance on hepatobiliary scan to diagnosis of Non Hodgkin's Lymphoma

    International Nuclear Information System (INIS)

    A 71-year-old patient presented with increasing dyspnoea and right upper quadrant pain. Hepatobiliary Imaging was performed which excluded acute and chronic cholecystitis. The same scan showed unusual initial vasculature seen during positioning that prompted extra flow images. The flow images showed apparent communication between the right pulmonary artery and azygous vein or coronary sinus. Also seen was significant hypo-perfusion of the right lung. On the basis of the unusual findings of hypo-perfusion the patient had a CT Pulmonary Angiogram to rule out pulmonary embolism (PE). PE was not evident. There were findings of enlarged lymph nodes and nodules in the lungs, and bilateral pleural effusion of both lungs were present. Also prominent superficial veins in the anterior chest wall were consistent with appearances in our study. Further examinations, which included Ultrasound Guided Biopsy and CT helped to diagnose the patient with Non-Hodgkins Lymphoma. The Patient is currently receiving Chemotherapy to treat the Non-Hodgkin's Lymphoma, with Nuclear Medicine being a part of the patient's ongoing treatment in the form of a Bone Scan and a Gated Heart Pool Scan. Though the initial Nuclear Medicine scan was employed to exclude cholecystitis, incidental findings of abnormal vasculature and hypo-perfusion of the lung has made it the starting point in the diagnosis and ongoing treatment of Non-Hodgkin's Lymphoma. This case study highlights the usefulness of flow phases in Hepatobiliary studies but also Nuclear Medicine studies in general. The flow sometimes may not aid in the final report but incidental findings may ultimately help in the treatment of the patient

  8. Laparoscopic cholecystectomy in children:with a report of 14 cases%小儿腹腔镜胆囊切除术14例报告

    Institute of Scientific and Technical Information of China (English)

    邓天工; 孔繁华; 李卫清; 秦芳蕖

    2011-01-01

    目的:探讨小儿胆囊结石的诊断、围手术期处理特点、术式选择及术中注意事项.方法:回顾分析2003年11月至2011年7月为14例结石性胆囊炎患儿行腹腔镜手术的临床资料.结果:14例手术均获成功,手术时间平均24 min,平均住院6.7d,无手术并发症发生.结论:小儿结石性胆囊炎发病率较低,且有其自身的病理生理特点,围手术期应施行个体化处理措施.腹腔镜胆囊切除术患者创伤小、康复快,可作为治疗小儿结石性胆囊炎的首选术式.%Objective: To discuss the diagnosis, perioperation management characteristic, the rugery mode selection and intraop-erative announcement of the children cholecystolithiasis. Methods: A retrospectively analysis on the clinical data of 14 children with calculus cholecystitis who underwent LC from Nov. 2003 to Jul. 2011 was performed. Results: Forteen cases of surgery were performed successfully, the average surgery time,hospitalization was 24 min,6. 7 days respectively,no complications occurred. Conclusions:The incidence rate of children acalculous cholecystitis is low. The disease with pathology physiology characteristic should be treated by individual measures,LC can be the first choice to cure children acalculous cholcaytitis.

  9. Clinical significance of tumor-infiltrating immune cells focusing on BTLA and Cbl-b in patients with gallbladder cancer.

    Science.gov (United States)

    Oguro, Seiji; Ino, Yoshinori; Shimada, Kazuaki; Hatanaka, Yutaka; Matsuno, Yoshihiro; Esaki, Minoru; Nara, Satoshi; Kishi, Yoji; Kosuge, Tomoo; Hiraoka, Nobuyoshi

    2015-12-01

    The host immune system plays a significant role in tumor control, although most cancers escape immune surveillance through a variety of mechanisms. The aim of the present study was to evaluate the clinicopathological significance of a novel co-inhibitory receptor, B and T lymphocyte attenuator (BTLA), the anergy cell marker Casitas-B-lineage lymphoma protein-b (Cbl-b), and clinical implications of tumor-infiltrating immune cells in gallbladder cancer (GBC) tissues. We investigated 211 cases of GBC, 21 cases of chronic cholecystitis (CC), and 11 cases of xanthogranulomatous cholecystitis (XGC) using immunohistochemistry to detect tissue-infiltrating immune cells and their expression of BTLA and Cbl-b, and carried out correlation and survival analyses. The density of infiltrating T cells was significantly higher in CC and XGC than in GBC. The density ratio of BTLA(+) cells to CD8(+) T cells (BTLA/CD8) and that of Cbl-b(+) cells to CD8(+) T cells (Cbl-b/CD8) were significantly higher in GBC than in CC and XGC. The FOXP3/CD4, BTLA/CD8, and Cbl-b/CD8 ratios were significantly correlated with each other, and also with malignant phenotypes. Survival analyses revealed that a lower density of tumor-infiltrating CD8(+) cells, and higher Foxp3/CD4, BTLA/CD8, and Cbl-b/CD8 ratios were significantly associated with shorter overall survival and disease-free survival in GBC patients. Multivariate analyses showed that M factor, perineural invasion, BTLA/CD8, and Cbl-b/CD8 were closely associated with shorter overall survival. These findings suggest that higher ratios of BTLA/CD8 and Cbl-b/CD8 are independent indicators of unfavorable outcome in GBC patients, and that upregulation of BTLA in cancer tissues is involved in inhibition of antitumor immunity. PMID:26395180

  10. Colecistectomia laparoscópica: experiência em 500 casos, enfatizando as vantagens da colecistocolangiografia e da ligadura do ducto e artéria cística utilizando fio de náilon Advantages of cholecystocholangiography and ligature of the cystic duct and artery with nylon suture: analysis of 500 laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Perim

    1999-02-01

    with nylon suture instead of metallic clips. Most (79, 4% patients were female and the median age was 48.2 years. Chronic cholecystitis was found in 424 patients, acute cholecystitis in 68, gallbladder cancer in four; acalculous cholecystitis in three and gallbladder polyp in a single patient. Stones in the CBD were diagnosed in twenty (4% patients. The mean operating time was 84 minutes. Of the 500 patients, 93.4% were discharged from the hospital within 48 hours after LC. Convertion was required in 39 (7.8% cases, mainly due to choledocholithisasis (15 patients and acute cholecystitis (14 patients. Clinically important complications developed in 12 (2.4% patients, including one (0,2% commom bile duct injury. The mortality rate was 0.4%. Cholecystocholangiography was satisfactory in 80.5% and inconclusive in 19.5% of the patients. This method is an excellent option for intraoperative cholangiography in LC because it is technically very simple and affords good results, mainly in chronic cholecystitis. Nevertheless, when there is obvious cystic duct obstruction, or when the gallbladder is filled with biliary mud, it is better to do primarely transcystic cholangiography. Numerous studies have indicated that the use o metallic clips in LC is associated with higher risks of bile peritonitis and hemorrhage. Besides that, this study has shown that the use of clips make the procedure much more expensive, when the great number of LC performed yearly is considered. On the other hand, the cystic duct and artery ligation with nylon suture is very segure and cost saving.

  11. Cholecystokinetic cholecysto-choledochography

    Energy Technology Data Exchange (ETDEWEB)

    Park, Han Kyu; Bahk, Yong Whee [Catholic Medical College, Seoul (Korea, Republic of)

    1980-12-15

    Oral cholecystography is a reliable and the most popular clinical examination. The examinations is not suitable for morphological study of the gallbladder but also efficient in diagnosing acalculous cholecystitis and cystic duct syndrome and some ill defined functional disorders. For the functional evaluation of the gallbladder fat meal stimulation has been used traditionally. Recently, however, potent cholecystagogues called cholecystokinin (CCK) and ceruletide were introduced in the radiological examination of the gallbladder stimulating acute interest in research of acalculous cholecystitis and cystic duct syndrome. The present study has been undertaken to test both experimentally and clinically the cholecystokinetic effects of CCK and ceruletide. In addition, the study has been designed to test if pharmacological constriction of the Oddi sphincter with morphine in animal and prostigmine in human subjects promotes visualization of the common bile duct and hopefully the common hepatic duct. Seen (7) mongrel dogs weighing 10 kg were anesthesized with Pentothal sodium (20mg/kg body wt) in the evening allowed to swallow 2 g of lopanoic acid (Telepaque) per os. Twelve hours later in the next morning dogs were radiographed of their upper abdomen in LAO. Upon confirming optimal opacification of the GB 0.03 {mu} g/kg of CCK was injected intravenously to each of the 7 mongrel dogs for the test of contraction-rate and contraction-time of the gallbladder. The same test was repeated after injecting 10 mg/dog of morphine to strict the Oddi sphincter. The clinical materials consisted of 30 normal human subjects and 60 patients with biliary symptoms and signs. Those with abnormal upper gastrointestinal series and abnormal function tests of the pancreas were excluded from the materials. We injected the same amount of CCK and studied the contraction rate and time with an emphasis on acalculous cholecystitis and cystic duct syndrome and some ill-defined functional disorder. In

  12. Prevention and treatment of complications for full-covered self-expanding removable metal stents in malignant obstructive jaundice%全覆膜自膨式可回收金属支架治疗恶性梗阻性黄疸的并发症及防治策略

    Institute of Scientific and Technical Information of China (English)

    张诚; 杨玉龙; 吴萍; 马跃峰; 张洪威; 林美举; 史力军; 李婧伊; 赵沐

    2015-01-01

    Objective To explore the prevention and treatment of complications for full-covered self-expanding removable metal stents (FCSERMS) in malignant obstructive jaundice.Methods The clinical data were analyzed retrospectively for 45 cases undergoing endoscopic biliary FCSERMS drainage for malignant obstructive jaundice from May 2012 to March 2014.Results Among them,45 cases were successful one time.The parameters of liver function improved significantly with a jaundice efficiency of 91.1%.There were 4 dead cases.Among 19 cases of early complications,hyperamylasemia (n =8),acute mild pancreatitis (n =4),acute cholecystitis (n =2) and hemobilia (n =1) recovered after conservative treatments.Acute suppurative cholecystitis (n =2) and acute obstructive suppurative cholangitis (n =2)were cured by percutaneous transhepatic cholangial drainage (PTCD) and percutaneous transhepatic gallbladder drainage (PTGBD).And late complications of obstructive jaundice (n =3),acute suppurative cholecystitis (n =4),acute cholangitis (n =2),hepatophyma (n =2) and acute pancreatitis (n =1) were cured by endoscopic retrograde cholangiopancreatography (ERCP),PTCD and PTGBD.Conclusion Various complications are associated with FCSERMS in malignant obstructive jaundice.However,positive and effective prevention and proper treatment reduce the incidence of complications.%目的 探讨全覆膜自膨式可回收金属支架(FCSERMS)治疗恶性梗阻性黄疸的并发症及防治策略.方法 回顾性分析2012年5月至2014年3月在大连大学附属中山医院接受内镜下胆道FCSERMS置入治疗的45例恶性梗阻性黄疸患者临床资料.结果 45例患者均一次性操作成功;肝功能明显改善,黄疸消退有效率91.1% (41/45),其中死亡4例.早期并发症19例,其中高淀粉酶血症8例、急性轻型胰腺炎4例、急性胆囊炎2例、胆道出血1例,经保守治疗后痊愈;发生急性化脓性胆管炎2例,急性化脓性胆囊炎2例,采取经皮肝穿刺胆道

  13. Cholecystokinetic cholecysto-choledochography

    International Nuclear Information System (INIS)

    Oral cholecystography is a reliable and the most popular clinical examination. The examinations is not suitable for morphological study of the gallbladder but also efficient in diagnosing acalculous cholecystitis and cystic duct syndrome and some ill defined functional disorders. For the functional evaluation of the gallbladder fat meal stimulation has been used traditionally. Recently, however, potent cholecystagogues called cholecystokinin (CCK) and ceruletide were introduced in the radiological examination of the gallbladder stimulating acute interest in research of acalculous cholecystitis and cystic duct syndrome. The present study has been undertaken to test both experimentally and clinically the cholecystokinetic effects of CCK and ceruletide. In addition, the study has been designed to test if pharmacological constriction of the Oddi sphincter with morphine in animal and prostigmine in human subjects promotes visualization of the common bile duct and hopefully the common hepatic duct. Seen (7) mongrel dogs weighing 10 kg were anesthesized with Pentothal sodium (20mg/kg body wt) in the evening allowed to swallow 2 g of lopanoic acid (Telepaque) per os. Twelve hours later in the next morning dogs were radiographed of their upper abdomen in LAO. Upon confirming optimal opacification of the GB 0.03 μ g/kg of CCK was injected intravenously to each of the 7 mongrel dogs for the test of contraction-rate and contraction-time of the gallbladder. The same test was repeated after injecting 10 mg/dog of morphine to strict the Oddi sphincter. The clinical materials consisted of 30 normal human subjects and 60 patients with biliary symptoms and signs. Those with abnormal upper gastrointestinal series and abnormal function tests of the pancreas were excluded from the materials. We injected the same amount of CCK and studied the contraction rate and time with an emphasis on acalculous cholecystitis and cystic duct syndrome and some ill-defined functional disorder. In

  14. 对比大柴胡汤与小柴胡汤的临床应用%Compare Clinical Application Dachaihu Decotion and Xiaochaihu Decotion

    Institute of Scientific and Technical Information of China (English)

    赵怀康

    2015-01-01

    Objective To explore the clinical application of Dachaihu Decoction and Xiaochaihu decoction. Methods Randomly selected in January 2013-January 2015 years in our hospital, application of Dachaihu Decoction in the treatment of 50 prescriptions and at the same time, application of Xiaochaihu Decoction in the treatment of 50 prescriptions as the object of study, retrospective analysis. Results 50 cases of prescriptions containing lump type pancreatitisand 10 cases of cholecystitis, gallstone pain in 7 cases, superifcial gastritis with bileregurgitation in 4 cases, 14 cases of cold, 9 cases of intractable insomnia, 6 cases of bacillary dysentery. 0 cases of prescriptions containing low cold with fear in 7 cases, 5 cases of cholecystitis afternoon fever, 10 patients with chills and fever, heat into the blood chamber in 14 cases, 14 cases of toothache. Conclusion Dachaihu Decoction to treat syndrome and Koshiba Koyu syndrome, the pain is different, the key lies in the knowledge of clinicalsyndromes, differentiation of the same.%目的:探讨大柴胡汤与小柴胡汤临床应用。方法随机选取2013年1月至2015年1月我院应用大柴胡汤治疗处方50张与同时期应用小柴胡汤治疗处方50张作为研究对象,进行回顾性分析。结果50例处方中包含肿块型胰腺炎10例,胆结石胆囊炎疼痛7例,浅表性胃炎伴胆汁反酸4例,感冒14例,顽固失眠9例,痢疾6例。50例处方中包含低热伴畏风寒7例,胆囊炎午后低热5例,寒热往来10例,热入血室14例,牙痛14例。结论大柴胡汤与小柴胡汤主治病证广泛,所主病证有痛有异,临床应用的关键在于识证候、辨同异。

  15. Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report.

    Science.gov (United States)

    Honmyo, Naruhiko; Kuroda, Shintaro; Kobayashi, Tsuyoshi; Ishiyama, Kohei; Ide, Kentaro; Tahara, Hiroyuki; Ohira, Masahiro; Ohdan, Hideki

    2016-12-01

    Laparoscopic cholecystectomy (LC) has been recently adapted to acute cholecystitis. Major bile duct injury during LC, especially Strasberg-Bismuth classification type E, can be a critical problem sometimes requiring hepatectomy. Safety and definitive treatment without further morbidities, such as posthepatectomy liver failure, is required. Here, we report a case of severe bile duct injury treated with a stepwise approach using (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging to accurately estimate liver function.A 52-year-old woman diagnosed with acute cholecystitis underwent LC at another hospital and was transferred to our university hospital for persistent bile leakage on postoperative day 20. She had no jaundice or infection, although an intraperitoneal drainage tube discharged approximately 500 ml of bile per day. Recorded operation procedure showed removal of the gallbladder with a part of the common bile duct due to its misidentification, and each of the hepatic ducts and right hepatic artery was injured. Abdominal enhanced CT revealed obstructive jaundice of the left liver and arterial shunt through the hilar plate to the right liver. Magnetic resonance cholangiopancreatography revealed type E4 or more advanced bile duct injury according to the Bismuth-Strasberg classification. We planned a stepwise approach using percutaneous transhepatic cholangiodrainage (PTCD) and portal vein embolization (PVE) for secure right hemihepatectomy and biliary-jejunum reconstruction and employed (99m)Tc-GSA SPECT/CT fusion imaging to estimate future remnant liver function. The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6 %, respectively. The increase of liver function was higher than that of volume (28.3 vs. 15.8 %). On postoperative day 63, the curative operation, right

  16. Treatment of malignant biliary obstruction with wallstent endoprosthesis

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures were mainly taken with 10 mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n = 6/33). Complications were fever (n = 4), cholecystitis (n = 1) and sepsis (n = 1). Long-term complications were mainly obstruction (n = 9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237) days among those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. Wallstent application provides good palliation with little discomfort and few complications in the patients with

  17. 胆囊管综合征的诊断与治疗%Diagnosis and treatment of cystic duct syndrome

    Institute of Scientific and Technical Information of China (English)

    范瑞芳; 袁克文; 雍召生; 李荣梓; 张超; 肖毅; 胡鹏; 许淑梅

    2011-01-01

    目的:探讨胆囊管综合征(cystic duct syndrome,CDS)的诊断方法及治疗措施.方法:回顾分析36例CDS的临床症状、诊断流程及治疗结果.结果:36例CDS均具有典型的胆绞痛症状.术前常规进行腹部超声、口服胆囊造影等检查,21例行MRCP检查提示胆囊管迂曲、慢性胆囊炎或胆囊积液.12例病程中发现继发性胆囊结石.合并急性化脓性胆囊炎6例.31例顺利实施腹腔镜胆囊切除术,其中2例行经脐单孔腹腔镜胆囊切除术.5例实施开腹胆囊切除术.术中所见及术后病理学检查均支持CDS的诊断.结论:CDS的诊断需综合考虑临床症状、影像学检查、术中发现及术后病理学检查等因素,腹腔镜胆囊切除术是CDS的理想治疗方法.%Objective: To discuss the diagnostic method and therapeutic measure of cystic duct syndrome (CDS). Methods: The clinical symptoms, diagnosis process and treatment outcome were analyzed retrospectively in 36 patients with CDS. Results: All of the 36 patients had the typical abdominal symptoms containing biliary colic. Abdominal ultrasound and oral cholecystography were routinely performed in 36 patients, and magnetic resonance cholangiopancreatography (MRCP) indicated cystic duct circuity, chronic cholecystitis and hydrops of gallbladder in 21 patients. The secondary gallbladder stones were found in 12 patients. Six patients were complicated with acute suppurative cholecystitis. Laparoscopic cholecystectomy (LC) was performed successfully in 31 patients, and 2 patients of them received transumbilical single - port laparoscopic cholecystectomy ( TUSPLC ). Five patients underwent conventional open cholecystectomy. The intraoperative findings and postoperative pathological examination were consistent with the diagnosis of CDS. Conclusion: The diagnosis of CDS should be based on clinical symptoms, medical imaging, intraoperative exploration and postoperative pathological results. LC may be an ideal treat method for

  18. Detection and quantitative estimation of entero gastric reflux by scintigraphy

    International Nuclear Information System (INIS)

    Purpose: The aim of the study is detection and quantification of enterogastric reflux (EGR). Patients and Methods: We investigated 162 patients and 10 controls. Dynamic acquisition was performed after i.v. application of 185 MBq 99m-Tc-EHIDA during 90 min (1f/min) with test-meal in 30th min. The stomach was labelled with of 18 MBq 99mTc-S-colloid. Index of enterogastric reflux (EGR%) and reflux duration were calculated from hepatobiliary and stomach curves. Results: The reflux was registered in the controls in small quantity (EGR%=4,4+/-4,2%) exclusively postprandially, shortly (4.3+/-2.0 min) while these values were significantly (p< 0.001) increased in patients after Billroth II resection(68.8+/-43.7%; 58.4+/-4.0min), with duodenal ulcer (36.6+/-33.0%; 40.3+/-22.2 min), cholecystitis (31.0+/-8.7%; 26.5+/-6.8 min), after Billroth I (28.2+/-22.7%; 34.1+/-12.4 min), postcholecystectomy (27.1+/-17.2%; 37.6+/-19.7 min), with gastric ulcer (24.5+/-13.6%; 21.9+/-10.2 min) with GER (24.5+/-14.9; 29.6+/-19.5min) and chronic duodenal disease (17.2+/-5.6%; 27.3+/-8.0 min). EGR% was highly correlated (r=0.580, DF=75, p<0.01) with its duration. In fasting conditions (prior to stimulation), reflux was detected in 28 out of 75 (37.3%) patients with reflux in average quantity of 41.0+/-29.7% which was significantly different (p<0.01) from those postprandially detected (23.26+/-16%). Increased values of EGR index are found in 75 (46.3%) patients: 85.7% and 75% after BII and BI gastrectomy, 60% with gastric and 52.4% with duodenal ulcer, 46.1% with chronic duodenal disease, 41.3% with GER, 39.3% with cholecystectomized patients and 20% in those with cholecystitis. Conclusion: EGR scintigraphy can provide exact data about EGR presence and the quantity

  19. Treatment of malignant biliary obstruction with wallstent endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Geun Seok; Kim, Sung Woo; Kim, Won Ho; Kim, Yong Joo [Kyung-pook National University Hospital, Daegu (Korea, Republic of)

    1995-01-15

    The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures were mainly taken with 10 mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n = 6/33). Complications were fever (n = 4), cholecystitis (n = 1) and sepsis (n = 1). Long-term complications were mainly obstruction (n = 9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237) days among those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. Wallstent application provides good palliation with little discomfort and few complications in the patients with

  20. Surgical treatment of gallbladder polypoid lesions

    Directory of Open Access Journals (Sweden)

    Pejić Miljko A.

    2003-01-01

    Full Text Available INTRODUCTION Polypoid lesions of the gallbladder can be divided into benign and malignant categories. Malignant polypoid lesions include carcinomas of the gallbladder, which is the fifth most common malignancy of the gastrointestinal tract and the most common malignancy of the biliary tract. Benign polypoid lesions of the gallbladder are divided into true tumors and pseudotumors. Pseudotumors account for most of polypoid lesions of the gallbladder, and include polyps, hyperplasia, and other miscellaneous lesions. Adenomas are the most common benign neoplasms of the gallbladder. Cholesterol polyps are the most common pseudotumors of the gallbladder. The polyps can be single or multiple, usually less than 10 mm in size. They have no predilection for any particular gallbladder site, and usually are attached to the gallbladder wall by a delicate, narrow pedicle. No malignant potential has been identified for this type of pseudotumor. Adenomas are the most common benign neoplasms of the gallbladder. They have no predilection site in the gallbladder, and may also be associated with gallstones or cholecystitis. The premalignant nature of adenomas remains controversial. Ultrasonography (US has been demonstrated to be significantly better in detecting polypoid lesions of the gallbladder as compared with computed tomography and cholecystography. A mass fixed to the gallbladder wall of normal thickness, without shadowing, is seen in case of gallbladder polyp. Since gallbladder cancers usually present as polypoid lesions, differentiation between benign polypoid lesion and malignant lesion can be very difficult, even with high-resolution imaging techniques. PATIENTS AND METHODS Retrospectively we have analyzed 38 patients with ultrasonographicaly detected gallbladder polyps during the period from January 1995 to December 2000, who were treated at surgical department of Health Centre in Uzice and at Surgical clinic of Clinical Centre in Nis. We have analyzed

  1. Complications and Monitoring – Guidelines on Parenteral Nutrition, Chapter 11

    Directory of Open Access Journals (Sweden)

    Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

    2009-11-01

    Full Text Available Compared to enteral or hypocaloric oral nutrition, the use of PN (parenteral nutrition is not associated with increased mortality, overall frequency of complications, or longer length of hospital stay (LOS. The risk of PN complications (e.g. refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. Occuring complications are e.g. the refeeding-syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycaemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis. Efficient monitoring in all types of PN can result in reduced PN-associated complications and reduced costs. Water and electrolyte balance, blood sugar, and cardiovascular function should regularly be monitored during PN. Regular checks of serum electrolytes and triglycerides as well as additional monitoring measures are necessary in patients with altered renal function, electrolyte-free substrate intake, lipid infusions, and in intensive care patients. The metabolic monitoring of patients under long-term PN should be carried out according to standardised procedures. Monitoring metabolic determinants of bone metabolism is particularly important in patients receiving long-term PN. Markers of intermediary, electrolyte and trace element metabolism require regular checks.

  2. 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.)

  3. Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

    Directory of Open Access Journals (Sweden)

    Alicia DeFelipe-Mimbrera

    2014-01-01

    Full Text Available Introduction. Our aim was to analyze our clinical experience with dabigatran etexilate in secondary stroke prevention. Methods. We retrospectively included patients starting dabigatran etexilate for secondary stroke prevention from March 2010 to December 2012. Efficacy and safety variables were registered. Results. 106 patients were included, median follow-up of 12 months (range 1–31. Fifty-six females (52.8%, mean age 76.4 (range 50–95, SD 9.8, median CHADS2 4 (range 2–6, CHA2DS2-VASc 5 (range 2–9, and HAS-BLED 2 (range 1–5. Indication for dabigatran etexilate was ischemic stroke in 101 patients and acute cerebral hemorrhage (CH due to warfarin in 5 (4.7%. Dabigatran etexilate 110 mg bid was prescribed in 71 cases (67% and 150 mg bid was prescribed in the remaining. Seventeen patients (16% suffered 20 complications during follow-up. Ischemic complications (10 were 6 transient ischemic attacks (TIA, 3 ischemic strokes, and 1 acute coronary syndrome. Hemorrhagic complications (10 were CH (1, gastrointestinal bleeding (6, mild hematuria (2, and mild metrorrhagia (1, leading to dabigatran etexilate discontinuation in 3 patients. Patients with previous CH remained uneventful. Three patients died (pneumonia, congestive heart failure, and acute cholecystitis and 9 were lost during follow-up. Conclusions. Dabigatran etexilate was safe and effective in secondary stroke prevention in clinical practice, including a small number of patients with previous history of CH.

  4. Cardiac tamponade as first manifestation of a lung neoplasm.

    Directory of Open Access Journals (Sweden)

    Pamela Medina A.

    2014-04-01

    Full Text Available INTRODUCTION: In cardiac tamponade, there is a filling restriction of the heart due to increased pressure of the pericardial cavity secondary to pericardial effusion. Pressure can reach values greater than that of the right heart cavities, compromising their filling, and, secondarily, affecting the preload of the left ventricle. CASE REPORT: A 52-year old male, with type 2 diabetes mellitus, consulted to the emergency department of Víctor Ríos Ruiz Hospital of Los Angeles, Chile for epigastric colic pain, nausea, vomiting, abdominal distention, choluria, oliguria, anorexia, constipation, asthenia, adynamia and malaise. He is admitted to the surgery ward on the suspicion of acute cholecystitis. Abdominal ultrasound showed perihepatic and perisplenic free fluid and increased caliber of the inferior vena cava, associated with bilateral pleural effusion. Hypotension, paradoxical pulse and jugular engorgement developed, so he is transferred to the ICU where echocardiography confirmed cardiac tamponade. Pericardiocentesis was performed, which showed malignant cells on microscopy. A computerized tomography (CT scan showed a solid mass in the left inferior lung lobe, a nodule in the middle lobe and multiple mediastinal and hiliar bilateral lymphoadenopaties. DISCUSSION: Malignant pericardial effusion commonly presents as cardiac tamponade, being the lung cancer its main etiology. The prognosis of pericardial effusion in lung cancer is rather ominous, with an overall survival of less than 3 months.

  5. Simultaneous determination of 10 components in traditional Chinese medicine Dachaihu Granule by reversed-phase-high-performance liquid chromatographic-diode array detector

    Directory of Open Access Journals (Sweden)

    Yingfei Hu

    2013-01-01

    Full Text Available Background: Dachaihu Granule, commonly used for treating cholecystitis, is derived from a famous traditional Chinese formula named Dachaihu Decoction. No analytical method has been reported for simultaneous determination of 10 bioactive compounds for quality control in Dachaihu Granule so far. Objective: To develop a high-performance liquid chromatographic (HPLC method with diode array detector (DAD for simultaneous determination of 10 bioactive compounds (paeoniflorin, aloe-emodin, rhein, emodin, chrysophanol, physcion, naringin, hesperidin, neohesperidin, and baicalin in traditional Chinese medicine Dachaihu Granule. Materials and Methods : The samples were separated on a Kromasil C 18 (250 × 4.6 mm,i.d. with 5.0 μm particle sizecolumn with multi-wavelength detection method by a gradient elution using acetonitrile (A and 0.2% acetic acid (B as the mobile phase. The column temperature was maintained at 30°C and the detection wavelength was set at 230 nm for paeoniflorin, 254 nm for aloe-emodin, rhein, emodin, chrysophanol, and physcion, 280 nm for naringin, hesperidin, neohesperidin, and baicalin. Results: The developed method provided satisfactory precision and the accuracy of this method was in the range from 94.0% to 103.1%, all of the 10 compounds showed good linearity (r > 0.999 in a detected concentration range. Conclusion: The validated method was successfully applied to the simultaneously of these active components in Dachaihu Granule from different production batches.

  6. Gallstones Risk Factor and Prevalence in the Elderly in Jeju Island

    Energy Technology Data Exchange (ETDEWEB)

    Sim, Hyun Sun; Choi, Joon Lock; Park, Jae Jin; Lee, Su Yeon; Lee, Ji Min; Jung, Hong Ryang; Lim, Chung Hwan; Kim, Jung Gu [Dept. of Radiological Science, Hanseo University, Cheju (Korea, Republic of)

    2009-09-15

    Gallbladder stone is the most common disease of biliary tract. It is lead to acute abdominal pain. The cholecystitis which is caused by in gallbladder stone occurs frequently and the possibility of the gallbladder cancer comes to be high. Our study was designed to determine the prevalence and risk factors gallbladder stone in a population who community. We enrolled a total of 826 (male : 297, female : 529) persons who 60 or older in Jeju-do 10 places from 2008 July one months. The height, weight, liver function tests, lipid profile, fasting blood sugar, were all measurement. They had their gallbladder examined with using ultrasonography. Statistical significance was defined as a p-value less than 0.05. Among 826 persons, gallbladder stone was found in 49 persons (5.9%). The male is 6.1% and the female is 5.8%, the male 1.03 times appeared more highly the female. The body mass index above of 23.0 kg/m{sup 2} with the gallbladder stone was 69.3% (p<0.047). The gallbladder stone appeared highly according to age increases. The obesity is the risk factor of gallbladder stone. The weight management and diet control is a possibility of reducing a gallbladder stone creation.

  7. MR and CT cholangiography in evaluation of the biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Masui, T.; Fujiwara, T.; Ichijo, K.; Imaoka, I.; Naito, M. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Radiology; Takehara, Y.; Kaneko, M. [Hamamatsu Univ. School of Medicine (Japan). Dept. of Radiology; Yamamoto, H.; Watahiki, H. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Gastroenterology

    1998-09-01

    Objective: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p<0.05). The cystic duct was demonstrated better by CTC than MRC (p<0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis, MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because its depicts RAS clearly. (orig.)

  8. TYPHOID IN ISFAHAN AREA

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    M. Maleki

    1975-09-01

    Full Text Available 245 patients with typhoid fever were admitted in university of Isfahan Medical Centers during the last 4 years are reported here in this study. The diagnosis was confirmed in each case by the history of the exposure physical examination, Widal seroreaction and blood culture test. The highest incidence of the disease occurred between 10-19 years of age, and mostly in summer months, during June, July, when the fresh fruits and vegetables are plentiful for consumption. There were 53 positive blood cultures for salmonella from 245 samples that were cultures. All patients were positive widal seroreaction with raising titer during the course of their illness. The complication were respectively as follow: hemorrhagic disorders 14% from which G.I. bleeding was the commonest form perforation 5% and myocarditis about 3% and other complications. These were arthritis, thromophelebitis and cholecystitis two cases of each are described here. It is worth of mentioning here the occurrence of hepatitis, osteomyelitis the two unusual complications of the disease in this communication.

  9. Laparoscopic Cholecystectomy: An Experience of 200 cases

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    Sanjay K. Bhasin, J.G. Langer.

    2004-04-01

    Full Text Available The surgical management of gallstones has been revolutionized after the advent of laparoscopiccholecystectomysince 1985/87. This minimally invasive technique has virtually become the goldstandard in the management of cholelithiasis. We share our experience of 200 cases of laparoscopiccholecystectomyperformed in symptomatic cholelithiasis over a period of five years from 1998 to2002 in Govt. Medical College, Jammu. There were 32 males and 168 females in the study group.Maximum age of the patients was 65-yr and minimum 17-yr. Patients with high-risk medical problems;deranged LFT, CBD stones and acute cholecystitis were excluded from this study. Average operationtime was 61.3 minute (40-130 mt, post-operative analgesic used were 3.02 doses per patient (2-15doses, post-operative hospital stay was 4.34 days (2-26 days and time to return to work was 13.2days (10-40 days. Rate of conversion to conventional-cholecystectomy was 4%. There was nomortality and negligible/acceptable morbidity. No complications were observed in the follow up periodranging from 2 weeks to 6 months. The patients were quite satisfied with the outcome of the procedure.

  10. Functional hepatobiliary MR imaging in children

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    Tamrazi, Anobel; Vasanawala, Shreyas S. [Stanford University, Department of Radiology, Stanford, CA (United States)

    2011-10-15

    Clinical application efforts for the hepatocyte-specific MRI contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) have mainly been directed toward detection and characterization of various hepatic masses in the adult population. Here we report our initial experience with Gd-EOB-DTPA for evaluating congenital and acquired hepatobiliary pathologies in the pediatric population. Twenty-one consecutive children receiving Gd-EOB-DTPA for functional hepatobiliary evaluation at our institution were retrospectively identified with IRB approval. The use of Gd-EOB-DTPA was classified in each case as definite, potential, or no clinical utility, focusing on the clinical value gained beyond traditional noncontrast fluid-sensitive MR cholangiopancreatography (FS-MRCP) and other imaging modalities. Definite added value of Gd-EOB-DTPA was found in 12 patients, with potential value in 4 patients, and no value in 5 patients. Benefit was seen in cases of iatrogenic and non-iatrogenic biliary strictures, perihepatic fluid collections for biliary leak, hepatobiliary dysfunction in the absence of hyperbilirubinemia, and in the functional exclusion of cystic duct occlusion that can be seen in acute cholecystitis. This is the first reported series of children with Gd-EOB-DTPA and this early work suggests potential pediatric applications. (orig.)

  11. Falciform ligament abscess: report of a case Abscesso de ligamento falciforme: relato de caso

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    Valdinaldo Aragão de Melo

    2003-01-01

    Full Text Available Falciform ligament abscess is rare. We report a case of a 65-year-old man who presented with right upper quadrant abdominal pain, postprandial fullness, and fever. Computed tomography disclosed a cylindrical mass in the anterior abdomen that aroused suspicion of a hepatic abscess. At laparoscopic surgery, an abscess of the falciform ligament was found and drained. Two months later, the patient developed recurrence of the abscess secondary to acute calculous cholecystitis. Abscess drainage and cholecystectomy were performed. The presence of right uppper quadrant abdominal pain, epigastric tenderness, fever, leukocytosis, and a mass in the anterior abdomen should arouse suspicion of falciform ligament abscess. Its treatment consists of abscess drainage.Abscesso de ligamento falciforme é raro. É relatado um caso de um homem de 65 anos que apresentou dor no quadrante superior direito do abdome, plenitude pós-prandial e febre. A tomografia computadorizada revelou uma massa cilíndrica no abdome anterior que causou suspeita de abscesso hepático. Na cirurgia laparoscópica, um abscesso de ligamento falciforme foi encontrado e drenado. Dois meses depois, o paciente desenvolveu recidiva do abscesso secundário a colecistite aguda calculosa. Drenagem do abscesso e colecistectomia foram realizados. A presença de dor no quadrante superior direito, febre, leucocitose e abaulamento no abdome ântero-superior deve causar suspeita dessa patologia. Seu tratamento consiste de drenagem do abscesso.

  12. Intranodal palisaded myofibroblastoma originating from retroperitoneum: an unusual origin

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    Manikkapurath Hemachandran

    2011-06-01

    Full Text Available Abstract Background Intranodal palisaded myofibroblastoma is one of the primary mesenchymal tumours. The inguinal region is the commonest site of this rare tumour. As there are only about 55 such cases reported in the literature, the precise aetiology and pathogenesis have yet to be explained adequately. Here we report a case of a 72 year old man presented with incidental finding of intranodal palisaded myofibroblastoma in the retroperitoneal region. Case Presentation A 72-year old man presented with abdominal pain in right upper quadrant with an incidental finding of abdominal mass in the right flank. The computerised tomogram scan of abdomen confirmed acute cholecystitis with a 5 x 5 cm retroperitoneal mass. He underwent cholecystectomy with excision of this mass. He recovered well following his operation and was discharged from the hospital. Histological examination confirmed the diagnosis of intranodal palisaded myofibroblastoma. Conclusion To our knowledge, this is the first case of intranodal palisaded myofibroblastoma originating from retroperitoneum. Along with the rarity of this case, we also discussed its typical histopathological findings, aetiology and pathogenesis.

  13. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

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    Fanelli, Fabrizio; Orgera, Gianluigi; Bezzi, Mario; Rossi, Plinio; Allegritti, Massimiliano; Passariello, Roberto [University of Rome, Department of Radiological Sciences, Rome (Italy)

    2008-05-15

    To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9{+-}4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct. (orig.)

  14. Transient hepatic attenuation difference (THAD) in patients without neoplasm. Frequency, shape, distribution, and causes

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    Yamasaki, Michio; Furukawa, Akira; Murata, Kiyoshi; Morita, Rikushi [Shiga Univ. of Medical Science, Otsu (Japan)

    1999-03-01

    Transient hepatic attenuation difference (THAD) is a valuable finding in detecting hypervascular lesions. However, similar findings are also observed in patients even without known hepatic diseases. We elucidate the characteristic findings and the causes of THAD in patients without hepatic neoplasm in this article. Dual-phased contrast-enhanced CT studies performed in 450 patients were reviewed, and THAD was observed in 42 (9.3%). THAD was linear or wedge-shaped and was seen contiguous to the liver surface with a relatively obscure margin in 40 of the 42 cases. The most common cause of THAD was chronic cholecystitis followed by previous biliary surgery. THAD was also seen in 30 patients with no hepatic diseases in whom it had a tendency to locate around the gallbladder fossa or in the periphery of the liver particularly in the left lobe. The knowledge of the prevalence, shape, distribution and causes of THAD is essential for the evaluation of contrast-enhanced CT images obtained during the arterial phase. (author)

  15. {sup 99m}Tc-trimethyl-BrIDA scintigraphy in HIV-related cholangiopathy

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    Bair, H.J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Behr, T. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Rubbert, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Internal Medicine 3; Becker, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Wolf, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine

    1995-12-01

    A HIV-infected 37-year-old man with diffuse mid-abdominal pain and elevated liver enzymes was sequentially studied by sonography, computed tomography (CT), {sup 99m}Tc-trimethyl-BrlDA scintigraphy and endoscopic retrograde cholangiopancreaticography (ERCP). CT and sonography did not lead to a final diagnosis. Cholescintigraphy showed signs of cholecystitis and sclerosing cholangitis with intra- and extrahepatic bile duct dilatation. These findings could be confirmed by ERCP, rendering HIV-associated cholepathy probable. Cytomegalovirus infection was demonstrated by polymerase chain reaction from bile fluid and the presence of cryptosporidia infection in a histology specimen isolated by ERCP. Therefore, biliary scintigraphy seems promising for screening for HIV-associated cholangio- and cholecystopathy, being less invasive and less bothering for the patient than ERCP. (orig.) [Deutsch] Ein 37jaehriger Mann mit diffusen Schmerzen im mittleren Abdomen wurde mittels Sonographie, Computertomographie (CT), {sup 99m}Tc-trimethyl-BrlDA-Szintigraphie und endoskopischer retrograder Cholangiographie (ERCP) untersucht. Sowohl die sonographische als auch die computertomographische Untersuchung fuehrte zu keiner endgueltigen Diagnose. Die hepatobiliaere Funktionsszintigraphie zeigte den Befund einer Cholezystitis und sklerosierenden Cholangitis mit Dilatation der intra- und extrahepatischen Gallengaenge. Die konsekutiv durchgefuehrte ERCP konnte dies bestaetigen und machte eine HIV-assoziierte Cholepathie wahrscheinlich. Eine Cytomegalievirusinfektion wurde durch eine Polymerase-Kettenreaktion mittels Gallefluessigkeit und eine Infektion mit Cryptosporidien durch eine Biopsie der Gallengaenge gesichert. Die hepatobiliaere Funktionsszintigraphie scheint eine geeignete nichtinvasive Screeningmethode zum Nachweis einer HIV-assoziierten Cholangio- und Cholezystopathie zu sein. (orig.)

  16. Outcome of laparoscopic cholecystectomy at a secondary level of care in Saudi Arabia

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    Abdulrahman S Al-Mulhim

    2011-01-01

    Full Text Available Background/Aim: The first option for gallbladder surgery is laparoscopic cholecystectomy. The aim of this study is to analyze the outcomes for all patients who underwent laparoscopic cholecystectomy at a secondary level of care. Patients and Methods: Between 2005 and 2008, 968 consecutive laparoscopic cholecystectomies were performed at King Fahad Hospital. We collected and analyzed data including age, gender, body mass index (kg/m 2 , the American Society of Anesthesiologists (ASA class, mode of admission (elective or emergency, indication for LC (chronic or acute cholecystitis [AC], co-morbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results : Nine hundred and sixty-eight patients had laparoscopic cholecystectomy at the center. There were 824 females and 144 males; the age range was 15-64 (mean 32.9± 12.7 years. The operating time was 45 to 180 min (median 85 min; the complication rate was 4.03% (39 patients. Conclusion: Laparoscopic cholecystectomy could be performed safely in the majority of patients with cholelithiasis, by an experienced surgical team at a secondary level of care.

  17. Role of Ultrasonography in Acute Abdomen

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    An, Ji Hyun; Lee, Yeon Hee; Kim, Tae Hoon; Yu, Pil Mun; Choi, Young Hi; Kim, Sang Joon; Kim, Seung Cheul; Cho, Jeong Hee [Dankook University College of Medicine, Cheonan (Korea, Republic of); Jung, Jae Un [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1996-12-15

    Authors analyzed the distribution of diseases and compared ultrasonographic conclusions with confirmed diagnoses of emergency abdominal ultrasonographies in acute abdominal conditions. We evaluated the role of emergency abdominal ultrasonography especially in the decision of emergency operation. In one hundred and forty five patients, emergent abdominal ultrasonography was performed within on admission. We compared the sonographic conclusion with postoperative pathology and analyzed the diagnoses of medically treated diseases. Twenty-eight patients underwent surgery and 117 patients were treated conservatively. Among the surgically treated patients, 19 patients (70.4%) were correctly diagnosed by preoperative ultrasonography.These included acute appendicitis (N = 8), acute cholecystitis (n = 7), ovarian cyst torsion (n = 2), and liver abscess (n = 1). Correct preoperative diagnosis was not made in 9 patients, including acute appendicitis (n = 4), peritonitis due to bowel perforation (n = 2), ectopic pregnancy (n = 1), colonic diverticulitis (n = 1) and pelvic inflammatory disease (n = 1). Clinical follow up was possible in 50 patients among the non-operative patient group, and the clinical diagnoses were chronic liver disease (n = 14), acute pyelonephritis (n = 10), and biliary stone (n = 10). Emergent ultrasonography plays an important role in acute abdominal conditions by supporting the differential diagnosis of medical and surgical disease

  18. Pancreatitis caused by Clostridium perfringens infection with extensive retropneumoperitoneum; Pancreatitis por Clostridium perfringens con retroneumoperitoneo extenso

    Energy Technology Data Exchange (ETDEWEB)

    Merchante, E.; Garcia, F. J.; Perez, H.; Marquez, J. L. [Hospital Universitario Virgen del Rocio. Sevilla (Spain)

    2001-07-01

    We present a case of primary emphysematous pancreatitis caused by Clostridium perfringens infection (also Known as spontaneous pancreatic gas gangrene) in a 66-year-old man with diabetes and a history of recurrent pancreatitis. One notable feature is the absence of a focal distribution, which is seen on radiological studies to be accompanied by extensive retropneumoperitoneum, with dissemination of the gas toward the mesenteric root and pelvic extra peritoneal spaces. This wide diffusion is aided by the C. perfringens toxins and the pancreatic enzymes released, leading to a fulminate course, an elevated rate of early mortality among the cases reviewed. The early diagnosis of this disease is fundamental, enabling aggressive medical treatment and emergency surgery. Diabetes is a known risk factor for anaerobic infection, including C. perfringens, as in the case of emphysematous cholecystitis. A diseased pancreas or pancreatic duct facilitates the development of infections since it eliminates poorly the microorganisms that reach it from the duodenum. Gas gangrene secondary to necrosis-related super infection or pancreatic collections is uncommon, and spontaneous or primary cases are exceptionally are. (Author) 13 refs.

  19. [The efficacy of the combined rehabilitative treatment of the patients presenting with obesity, metabolic syndrome, and diseases of the hepatobiliary system].

    Science.gov (United States)

    Cherchinian, A S

    2012-01-01

    A total of 80 patients presenting with exogenous constitutional obesity, metabolic syndrome, and diseases of the hepatobiliary system (including chronic non-calculous cholecystitis and fatty hepatosis) were enrolled to participate in the present study. The basal treatment consisted of the adequate reducing diet, remedial gymnastics, massage, reflexo-acupuncture, the application of galvanic muds, and controlled intake of chofitol. It was supplemented with magnetic laser irradiation of selected abdominal regions, and electrical stimulation of femoral, dorsal, and abdominal muscles. It was shown that the combination of the above procedures and physical factors significantly improves the overall outcome of the treatment. The patients suffering intestinal dysbacteriosis were prescribed the intake of probiotic Nor Narine together with Jermuk mineral water; they were found to benefit from such treatment due to normalization of intestinal biocenosis and improvement of their general condition. The clinical and paraclinical data obtained in this study give evidence of the therapeutic efficacy of certain physical factors and especially their combination used for the medical rehabilitation of the patients presenting with constitutional obesity, metabolic syndrome, and digestive disorders. Moreover, the well-apparent positive results were documented from the combined treatment with magnetic laser radiation and therapeutic muds. PMID:23210358

  20. Radiopharmacology of iminodiacetic acid N-derivatives analysis in biological models and comparison to human beings

    International Nuclear Information System (INIS)

    It was studied the influence of chemical structures and molecular weight in the distribution of several iminodiacetic acid N-derivatives and to determine the potential use of these radiopharmaceuticals in humans. The study was performed with the following derivatives: N-(2,6 dimetyphenylcarbamoylmethy) iminodiacetic acid, N(2.6 dietylphenyl-carbamoylmethy) iminodiacetic acid, N-(2,6 diisopropylphenylcarbamoylmethy) iminodiacetic acid and the previously unknown N-derivative N-(2,6 diisopropyl, phenylcarbamoylethyl) iminodiacetic aced. These were sinthesized by a modified procedure by MITTA et al. and controlled by NMR, mass spectrometry, elemental composition and also toxicity pirogens, lethal dose and the chelate's radiochemical dose were determined. Liver gallbladder, intestinal and renal kinetics were studied in mice. In order to evaluate the metabolic pathways of the radiopharmaceuticals, the content of gallbladder and the urine were reinjected. Plasma kinetics and the plasmatic half life was determined by extracorporeal circulation in Wistar rats. For the use in human beings, test were carried out in different branches of nuclear medicine, in normal volunteers and carriers of different pathologic disorders. The patients were divided into four groups: acute and chronic cholecystitis, cirrhosis and jaundice. It was obtained the liver/heart activity ratio and estimated the appearance times of the intrahepatic ducts, gallbladder, duodenum and renal persistence. (M.E.L.)