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Sample records for cholecystitis

  1. Cholecystitis

    Science.gov (United States)

    Diseases and Conditions Cholecystitis By Mayo Clinic Staff Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. Your gallbladder is a ... the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can ...

  2. Chronic cholecystitis

    Science.gov (United States)

    Cholecystitis - chronic ... Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. Most of these attacks are caused by gallstones in the gallbladder. These ...

  3. Acute cholecystitis

    OpenAIRE

    Halpin, Valerie

    2014-01-01

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

  4. Sonography of gangrenous cholecystitis

    OpenAIRE

    Peter Corr

    2012-01-01

    Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-laminatio...

  5. Idiopathic Eosinophilic Cholecystitis

    OpenAIRE

    Huseyin Tas

    2014-01-01

    Eosinophilic cholecystitis is one of the rare causes of cholecystitis. Diagnosis is made by exclusion of other causes for eosinophilic cholecystitis and by pathological examination of the gallbladder wall infiltration with more than 90% of the eosinophilic leukocytes. We have aimed to present a case of 24 year old man who had Eosinophilia in blood tests, progressive complaints after medical treatment, was diagnosed with acute acalculous cholecystitis and was treated with cholecystectomy. Idio...

  6. Sonography of gangrenous cholecystitis

    Directory of Open Access Journals (Sweden)

    Peter Corr

    2012-01-01

    Full Text Available Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-lamination, gas within the gall bladder, absence of calculi, and large peri-cholecystic collections. Both sonogram with color flow imaging and contrast-enhanced Computed tomography are complementary investigations to establish this important diagnosis in critically ill patients.

  7. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis.

    Science.gov (United States)

    del-Moral-Martínez, María; Barrientos-Delgado, Andrés; Crespo-Lora, Vicente; Cervilla-Sáez-de-Tejada, María Eloísa; Salmerón-Escobar, Javier

    2015-01-01

    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.

  8. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

    Directory of Open Access Journals (Sweden)

    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.

  9. [Enzymatic cholecystitis and cholecystopancreatitis].

    Science.gov (United States)

    Sobeshchanskaia, E A; Myrkin, S D; Babalich, A K

    1977-02-01

    Taking into consideration the role of pancreatic enzymes in the etiology of cholecystitis and cholecystopancreatits, the authors examined amylase in 92 patients, bile lipase--in 39 patients during cholecystectomy and also amylase in the choledochus bile during external drainage of the duct in 15 patients in the early postoperative period. The investigations inducated different levels of pancreatic enzymes in bile. Their level is found to depend on the occurrence of hypertension in the bile tract both pre- and postoperatively.

  10. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    Science.gov (United States)

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-05-08

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

  11. Gall bladder perforation in acalculous cholecystitis

    OpenAIRE

    Dayananda Srinivasan; Sujith Sherigar; Durganna Thimmappa

    2014-01-01

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

  12. Acute calculous cholecystitis

    OpenAIRE

    Angarita, Fernando A.; University Health Network; Acuña, Sergio A.; Mount Sinai Hospital; Jimenez, Carolina; University of Toronto; Garay, Javier; Pontificia Universidad Javeriana; Gömez, David; University of Toronto; Domínguez, Luis Carlos; Pontificia Universidad Javeriana

    2010-01-01

    Acute calculous cholecystitis is the most important cause of cholecystectomies worldwide. We review the physiopathology of the inflammatory process in this organ secondary to biliary tract obstruction, as well as its clinical manifestations, workup, and the treatment it requires. La colecistitis calculosa aguda es la causa más importante de colecistectomías en el mundo. En esta revisión de tema se resume la fisiopatología del proceso inflamatorio de la vesículabiliar secundaria a la obstru...

  13. 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.

  14. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

    OpenAIRE

    María del Moral-Martínez; Andrés Barrientos-Delgado; Vicente Crespo-Lora; María Eloísa Cervilla-Sáez-de-Tejada; Javier Salmerón-Escobar

    2015-01-01

    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. Whe...

  15. 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 ...

  16. Granulomatous lithiasic cholecystitis in sarcoidosis

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    Adriana Handra-Luca

    2016-03-01

    Full Text Available Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis diagnosed more than 20-years previously. 2-years previously the patient showed renal lithiasis, hypercalcemia and, increased angiotensin converting enzyme. The imaging features suggested thoraco-abdominal sarcoidosis. Prednisone was given at 1.2 mg/kg/day initially, than decreased, being at 2.5 mg/day at present. The ultrasound examination showed gallbladder lithiasis. A cholecystectomy was performed. Microscopy showed subacute and chronic cholecystitis with several epithelioid and giant cell granulomas some of them perineural. In conclusion, we report a case of granulomatous cholecystitis occurring in the course of treated sarcoidosis. The perineural location of granulomas may give further insights into the pathogenesis of gallbladder dysmotility.

  17. 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.

  18. 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

  19. Pharm GKB: Acute cholecystitis unspecified [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: PharmGKB Accession Id: PA165108452 External Vocabularies MeSH: Cholecystitis, Acut...e (D041881) SnoMedCT: Acute cholecystitis unspecified (197409009) UMLS: C0149520 (C0149520) MedDRA: Acute... cholecystitis (10000691) NDFRT: Cholecystitis, Acute [Disease/Finding] (N0000010952) ...Common Searches Search Medline Plus Search CTD Pharm GKB: Acute cholecystitis unspecified ...

  20. Pharm GKB: Acute cholecystitis NOS [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: PharmGKB Accession Id: PA165108810 External Vocabularies MeSH: Cholecystitis, Acut...e (D041881) SnoMedCT: Acute cholecystitis NOS (197411000) UMLS: C0149520 (C0149520) MedDRA: Acute... cholecystitis (10000691) NDFRT: Cholecystitis, Acute [Disease/Finding] (N0000010952) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute cholecystitis NOS ...

  1. LAPAROSCOPIC TREATMENT OF ACUTE CHOLECYSTITIS

    Institute of Scientific and Technical Information of China (English)

    Davaadorj Nyamkhuu MD; Nyamkhuu Gonchigsenghe MD; Albert Holly Rusher MD

    2003-01-01

    Objctive: To assess the current treatment of AC in a single institution in the series,which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery. Methods: From December 1996 to December 2001,138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age:45.3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26 % were empyema, 13 % had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15.2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6:15. There was no significant difference in operative time (122.0 min in 1 group versus 124.0 min in 2 group) and postoperative stay ( 5.1 days in group 1 vs 6.8 days in group 2). The hepatorenal space was drained in 78 (56.5 % ), and the drain is removed in 3rd postoperative days. Twenty six patients (18.8%) had undergone previous abdominal surgery. Thirty seven patients (26.8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense,thus increasing the technical difficulty of LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and

  2. 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.

  3. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    OpenAIRE

    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 histopathologic studies. The purpose of this paper is to comment on a case report published in World J Gastroenterol 2007 July; 13 (27): 3760-3762, about eosinophilic cholecystitis along with pericarditis without histopathological studies, which are considered necessary for its diagnosis.

  4. 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.

  5. Patients' experiences with cholecystitis and a cholecystectomy.

    Science.gov (United States)

    Lindseth, Glenda N; Denny, Dawn L

    2014-01-01

    Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

  6. Oriental Medical Treatment of chronic Acalculous Cholecystitis

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    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.

  7. Dengue fever presenting as acute acalculus cholecystitis.

    Science.gov (United States)

    Joshipura, Vismit P; Soni, Harshad N; Patel, Nitin R; Haribhakti, Sanjiv P

    2007-06-01

    Classically dengue fever presents as fever with myalgia. A patient of dengue fever presented with classical symptoms and signs of acute acalculous cholecystitis. Serology and ultrasound examination identified dengue as the aetiology. Patient was treated successfully by conservative measures.

  8. Acalculous cholecystitis due to Salmonella enteritidis

    OpenAIRE

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

    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 gastrointestinal infection.

  9. 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.

  10. 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.

  11. 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.

  12. Emphysematous cholecystitis successfully treated by laparoscopic surgery

    Science.gov (United States)

    Katagiri, Hideki; Yoshinaga, Yasuo; Kanda, Yukihiro; Mizokami, Ken

    2014-01-01

    Emphysematous cholecystitis (EC) is an uncommon variant of acute cholecystitis, which is caused by secondary infection of the gallbladder wall with gas-forming organisms. The mortality rate of EC is still as high as 25%. Emergency surgical intervention is indicated. Open cholecystectomy has been traditionally accepted as a standard treatment for EC. We present a case of EC successfully treated by laparoscopic surgery. Laparoscopic cholecystectomy for EC is considered to be safe and effective when indicated. PMID:24876461

  13. 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.

  14. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

    OpenAIRE

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-01-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgic...

  15. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.

    Science.gov (United States)

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-08-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.

  16. Complicated cholecystitis: the complementary roles of sonography and computed tomography.

    Science.gov (United States)

    Charalel, Resmi A; Jeffrey, R Brooke; Shin, Lewis K

    2011-09-01

    Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.

  17. Xanthogranulomatous cholecystitis--a diagnostic challenge.

    Science.gov (United States)

    Jetley, Sujata; Rana, Safia; Khan, Rehan Nabi; Jairajpuri, Zeeba Shamim

    2012-11-01

    Xanthogranulomatous cholecystitis is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammation of the gall bladder. The present study was undertaken to analyse the clinical presentation, pre-operative imaging, intra-operative findings and histological features of xanthogranulomatous cholecystitis and the results compared with those in the literature. Thirteen histologically confirmed cases of xanthogranulomatous cholecystitis were identified from the retrospective analysis of the patient records of 217 cholecystectomies performed during the period January 2011 to March 2012 at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. The clinical, radiological and operative details of these patients have been analysed. The incidence of xanthogranulomatous cholecystitis was 6% and age range was between 25 and 62 years with a mean age of 40.3 years. A female: male ratio was 1.6:1. Chronic right upper quadrant pain was the most common clinical presentation. In 2 patients, a gall bladder carcinoma was suspected radiologically as well as clinically, but was later disproved on histology. Abdominal ultrasound scan showed marked thickening of the gall bladder wall in 11 cases (84.6%). Laproscopic procedure required conversion to an open procedure in 8 patients (61.5% conversion rate). Histologically focal or diffuse inflammation with foamy histiocytes, inflammatory cells, giant cells and fibroblasts in varying proportion were seen. Xanthogranulomatous cholecystitis is an unusual destructive inflammatory process, characterised by severe fibrosis and gall bladder wall thickening presenting as a gall bladder mass that mimics gall bladder carcinoma. The pre- and intra-operative differential diagnosis of the disease still remains a challenge to the practising surgeon and histological assessment of all gall bladders excised for xanthogranulomatous cholecystitis is critical, considering the occasional coexistence with gall bladder

  18. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    OpenAIRE

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

    2015-01-01

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

  19. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    Science.gov (United States)

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

  20. 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.

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

    Science.gov (United States)

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

    2002-01-01

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

  2. Xanthogranulomatous cholecystitis:a premalignant condition?

    Institute of Scientific and Technical Information of China (English)

    Mila Ghosh; Puja Sakhuja; Anil KAgarwal

    2011-01-01

    BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. It often mimics a gallbladder carcinoma (GBC), and may coexist with GBC, leading to a diagnostic dilemma. Furthermore, the premalignant nature of this entity is not known. This study was undertaken to assess the p53, PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation. METHODS: Sections from paraffin-embedded blocks of surgically resected specimens of GBC (69 cases), XGC (65), chronic cholecystitis (18) and control gallbladder (10) were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin. p53 expression was scored as the percentage of nuclei stained. PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining (1-3). A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous, cytoplasmic or nuclear staining. RESULTS: p53 mutation was positive in 52% of GBC cases and 3% of XGC, but was not expressed in chronic cholecystitis and control gallbladders. p53 expression was lower in XGC than in GBC (P CONCLUSION: The expression of p53, PCNA and beta-catenin in XGC was significantly different from GBC and similar to chronic cholecystitis, thus indicating the inflammatory nature of XGC and may not support a premalignant nature of the lesion.

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

    Science.gov (United States)

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

    2013-08-01

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

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

    DEFF Research Database (Denmark)

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

    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. 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."

  6. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Directory of Open Access Journals (Sweden)

    Olfa Kassar

    2015-01-01

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

  7. Kocuria kristinae infection associated with acute cholecystitis

    Directory of Open Access Journals (Sweden)

    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. Gangrenous cholecystitis: mortality and risk factors.

    Science.gov (United States)

    Önder, Akın; Kapan, Murat; Ülger, Burak Veli; Oğuz, Abdullah; Türkoğlu, Ahmet; Uslukaya, Ömer

    2015-02-01

    As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

  9. 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.

  10. Percutaneous drainage of emphysematous cholecystitis associated with pneumoperitoneum

    NARCIS (Netherlands)

    Zeebregts, CJ; Wijffels, RTM; de Jong, KP; Peeters, PM; Slooff, MJH

    1999-01-01

    Emphysematous cholecystitis, a relatively rare variant of acute cholecystitis, is associated with high morbidity and mortality rates. In the presence of a concomitant pneumoperitoneum, these rates may be considered even higher, approaching those of perforation of the gallbladder. The first choice of

  11. 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.

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

    OpenAIRE

    1985-01-01

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

  13. A rare finding during a common procedure: xanthogranulomatous cholecystitis.

    Science.gov (United States)

    Taskesen, Fatih; Arikanoglu, Zulfu; Uslukaya, Omer; Oguz, Abdullah; Aliosmanoglu, Ibrahim; Dusak, Abdurrahim; Turkcu, Gul; Kuzu, Hekim

    2014-01-01

    Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.

  14. Xanthogranulomatous cholecystitis: What every radiologist should know

    Institute of Scientific and Technical Information of China (English)

    Vaibhav P Singh; S Rajesh; Chhagan Bihari; Saloni N Desai; Sudheer S Pargewar; Ankur Arora

    2016-01-01

    Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

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

    DEFF Research Database (Denmark)

    Lauritsen, K B; Sommer, W; Hahn, L;

    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...... that in 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...

  16. Hemorrhagic Cholecystitis in an Elderly Patient Taking Aspirin and Cilostazol

    Directory of Open Access Journals (Sweden)

    David S. Morris

    2008-06-01

    Full Text Available Hemorrhage is a rare complication of acute cholecystitis. Patients who develop this complication often are receiving anticoagulation therapy or have a pathologic coagulopathy. We present a case of an elderly patient who developed hemorrhagic cholecystitis while taking aspirin and cilostazol, a phosphodiesterase inhibitor. The patient underwent an emergent abdominal exploration. A large, blood-filled gallbladder was found along with a large hematoma between the liver and gallbladder. We also briefly review the literature regarding hemorrhagic cholecystitis, hemorrhage into the biliary tree, and hemorrhage as a complication of aspirin and phosphodiesterase inhibitor therapy.

  17. A case of scrub typhus complicated by acute calculous cholecystitis.

    Science.gov (United States)

    Lee, Su Jin; Cho, Young Hye; Lee, Sang Yeoup; Jeong, Dong Wook; Choi, Eun Jung; Kim, Yun Jin; Lee, Jeong Gyu; Lee, Yu Hyun

    2012-07-01

    We report a case of acute calculous cholecystitis through scrub typhus. A 69-year-old woman presented with a history of general myalgia, fever, and right abdominal pain. She referred to our hospital for surgical treatment of clinically suspected acute cholecystitis. Physicians concluded the cause of cholecystitis as gall bladder (GB) stone and proper antibiotics treatment of scrub typhus was started later. The patient developed acute respiratory distress syndrome and multi organ failure through scrub typhus. Five days after admission, the patient was treated with proper antibiotics and discharged on the 13th day after starting doxycycline treatment without any sequelae. In areas endemic for tsutsugamushi disease, even though a patient with GB stone presents with symptoms of acute cholecystitis, careful history and physical examination are required to reveal the existence of eschars or skin eruptions.

  18. 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)

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

    Science.gov (United States)

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

    2011-09-25

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

  20. Eosinophilic cholecystitis with common bile duct stricture: a rare disease.

    Science.gov (United States)

    Mehanna, Daniel; Naseem, Zainab; Mustaev, Muslim

    2016-05-24

    Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.

  1. 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.

  2. 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.

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

    Science.gov (United States)

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

    2016-02-01

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

  4. Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer.

    Science.gov (United States)

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

    2015-01-01

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

  5. 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.

  6. 2016 WSES guidelines on acute calculous cholecystitis.

    LENUS (Irish Health Repository)

    Ansaloni, L

    2016-01-01

    Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

  7. Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

    Directory of Open Access Journals (Sweden)

    Dirk J. Gouma

    1992-01-01

    Full Text Available The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

  8. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding.

    Science.gov (United States)

    Hicks, Natalie

    2014-01-17

    Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.

  9. Chronic cholecystitis with Cystoisospora belli in an immunocompetent patient.

    Science.gov (United States)

    Takahashi, Hideo; Falk, Gavin A; Cruise, Michael; Morris-Stiff, Gareth

    2015-06-11

    A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A (99m)technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with Cystoisospora belli identified in the gallbladder wall. Cystoisospora has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to C. belli in an immunocompetent patient.

  10. 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.

  11. 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.

  12. A focus on acute cholecystitis and acute cholangitis

    Directory of Open Access Journals (Sweden)

    Massimo Sartelli

    2012-01-01

    Full Text Available 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.

  13. Spontaneous biliary peritonitis in acalculous cholecystitis: fact or misdiagnosis?

    Science.gov (United States)

    Sökmen, S; Coker, A; Unek, T

    2001-01-01

    It is often speculated that an inflamed gallbladder weeps bile to produce bile peritonitis. This may be so, but more likely the problem is a peritoneal effusion in a jaundiced patient which thus resembles bile. So-called "spontaneous or idiopathic biliary peritonitis" in acute acalculous cholecystitis without a proven cause is a further example of this very rare condition. Spontaneous perforations of the extrahepatic biliary ductal system associated with acalculous cholecystitis are uncommon albeit reported in adults. Most patients present with an acute abdomen and are operated upon urgently without diagnostic iter. A recent experience with such a case prompted a thorough review of 27 similar cases previously reported.

  14. 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.

  15. 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.

  16. Effect of pancreatic biliary reflux as a cofactor in cholecystitis.

    Science.gov (United States)

    Amr, Abdel Raouf; Hamdy, Hussam Mohamed; Nasr, Magid Mahmoud; Hedaya, Mohammed Saied; Hassan, Ahmed Mohamed Abdelaziz

    2012-04-01

    This study assessed the effect of pancreatico-biliary reflux (PBR) as co-factor in the process of chronic cholecystitis by measurement of the levels of active pancreatic enzyme amylase in gallbladder bile and serum of patients undergoing cholecystectomy. Pancreatic Amylase levels in bile from the gallbladder and serum were measured during surgery in 68 patients with chronic calcular cholecystitis subjected to elective open or laparoscopic cholecystectomy in the National Hepatology and Tropical Medicine Research Institution and Theodore Bilharz Research Institute. Bile amylase was detected in 64 patients (94.1%) indicating pancreatico-biliary reflux. Biliary amylase level ranged from 20-50 IU/L in 42 patients (61.76%), below 20 IU/l in 14 patients (20.59%), over 50 IU/L in 8 patients (11.76%) and undetectable in two patients. According to gallbladder bile amylase, the incidence of Occult PBR in patients operated upon for chronic calcular cholecystitis was 94.1%. The reason should be clarified by further research and wider scale study. Routinely investigating biliary amylase in every patient having cholecystitis can be a method for early detection of precancerous lesions.

  17. 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

  18. Feasibility of single-incision laparoscopic cholecystectomyfor acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To assess the safety of single-incision laparoscopiccholecystectomy (SILC) for acute cholecystitis.METHODS: All patients who underwent SILC atSano Hospital (Kobe, Japan) between January 2010and December 2014 were included in this retrospectivestudy. Clinical data related to patient characteristics andsurgical outcomes were collected from medical records.The parameters for assessing the safety of the procedureincluded operative time, volume of blood loss,achievement of the critical view of safety, use of additionaltrocars, conversion to laparotomy, intraoperative and postoperativecomplications, and duration of postoperativehospital stay. Patient backgrounds were statisticallycompared between those with and without conversion tolaparotomy.RESULTS: A total of 100 patients underwent SILCfor acute cholecystitis during the period. Preoperativeendoscopic treatment was performed for suspectedcholedocholithiasis in 41 patients (41%). The mean timefrom onset of acute cholecystitis was 7.7 d. According tothe Updated Tokyo Guidelines (TG13) for the severity ofcholecystitis, 86 and 14 patients had grade Ⅰ and gradeⅡ acute cholecystitis, respectively. The mean operativetime was 87.4 min. The mean estimated blood loss was80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performedin 12 patients (12%). Postoperative complications ofClavien-Dindo grade Ⅲ or greater were observed in4 patients (4%). The mean duration of postoperativehospital stay was 5.7 d. Patients converted from SILC tolaparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis;in addition, early surgical intervention may reduce therisk of laparotomy conversion.

  19. 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.

  20. Effect of Danshu capsules combined with Xiyanping on acute cholecystitis treatment

    Institute of Scientific and Technical Information of China (English)

    Hong-Liang Wang; Lv-Rong Yuan; Ya-Ming Liu

    2016-01-01

    Objective:To observe the effect of Danshu capsules combined with Xiyanping on acute cholecystitis treatment and offer help to acute cholecystitis treatment.Methods: A total of 180 patients with acute cholecystitis were selected and randomly divided into groups: the observation group (90 people) and the control group (90 people). The patients in the control group were treated with conventional therapy and the patients in the observation group were treated with Danshu capsules combined with Xiyanping on the basis of conventional therapy. Immunological cell, cholecystitis related factors, inflammatory factors, and the coagulation function related factors were detected and analyzed before and after treatment.Results:Coagulation function related factors (PT and APTT), CD8+, cholecystitis related factors (total bilirubin, amylase and PCT), inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in both groups after treatment significantly decreased. PA, immunological cell (CD3+, CD4+ and CD4+/CD8+) significantly increased compared with that before treatment (P0.05). Coagulation function related factors (PT and APTT), CD8+, cholecystitis related factors (total bilirubin, amylase and PCT), and inflammatory factor (hs-CRP, TNF-α, IL-6 and IL-10) in observation group after treatment decreased more significantly than that in control group (P<0.05).Conclusions: Danshu capsules combined with Xiyanping can perfect effectively immunological cell, cholecystitis related factors, inflammatory factors and coagulation function related factors on patients with acute cholecystitis, and it has important clinical significance for acute cholecystitis.

  1. Cholecystocolonic fistula mimicking acute cholecystitis diagnosed unequivocally by computed tomography.

    Science.gov (United States)

    Chick, Jeffrey Forris Beecham; Chauhan, Nikunj Rashmikant; Paulson, Vera Ashley; Adduci, Alexander J

    2013-12-01

    Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.

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

    Science.gov (United States)

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

    2016-05-11

    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.

  3. Recurrent cholecystitis in an elderly mentally retarded patient with pica.

    Science.gov (United States)

    Miyakawa, Koichi; Ito, Masanobu; Hatta, Kotaro; Eto, Ko; Arai, Heii

    2011-12-01

    The case of a 64-year-old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients.

  4. Acute acalculous cholecystitis complicated with peritonitis caused by Lactobacillus plantarum.

    Science.gov (United States)

    Tena, Daniel; Martínez, Nora Mariela; Losa, Cristina; Fernández, Cristina; Medina, María José; Sáez-Nieto, Juan Antonio

    2013-08-01

    Lactobacillus spp. rarely causes human disease. We report a case of a 57-year-old man with non-insulin-dependent diabetes and vascular disease admitted to our hospital with severe abdominal pain and fever. Signs of peritonitis were found upon examination. The patient underwent surgery, and a diagnosis of perforated cholecystitis with purulent peritonitis was made intra-operatively. A cholecystectomy was performed, and therapy with imipenem was initiated. Lactobacillus plantarum was isolated from bile and peritoneal fluid cultures 2 days later. The patient recovered well and was discharged on post-operative day 16 after 14 days of treatment with imipenem. To our knowledge, this is the second case reported of acute cholecystitis caused by Lactobacillus spp. This organism should be considered as a cause of biliary infections, especially in patients with underlying diseases. Correct identification is often difficult, but it is very important because these organisms are usually resistant to vancomycin and other antibiotics.

  5. 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.

  6. 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.)

  7. TG13 miscellaneous etiology of cholangitis and cholecystitis.

    Science.gov (United States)

    Higuchi, Ryota; Takada, Tadahiro; Strasberg, Steven M; Pitt, Henry A; Gouma, Dirk J; Garden, O James; Büchler, Markus W; Windsor, John A; Mayumi, Toshihiko; Yoshida, Masahiro; Miura, Fumihiko; Kimura, Yasutoshi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Gomi, Harumi; Supe, Avinash N; Jagannath, Palepu; Singh, Harijt; Kim, Myung-Hwan; Hilvano, Serafin C; Ker, Chen-Guo; Kim, Sun-Whe

    2013-01-01

    This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as miscellaneous etiology that has not so far been touched on. (1) Oriental cholangitis is the type of cholangitis that occurs following intrahepatic stones and is frequently referred to as an endemic disease in Southeast Asian regions. The characteristics and diagnosis of oriental cholangitis are also commented on. (2) TG 07 recommended percutaneous transhepatic biliary drainage in patients with cholestasis (many of the patients have obstructive jaundice or acute cholangitis and present clinical signs due to hilar biliary stenosis or obstruction). However, the usefulness of endoscopic naso-biliary drainage has increased along with the spread of endoscopic biliary drainage procedures. (3) As for biliary tract infections in patients who underwent biliary tract surgery, the incidence rate of cholangitis after reconstruction of the biliary tract and liver transplantation is presented. (4) As for primary sclerosing cholangitis, the frequency, age of predilection and the rate of combination of inflammatory enteropathy and biliary tract cancer are presented. (5) In the case of acalculous cholecystitis, the frequency of occurrence, causative factors and complications as well as the frequency of gangrenous cholecystitis, gallbladder perforation and diagnostic accuracy are included in the updated Tokyo Guidelines 2013 (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

  8. 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.

  9. 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.

  10. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

    Directory of Open Access Journals (Sweden)

    Jonas P. DeMuro

    2012-01-01

    Full Text Available While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

  11. Simultaneous Acute Cholecystitis and Acute Appendicitis Treated by a Single Laparoscopic Operation

    OpenAIRE

    DeMuro, Jonas P.

    2012-01-01

    While acute appendicitis and acute cholecystitis are both common, they are only rarely seen simultaneously. The clinical presentation and hospital course of a 45-year-old female with concurrent acute appendicitis and acute cholecystitis is presented. The laparoscopic approach is ideal for dealing with multiple, simultaenous abdominal pathologies.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  13. [Toxocarosis and acalculous acute cholecystitis: Consequence or coincidence?].

    Science.gov (United States)

    Strickler, Alexis; Vásquez, Natalia; Maggi, Leonardo; Hernández, Juvenal; Hidalgo, Ximena

    2016-06-01

    Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.

  14. 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.

  15. 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.

  16. Obstructive cholelithiasis and cholecystitis in a kinkajou (Potos flavus).

    Science.gov (United States)

    Potier, Romain; Reineau, Olivier

    2015-03-01

    A 14.5-yr-old female kinkajou (Potos flavus) was diagnosed with cholelithiasis after an episode of vomiting; diagnostics included biochemical analysis and abdominal ultrasound exam. Despite antimicrobial treatment, cholelithiasis led to cholecystitis. A cholecystotomy was performed to remove choleliths and inspissated bile. Morphological and spectroscopic properties of the choleliths were similar to those of gallstones from the brown pigment family and Streptococcus sp. and Escherichia coli were isolated from the bile. Biliary tract infection is directly related to pathogenesis of brown pigment gallstones. Serial ultrasound exams revealed that cholecystitis developed secondary to the presence of gallstones in the biliary tree. Despite full recovery postsurgery, the patient died 15 mo later from gallbladder necrosis. Based on the progression of this case, a cholecystectomy would be preferred over a cholecystotomy in similar cases, and the efficacy of long-acting antibiotics may not be adequate in nontarget species. Gallstones and biliary tract infection are rarely described in small domestic carnivores, and this is the first reported case in a kinkajou.

  17. 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.

  18. Heterogenous wall thickening of gall blabber: xanthogranulomatous cholecystitis or carcinoma, with type 3 choledochal cyst.

    Science.gov (United States)

    Darji, Parth; Thakkar, Gurudatt; Prajapati, Sanjay

    2012-06-21

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterised by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. The authors present a case of xanthogranulomatous cholecystitis with type 3 choledochal cyst in a 20-year-old man who was referred to our hospital with a 1-week history of abdominal pain and fever. He underwent endoscopic sphincterotomy and then open cholecystectomy. A histological diagnosis of xanthogranulomatous cholecystitis was made.

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

    Science.gov (United States)

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

    2012-09-01

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

  20. Post-ERCP Emphysematous Cholecystitis in a Young Woman: A Rare and Potentially Fatal Complication

    Directory of Open Access Journals (Sweden)

    Roisin Stack

    2017-01-01

    Full Text Available A 45-year-old woman with suspected Functional Biliary Sphincter Disorder (FBSD developed Clostridium perfringens related emphysematous cholecystitis after ERCP. A low index of suspicion for emphysematous cholecystitis in this young, otherwise healthy woman led to a significant delay in making the correct diagnosis, and air in the gallbladder was wrongly attributed to a possible gallbladder perforation. ERCP is associated with significant risks, particularly in patients with FBSD, where diagnostic uncertainty renders the balance of risk versus benefit even more critical. Post-ERCP emphysematous cholecystitis secondary to Clostridium perfringens is a rare but potentially fatal complication.

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

    Science.gov (United States)

    Bhamrah, Jasprit; Diep, Phuoc-Tan; Bennet, John; Warren, Hugh

    2010-01-01

    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. PMID:24946358

  2. 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)

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

    DEFF Research Database (Denmark)

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

    1998-01-01

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

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

    DEFF Research Database (Denmark)

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

    1995-01-01

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

  5. Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Sang-Heum Park; Sang Pil Kim; Ji-Young Park; Chang Kyun Lee; Il-Kwun Chung; Hong Soo Kim; Sun-Joo Kim

    2009-01-01

    Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery.Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

  6. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?

    Science.gov (United States)

    Song, Guo-Min; Bian, Wei; Zeng, Xian-Tao; Zhou, Jian-Guo; Luo, Yong-Qiang; Tian, Xu

    2016-01-01

    Abstract The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant

  7. Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Chris N Daniak; David Peretz; Jonathan M Fine; Yun Wang; Alan K Meinke; William B Hale

    2008-01-01

    AIM:To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis.METHODS:A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted.Data collected included demographic data,co-morbidities,symptoms and physical findings at presentation,laboratory and radiological investigations,length of stay,complications,and admission service (medical or surgical).Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis.Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures,presenting signs,and admitting service with time to surgery.RESULTS:Seventy cases met inclusion and exclusion criteria,among which 12 were admitted to the medical service and 58 to the surgical service.Mean±SD time to surgery was 39.3±43 h,with 87% of operations performed within 72 h of hospital arrival.In the adjusted models,longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP,P=0.01) as well with admission to medical service without adjustment for ERCP (P<0.05).Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery.Patients admitted to the surgical versus medical service underwent surgery earlier (30.4±34.9 vs 82.7±55.1 h,P<0.01),had less postoperative complications (12% vs 58%,P<0.01),and shorter length of stay (4.3±3.4 vs 8.1±5.2 d,P<0.01).CONCLUSION:Admission to the medical service and performance of numerous diagnostic procedures,ERCP,or MRCP combined with CT scan were associated with longer time to surgery.Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.

  8. 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.

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

    OpenAIRE

    Jasprit Bhamrah; Phuoc-Tan Diep; John Bennet; Hugh Warren

    2010-01-01

    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-e...

  10. Hyalinizing cholecystitis with features of immunoglobulin G4-related disease-coincidence or an unrecognized association? A case report.

    Science.gov (United States)

    Gupta, Rajib K; Patton, Kurt T

    2015-04-01

    Hyalinizing cholecystitis (HC) is a recently described rare subtype of chronic cholecystitis characterized by dense, paucicellular collagenous transmural fibrosis, which usually replaces the mucosa and muscularis propria. Immunoglobulin (Ig)G4-associated cholecystitis is also a newly described cholecystitis variant characterized by transmural or extramural lymphoplasmacytic inflammation, lymphoid follicles, storiform fibrosis, phlebitis, and increased tissue IgG4-positive plasma cells. We describe a case of cholecystitis in an elderly white man who harbored features of both HC and IgG4-associated cholecystitis. In retrospect, the patient also had a significantly elevated serum IgG4 level. To the best of our knowledge, an association between HC and IgG4-related disease has not been previously described in the literature. Although not entirely conclusive, our observations raise the possibility that some cases of HC represent the end stage of IgG4-related disease.

  11. Acute alithiasic cholecystitis: a not so rare disease

    Directory of Open Access Journals (Sweden)

    Javier Blasco-Alonso

    2014-08-01

    Full Text Available Introduction: Acute acalculous cholecystitis (AAC occurs more frequently in critically ill patients, in the immediate postoperative period, after trauma or extensive burns. It has a high rate of morbidity and mortality. Ischemia, infection and vesicular stasis are determinants in its pathogenesis. Material and method: Retrospective study including all cases of AAC diagnosed in our pediatric intensive care unit between January 1997 and December 2012. Results: We included 7 patients, all associated with viral or bacterial infection. All of them suffered from abdominal pain, mainly localized in the right upper quadrant, jaundice and dark urine. Abdominal ultrasound showed thickening and hypervascularity of the gallbladder wall in all cases. The outcome was satisfactory without surgery in all patients. Conclusions: The clinical presentation is oligosymptomatic within severe systemic diseases. The AAC should be suspected in the appearance of any abdominal pain with jaundice/dark urine and hypertransaminasemia in patients suffering from critical or serious infections.

  12. A Rare Case of Cholecystitis Caused by Raoultella planticola

    Directory of Open Access Journals (Sweden)

    Isabel Teo

    2012-01-01

    Full Text Available A 62-year-old female presented with right upper quadrant pain. Clinical examination and ultrasound scan were consistent with gallstones and acute cholecystitis. She received 3 days of intravenous Co-amoxiclav and was discharged with 5-days of oral antibiotics with arrangements to return for an elective cholecystectomy. This was performed 5 months later which revealed an inflamed gallbladder and a localised abscess secondary to gallbladder perforation. Fluid from the gallbladder was taken which cultured Raoultella planticola, a gram-negative, nonmotile environmental bacteria (Bagley et al. (1981. This is the first report of biliary sepsis with a primary infection by R. planticola. This patient was treated with a 5-day course of oral Co-amoxiclav and made a full recovery.

  13. A Rare Case of Cholecystitis Caused by Raoultella planticola.

    Science.gov (United States)

    Teo, Isabel; Wild, Jonathan; Ray, Saikat; Chadwick, David

    2012-01-01

    A 62-year-old female presented with right upper quadrant pain. Clinical examination and ultrasound scan were consistent with gallstones and acute cholecystitis. She received 3 days of intravenous Co-amoxiclav and was discharged with 5-days of oral antibiotics with arrangements to return for an elective cholecystectomy. This was performed 5 months later which revealed an inflamed gallbladder and a localised abscess secondary to gallbladder perforation. Fluid from the gallbladder was taken which cultured Raoultella planticola, a gram-negative, nonmotile environmental bacteria (Bagley et al. (1981)). This is the first report of biliary sepsis with a primary infection by R. planticola. This patient was treated with a 5-day course of oral Co-amoxiclav and made a full recovery.

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

    Science.gov (United States)

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

    2015-03-04

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

  15. 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...

  16. Hyalinizing cholecystitis and associated carcinomas: clinicopathologic analysis of a distinctive variant of cholecystitis with porcelain-like features and accompanying diagnostically challenging carcinomas.

    Science.gov (United States)

    Patel, Samip; Roa, Juan Carlos; Tapia, Oscar; Dursun, Nevra; Bagci, Pelin; Basturk, Olca; Cakir, Asli; Losada, Hector; Sarmiento, Juan; Adsay, Volkan

    2011-08-01

    We describe a clinicopathologically distinct subtype of cholecystitis, the extensively calcific version of which has been presented in the clinical literature as "porcelain gallbladder (PG)." This cholecystitis, which we propose to refer to as hyalinizing cholecystitis (HC), is characterized by dense, paucicellular hyaline fibrosis transforming the gallbladder (GB) wall into a relatively thin and uniform band. The process diffusely effaces most of the normal structures of GB, and some cases show calcifications. To determine the clinicopathologic associations of HC, we systematically analyzed 4231 cholecystectomies (606 of which had carcinoma) histopathologically, in addition to a targeted search in our databases. Ninety-six cases of HC were identified (1.6% of cholecystectomies). Patients with HC were a decade older than ordinary cholecystitis patients (56 vs. 47; Pcholecystitis, HC with minimal or no calcifications (incomplete PG), is associated with invasive carcinoma. Thus, imaging protocols ought to focus on the correlates of HC rather than fixating on calcifications. Further studies into the pathogenesis of this process and its mechanisms of progression to carcinoma are warranted.

  17. [Acute pancreatitis and acalculous cholecystitis associated with viral hepatitis A].

    Science.gov (United States)

    Arcana, Ronald; Frisancho, Oscar

    2011-01-01

    We report the case of a 14 year-old male from Lima. He is a student with a history of bronchial asthma since age 4 receives conditional salbutamol, corticosteroids used for asthma attacks (a crisis in 2010, 1 month ago) Refuses surgery or transfusions. He presented with a two weeks for abdominal pain, nausea, fever, and jaundice. Epigastric pain is colicky and radiated back to righ upper quadrant, refers in addition to nausea and fever, for ten days notice jaundice of skin and sclera. On examen he was lucid, with jaundice of skin and mucous membranes. There was no palpable lymph nodes, abdomen with bowel sounds, soft, depressible, liver span of 15cm, positive Murphy, no peritonitis. The laboratory findings showed hemoglobin 13gr, MCV 90, platelets 461.000/mm3, WBC 4320/mm, lymphocytes 1700 (39%). total bilirubin: 8.8, B Direct: 7.6, ALT (alanine aminotransferase): 3016, AST (aspartate aminotransferase): 984, alkaline phosphatase: 250, albumin: 3.34gr%, globulin: 2.8, amylase: 589 (high serum amylase), TP: 17, INR: 1.6, VHA IgM positive. 89 mg glucose, urea 19 mg%, creatinine 0.5 mg Hemoglobin 13gr, MCV 90 Platelet 461000/mm3, WBC 4320/mm, Lymphocytes 1700 (39%). The nuclear magnetic resonance showed hepatomegaly associated with thickening of gallbladder wall without stones up to 11mm inside. No bile duct dilatation, bile duct 4mm, pancreas increased prevalence of body size. Mild splenomegaly and free fluid in the space of Morrison and right flank. Abdominal ultrasound revealed a gallbladder wall thickness (11mm), without stones in his light. Pancreas to increase volume with peripancreatic fluid free perivesicular with a volume of 430 cc. Findings consistent with acute acalculous cholecystitis and acute pancreatitis. CT-scan showed enlarged pancreas with predominance of body and tail with peripancreatic edema; the gallbladder was thickening. We report this case because the extrahepatic manifestations of viral hepatitis A infection are uncommon, specially the

  18. 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.

  19. Early laparoscopic cholecystectomy is the appropriate management for acute gangrenous cholecystitis.

    Science.gov (United States)

    Choi, Sae Byeol; Han, Hyung Joon; Kim, Chung Yun; Kim, Wan Bae; Song, Tae-Jin; Suh, Sung Ock; Kim, Young Chul; Choi, Sang Yong

    2011-04-01

    Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.

  20. Update on bedside ultrasound (US) diagnosis of acute cholecystitis (AC).

    Science.gov (United States)

    Zenobii, Maria Francesca; Accogli, Esterita; Domanico, Andrea; Arienti, Vincenzo

    2016-03-01

    Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy's sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.

  1. 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.

  2. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

    Science.gov (United States)

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  3. IgG4-related cholecystitis presenting as biliary malignancy: report of three cases.

    Science.gov (United States)

    Feely, Michael M; Gonzalo, David H; Corbera, Montserrat; Hughes, Steven J; Trevino, Jose G

    2014-09-01

    An increased awareness of IgG4-related diseases has led to an escalation in the number of sites known to be involved by this fibroinflammatory disease. We report three cases of IgG4-related cholecystitis which were thought to represent biliary malignancies both clinically and radiographically. All three cases underwent surgery tailored towards presumed malignant neoplasms. Only following pathologic examination was the true nature of the disease identified. Recognition of the clinical, radiographic, and pathologic presentation of IgG4-related cholecystitis is essential for the consideration of this disease process prior to surgical management for suspected gallbladder malignancies. However, the pre-operative diagnosis remains challenging and extensive surgical intervention is often necessary given the distressing presentation of IgG4-related cholecystitis.

  4. Gangrenous Cholecystitis Related to Transcatheter Arterial Chemoembolization (TACE) Treatment for Hepatocellular Carcinoma.

    Science.gov (United States)

    Karavias, Dimitrios; Kourea, Helen; Sotiriadi, Athanasia; Karnabatidis, Dimitrios; Karavias, Dionissios

    2015-11-01

    A 69-year-old male with a history of hepatitis B-induced cirrhosis underwent segmental liver resection for hepatocellular carcinoma. At his 12-month follow-up, local recurrence in segment VII was diagnosed, measuring 7.8 by 6.2 cm, with irregular margins and the presence of a tumor thrombus in the portal vein. After evaluation by the multidisciplinary liver team, the patient underwent transcatheter arterial chemoembolization with drug-eluting beads. Forty-eight hours after his discharge, the patient presented with gangrenous cholecystitis and he underwent an uneventful cholecystectomy. Cholecystitis is a well-documented complication of transcatheter arterial chemoembolization due to inadvertent reflux of the embolic material into the cystic artery. However, super selective embolization significantly reduces the risk of cholecystitis. In most cases, management is conservative and only severe cases require further intervention.

  5. 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.

  6. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    Science.gov (United States)

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  7. 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".

  8. Characterization, treatment, and outcome of bacterial cholecystitis and bactibilia in dogs.

    Science.gov (United States)

    Lawrence, Yuri A; Ruaux, Craig G; Nemanic, Sarah; Milovancev, Milan

    2015-05-01

    Objective-To characterize historical, clinicopathologic, ultrasonographic, microbiological, surgical, and histopathologic features of bacterial cholecystitis and bactibilia in dogs and evaluate response to treatment and outcomes in these patients. Design-Retrospective case-control study. Animals-40 client-owned dogs (10 with bacterial cholecystitis on histologic analysis or bactibilia on cytologic examination [case dogs] and 30 without bactibilia [controls]) evaluated at a veterinary teaching hospital between 2010 and 2014. Procedures-Signalment, history, clinicopathologic findings, ultrasonographic features, microbiological results, surgical findings, histopathologic changes, treatments, and outcomes of case dogs were derived from medical records and summarized. Demographic and clinicopathologic data and ultrasonographic findings were compared between case and control dogs. Relationships among prior antimicrobial treatment, sediment formation in the gallbladder, presence of immobile biliary sludge, and presence of bactibilia or bacterial cholecystitis were assessed. Results-No finding was pathognomonic for bactibilia or bacterial cholecystitis in dogs. Case dogs were significantly more likely to have immobile biliary sludge and had a greater degree of biliary sediment formation than did control dogs. All case dogs for which gallbladders were examined histologically (6/6) had bacterial cholecystitis. Five of 10 case dogs were Dachshunds. Medical or surgical treatment resulted in good outcomes. Conclusions and Clinical Relevance-Bactibilia and bacterial cholecystitis were important differential diagnoses in dogs with signs referable to biliary tract disease. Dachshunds were overrepresented, which may suggest a breed predisposition. Cytologic evaluation of bile should be considered in the routine assessment of dogs with hepatobiliary disease if immobile biliary sludge is present. (J Am Vet Med Assoc 2015;246:982-989).

  9. 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.

  10. [DISSEMINATION BY H. PYLORI IN PATIENTS, SUFFERING VARIOUS FORMS OF CHOLECYSTITIS].

    Science.gov (United States)

    Kyazimov, I L; Takhmazova, Ch T

    2015-05-01

    Comparative analysis of dissemination by H. pylori of the bile portions in patients of a control group, suffering an acute calculous cholecystitis (ACCH), was performed. Dissemination of H. pylori in a control group was significantly less, than in a bile portions of patients, suffering ACCH. While analyzing the rate and degree of dissemination by H. pylori of the gastic and gallbladder mucosa biopsies of patients, suffering chronic non-calculous cholecystitis, associated with duodenogastric reflux and gastroduodenitis, bacteria were revealed trustworthy more often and in more number, than in a gallbladder mucosa in patients, suffering ACCH.

  11. Percutaneous Placement of Permanent Metallic Stents in the Cystic Duct to Treat Obstructive Cholecystitis.

    Science.gov (United States)

    Brown, Nicholas I; Jhamb, Ashu; Brooks, Duncan M; Little, Andrew F

    2015-12-01

    This report presents a series of five patients unsuitable for surgery who had nonretrievable self-expanding metallic stents deployed along the cystic duct as treatment for benign and malignant causes of gallbladder obstruction. Techniques are described for draining cholecystitis, removing gallstones, bypassing gallbladder obstructions, and inserting metallic stents across the cystic duct to restore permanent antegrade gallbladder drainage in acute and chronic cholecystitis. Symptoms resolved in all cases, and stents remained patent for as long as 22 months. This procedure may be an effective alternative to cholecystectomy or long-term gallbladder drainage for patients in inoperable condition.

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

    Science.gov (United States)

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

    2010-09-01

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

  13. 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...

  14. 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.

  15. Heterotopic gastrointestinal cyst mimicking chronic cholecystitis: a case report

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    Popkharitov Angel I

    2008-05-01

    Full Text Available Abstract Introduction Heterotopic gastric mucosa is described almost everywhere in the gastrointestinal tract, from the oral cavity to the rectum. The occurrence of heterotopic gastric tissue in the gallbladder is rare. A choristoma can be defined as a new growth developing from a displaced anlage not normally present in the anatomical site where it developed. We present an extremely uncommon case of a cyst (choristoma attached to the gallbladder, which contained gastric and intestinal mucosa. Case presentation A 33-year-old woman was hospitalized with clinical symptoms of chronic cholecystitis. The laboratory findings were within the normal range. Abdominal ultrasonography revealed a thickened gallbladder wall and a stone in the cystic duct was suspected. In the course of laparoscopic cholecystectomy, a cyst was visualized in the vicinity of the duct and the gallbladder neck. Microscopic examination of the removed cyst revealed evidence of gastric, duodenal and small-intestinal mucosa. The immunohistochemical study revealed many endocrine cells, which were positive for several endocrine cell markers such as chromogranin, serotonin, gastrin and so on. It can be inferred that the observed cyst had arisen from the foregut early in the development of the gastrointestinal tract. Conclusion The presence of endocrine cells together with epithelial cells supports the hypothesis that these had developed simultaneously, and that the endocrine cells had probably supported the development of the epithelial cells by the release of hormones and growth factors. To the best of the authors' knowledge, this report is the first to report a gastrointestinal cyst choristoma with endocrine cells in the region of the cystic duct and gallbladder.

  16. SIMULTANEOUS OCCURANCE OF EMPHYSEMATOUS PYELONEPHRITIS AND EMPHYSEMATOUS CHOLECYSTITIS IN AN UNCONTROLLED TYPE 2 DIABETIC: A CASE REPORT

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    Savitri

    2015-04-01

    Full Text Available Emphysematous pyelonephritis a life - threatening, fulminant, necrotizing upper urinary tract infection associated with gas within the kidney . W hich is a rare condition. Only 1 - 2 cases per year are encountered in a urological department in the United States. Emphysematous cholecystitis is a variant of acute cholecystitis which is generally caused by gas - forming organisms. This condition d evelops in approximately 1% of all cases of acute cholecystitis. Compared with typical acute pyelonephritis and typical acute cholecystitis , emphysematous pyelonephritis and emphysematous cholecystitis is associated with much higher rates of morbidity and significantly increased rates of mortality (15 - 25%. Individually these conditions are less reported, there by, Simultaneous occcurance of emphysematous pyelonephritis and emphysematous cholecystitis are uncommon and only two cases are reported in literature . As clinical course of both entities are individually severe and life - threatening if not recognized and treated promptly, so in a case of simultaneous occurrence, early diagnosis is to be made and a potentially devastating outcome is to be avoided. We present a case of emphysematous pyelonephritis with emphysematous cholecystitis and pneumoperitoneum in a middle aged uncontrolled diabetic patient and discussed etio - pathogenesis, classification and therapy of these entities.

  17. Acute Cholecystitis Detected by Serial Emergency Department Focused Right Upper Quadrant Ultrasound

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    David Bosch

    2016-06-01

    Full Text Available Acute cholecystitis is a common etiology of acute right upper quadrant pain in patients presenting to the emergency department (ED. The use of ED-focused right upper quadrant ultrasound (RUQ US is becoming more widely utilized to evaluate abdominal pain thought to be hepatobiliary in nature. We describe a case series of two patients with acute cholecystitis detected by serial ED-focused RUQ US. Case 1: A woman presented to the ED with epigastric pain of acute onset. She was initially found to have a mild leukocytosis and cholelithiasis detected by ED-focused RUQ US. Seventy-five minutes later, the patient had a repeat bedside ultrasound by the same sonographer that showed visual evidence of acute cholecystitis that was later confirmed by surgical pathology. She was treated operatively. Case 2: A man with known cholelithiasis presents to the ED with acute-onset RUQ pain. Initial RUQ ultrasound performed by the Department of Radiology (University of Colorado Hospital was equivocal, showing cholelithiasis with a mildly thickened wall and no pericholecystic fluid. A repeat ED-focused RUQ ultrasound 5 hours later showed increased wall thickness and pericholecystic fluid. The patient was subsequently taken for same-day cholecystectomy. This case series demonstrates the dynamic and progressive nature of acute cholecystitis detected by ED-focused RUQ US. It also highlights how serial bedside ultrasonography can reduce harm, appropriately triage patients with hepatobiliary disease and lead to reductions in overall morbidity.

  18. First Report of Acute Cholecystitis with Sepsis Caused by Cellulomonas denverensis▿

    Science.gov (United States)

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Sawamura, Haruki; Ohta, Hirotoshi; Inoue, Rina; Iwasa, Junpei; Ito, Hiroyasu; Murakami, Nobuo; Ezaki, Takayuki; Moriwaki, Hisataka; Seishima, Mitsuru

    2009-01-01

    Cellulomonas denverensis is a small and thin gram-positive rod-shaped bacterium that was proposed as a new species in 2005. Here we report a female case of acute cholecystitis and sepsis in which C. denverensis was determined to be causative. PMID:19656981

  19. Isolated IgG4-related cholecystitis mimicking gallbladder cancer: a case report.

    Science.gov (United States)

    Shin, Sang-Wook; Kim, Yongsoo; Jeong, Woo Kyoung; Kim, Jinoo; Kim, Min Yeong; Oh, Young Ha; Pyo, Ju Yeon

    2013-01-01

    A 58-year-old man with right upper quadrant pain was referred to the radiology department. The patient underwent computed tomography and magnetic resonance imaging, which suggested the diagnosis of gallbladder cancer invading the liver. After surgical removal of the gallbladder, and the adjacent liver parenchyma was performed, the histologic diagnosis of IgG4-related cholecystitis was made.

  20. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

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    Minoru Tomizawa

    2016-08-01

    Full Text Available Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis.

  1. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    Science.gov (United States)

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI) enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI) showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis. PMID:27721732

  2. Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Ling-Tang Li; Jie-Shou Li

    2006-01-01

    BACKGROUND:Laparoscopic cholecystectomy (LC) has become the "gold standard" in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecystectomy (LSC) a feasible option in more complex procedures. In recent years, few studies with a few cases of LSC have reported good results in patients with various types of cholecystitis. This study was designed to evaluate the feasibility, indications, characteristics and beneifts of LSC in patients with complicated cholecystitis. METHODS:Altogether, 3485 patients were scheduled to receive LC during the past 4 years at our institute. Among them, 168 patients with various complicated forms of cholecystitis were treated by LSC. Meanwhile, the other 3317 patients who received standard LC were enrolled as the control group. Perioperative data from the two groups were collected and retrospectively analyzed. RESULTS:In the LSC group, 135 patients suffered from acute calculic cholecystitis, 18 from chronic calculic cholecystitis with cirrhotic portal hypertention, and 15 from chronic calculic atrophy cholecystitis with severe ifbrosis. These patients constituted 4.8% of the total patients who underwent LC (168/3485) in the same period at our institute. In 122 patients, the cystic duct and artery were clipped before division. In another 46 patients, the gallbladder was initially incised at Hartmann's pouch. Five patients (3.0%) were converted to open subtotal cholecystectomy. The median operation time for LSC was 65.5±15.2 minutes, estimated operative blood loss was 71.5±15.5 ml, and the time to resume diet was 20.4±6.3 hours. Thirteen patients (7.7%) had local complications. The mean postoperative hospital stay was 4.2±2.6 days. In the LC group, 2887 had chronic calculic cholecystitis, 312 had acute calculic cholecystitis, 47 had chronic calculic atrophy cholecystitis, and 71 had polypus. Seventeen patients (0.5%) were converted to open cholecystectomy. The

  3. Acute cholecystitis is a common complication after allogeneic stem cell transplantation and is associated with the use of total parenteral nutrition.

    Science.gov (United States)

    Bagley, Stephen J; Sehgal, Alison R; Gill, Saar; Frey, Noelle V; Hexner, Elizabeth O; Loren, Alison W; Mangan, James K; Porter, David L; Stadtmauer, Edward A; Reshef, Ran; Luger, Selina M

    2015-04-01

    The incidence and risk factors for acute cholecystitis after allogeneic hematopoietic stem cell transplantation (HSCT) are not well defined. Of 644 consecutive adult transplants performed at our institution between 2001 and 2011, acute cholecystitis occurred in the first year of transplant in 32 patients (5.0%). We conducted 2 retrospective case-control studies of this population to determine risk factors for cholecystitis after HSCT and to evaluate the performance of different methods of imaging to diagnosis cholecystitis in patients undergoing HSCT compared with non-HSCT patients. In the HSCT population, development of cholecystitis was associated with an increased 1-year overall mortality rate (62.5% versus 19.8%, P cholecystitis was higher in patients who received total parenteral nutrition (TPN) (adjusted odds ratio, 3.41; P = .009). There was a trend toward more equivocal abdominal ultrasound findings in HSCT recipients with acute cholecystitis compared with nontransplant patients (50.0% versus 30.6%, P = .06). However, hepatobiliary iminodiacetic acid (HIDA) scans were definitively positive for acute cholecystitis in most patients in both populations (80.0% of HSCT recipients versus 77.4% of control subjects, P = .82). In conclusion, acute cholecystitis is a common early complication of HSCT, the risk is increased in patients who receive TPN, and it is associated with high 1-year mortality. In HSCT recipients with findings suggestive of acute cholecystitis, especially those receiving TPN, early use of HIDA scan may be considered over ultrasound.

  4. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis.

    Science.gov (United States)

    Mayumi, Toshihiko; Someya, Kazuki; Ootubo, Hiroki; Takama, Tatsuo; Kido, Takashi; Kamezaki, Fumihiko; Yoshida, Masahiro; Takada, Tadahiro

    2013-12-01

    The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The world's first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

  5. Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review

    OpenAIRE

    Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A.; Zirngibl, Hubert

    2015-01-01

    Background Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed wit...

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

    Science.gov (United States)

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

    2015-01-01

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

  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. 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.

  9. 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.

  10. Treatment of cholecystitis with Chinese herbal medicines: A systematic review of the literature

    Institute of Scientific and Technical Information of China (English)

    Zhi-Yong Dong; Guan-Liang Wang; Xing Liu; Jia Liu; De-Zeng Zhu; Chang-Quan Ling

    2012-01-01

    AIM:To analyze the literature on the use of Chinese herbal medicines for the treatment of cholecystitis.METHODS:The literature on treatment of cholecystitis with traditional Chinese medicines (TCM) was analyzed based on the principles and methods described by evidence-based medicine (EBM).Eight databases including MEDLINE,EMbase,Cochrane Central (CCTR),four Chinese databases (China Biological Medicine Database,Chinese National Knowledge Infrastructure Database,Database of Chinese Science and Technology Periodicals,Database of Chinese Ministry of Science and Technology) and Chinese Clinical Registry Center,were searched.Full text articles or abstracts concerning TCM treatment of cholecystitis were selected,categorized according to study design,the strength of evidence,the first author's hospital type,and analyzed statistically.RESULTS:A search of the literature published from 1977 through 2009 yielded 1468 articles in Chinese and 9 in other languages; and 93.92% of the articles focused on clinical studies.No article was of level I evidence,and 9.26% were of level Ⅱ evidence.The literature cited by Science Citation Index (SCI),MEDLINE and core Chinese medical journals accounted for 0.41%,0.68% and 7.29%,respectively.Typically,the articles featured in case reports of illness,examined from the perspective of EBM,were weak in both quality and evidence level,which inconsistently conflicted with the fact that most of the papers were by authors from Level-3 hospitals,the highest possible level evaluated based on their comprehensive quality and academic authenticity in China.CONCLUSION:The published literature on TCM treatment of cholecystitis is of low quality and based on low evidence,and cognitive medicine may functions as a useful supplementary framework for the evaluation.

  11. 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.

  12. Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

    Directory of Open Access Journals (Sweden)

    Shuji Akimoto

    2016-08-01

    Full Text Available Serum carbohydrate antigen 19-9 (CA 19-9, a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET-computed tomography (CT findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3 without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

  13. Hemobilia secundaria a colecistitis crónica Hemobilia secondary to chronic cholecystitis

    OpenAIRE

    R. de Quinta Frutos; L. Moles Morenilla; F. Docobo Durantez; J. A. Soto Pradas; Iriarte Calvo, J.; A. Vázquez Medina

    2004-01-01

    The term hemobilia is used to describe the presence of blood in the biliary tract. We report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. We review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. In our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. The clinical condition was resolved by mean...

  14. 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.

  15. 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.)

  16. 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

  17. Eosinophilic granulomatosis with polyangiitis complicated by cholecystitis: a case report and review of the literature.

    Science.gov (United States)

    Ye, Lu; Lu, Xiaoyong; Xue, Jing

    2016-01-01

    The objectives are to report an atypical case of eosinophilic granulomatosis with polyangiitis (EGPA) associated with cholecystitis and to review the main clinical features, therapy, and prognosis of it. We present a 49-year-old male with non-classic clinical manifestations of EGPA and EGPA-related cholecystitis. EGPA was diagnosed by histology of the gallbladder after cholecystectomy. In addition, 11 cases of EGPA-associated cholecystitis have been reported and were described in details in this article. Gallbladder involvement is very uncommon in EGPA. All cases reviewed showed multiple organs involved as well as obviously elevated eosinophilic granulocyte proportion with inflammatory index, although antineutrophil cytoplasmic antibody may be negative. All patients in this cohort that showed gallbladder involvement were eventually confirmed with EGPA by histology examination after cholecystectomy. The pathological change could be infiltration of inflammatory mononuclear cells of small- and medium-sized vessels. Of the cases, 91.7% responded well to steroid and immunosuppressant therapy. Gallbladder involvement is a very rare comorbid condition in EGPA. However, it is an important symptom or secondary condition to alert physicians the diagnosis of EGPA. Moreover, timely diagnosis and correct administration in the early stage of this disease could obviously improve the prognosis.

  18. Diagnosis and treatment of xanthogranulomatous cholecystitis: a report of 39 cases.

    Science.gov (United States)

    Han, Sheng-Hua; Chen, Yan-Ling

    2012-11-01

    This study focuses on providing diagnosis and treatment for xanthogranulomatous cholecystitis (XGC). Clinical data from 39 patients diagnosed with XGC by pathological examination between 2002 and 2010 were analyzed retrospectively. As a result, in this group of patients, the male to female ratio was 30:9 and the average age of XGC onset was 62.2 years. Clinical manifestation of the disease was similar to general cholecystitis and preoperative CT examination showed that there were only 4 XGC cases, while the others were possibly misdiagnosed. Intraoperative observations showed that all the patients had gallbladder wall thickening. This was associated with gallbladder stones in 37 patients (94.9 %), choledocholith in 11 patients (28.2 %), and Mirizzi syndrome in 5 patients (12.8 %). In this study, intraoperative frozen section pathology was conducted in 14 patients and no gallbladder cancer was found. Laparoscopic cholecystectomy was performed on 7 patients, of which two were transferred to laparotomy. Of the remaining 32 cases, 25 were subjected to open cholecystectomy, 3 to partial cholecystectomy, and 4 to the cholecystectomy and partial liver wedge resection. It was concluded that XGC is a unique type of cholecystitis with atypical clinical manifestations and is often difficult to diagnose preoperatively. Pathological examination is a key to diagnose XGC and cholecystectomy is the primary surgical treatment. In patients with choledochectasia or jaundice, for whom we cannot exclude calculus of common bile duct, common bile duct exploration should be considered. The prognosis of XGC appears to be good with the above approaches.

  19. Timing of laparoscopic cholecystectomy for acute cholecystitis: A prospective non randomized study

    Institute of Scientific and Technical Information of China (English)

    George Tzovaras; Dimitris Zacharoulis; Paraskevi Liakou; Theodoros Theodoropoulos; George Paroutoglou; Constantine Hatzitheofilou

    2006-01-01

    AIM: To study the timing of laparoscopic cholecystectomy for patients with acute cholecystitis.METHODS: Between January 2002 and December 2005,all American Society of Anesthesiologists classification (ASA) Ⅰ ,Ⅱand Ⅲ patients with acute cholecystitiswere treated laparoscopically during the urgent (index) admission. The patients were divided into three groups according to the timing of surgery: (1) within the first 3 d, (2) between 4 and 7 d and (3) beyond 7 d from the onset of symptoms. The impact of timing on the conversion rate, morbidity and postoperative hospital stay was studied.RESULTS: One hundred and twenty-nine patients underwent laparoscopic cholecystectomy for acute cholecystitis during the index admission. Thirty six were assigned to group 1, 58 to group 2, and 35 to group 3. The conversion rate and morbidity for the whole cohort of patients were 4.6% and 10.8%, respectively. There was no significant difference in the conversion rate, morbidity and postoperative hospital stay between the three groups.CONCLUSION: Laparoscopic cholecystectomy for acute cholecystitis during the index admission is safe, regardless of the time elapsed from the onset of symptoms. This policy can result in an overall shorter hospitalization.

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

    Science.gov (United States)

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

    2013-12-01

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

  1. Fluorodeoxyglucose positron emission tomography-computed tomography: a novel approach for the diagnosis of cholecystitis for equivocal diagnoses after ultrasound imaging.

    Science.gov (United States)

    Nasseri, Yosef; Ourian, Ariel J; Waxman, Alan; D'Angolo, Alessandro; Thomson, Louise E; Margulies, Daniel R

    2012-10-01

    Although hepatobiliary iminodiacetic acid (HIDA) scan is often used when the diagnosis of cholecystitis remains questionable after ultrasound, it carries a high false-positive rate and has other limitations. Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) has recently gained enthusiasm for its ability to detect infection and inflammation. In this study, we evaluate the accuracy of 18FDG PET-CT in diagnosing cholecystitis. Nineteen patients with suspected cholecystitis (Group S) underwent PET-CT and 10 had positive PET-CT findings. Of these 10, nine underwent cholecystectomies, and pathology confirmed cholecystitis in all nine. One patient was managed nonoperatively as a result of multiple comorbidities. Of the nine patients with negative PET-CT, six were managed nonoperatively, safely discharged, and had no readmissions at 3-month follow-up. The other three patients with negative PET-CT underwent cholecystectomies, and two showed no cholecystitis on pathology. The third had mild to moderate cholecystitis with focal mucosal erosion/ulceration without gallbladder wall thickening on pathology. 18FDG PET-CT detected gallbladder inflammation in all but one patient with pathology-proven cholecystitis with a sensitivity and specificity of 0.90 and 1.00, respectively. 18FDG-PET-CT appears to be a promising, rapid, direct, and accurate test in diagnosing cholecystitis and could replace HIDA scan in cases that remain equivocal after ultrasound.

  2. 针刺治疗慢性胆囊炎临床观察%Clinical Observation on Chronic Cholecystitis Treated by Acupuncture

    Institute of Scientific and Technical Information of China (English)

    潘纪华; 洪珏

    2011-01-01

    @@ Chronic cholecystitis is a commonly encountered disease,bringing much inconvenience to the patients'daily life and work.The author has adopted electroacupuncture in treatment of 74 cases of chronic cholecystitis.and compared the effects with a medication group.It is now reported as follows.

  3. DETECTION OF HELICOBACTER ANTIGEN IN STOOL SAMPLES AND ITS RELATION TO H. PYLORI POSITIVE CHOLECYSTITIS IN EGYPTIAN PATIENTS WITH CHRONIC CALCULAR CHOLECYSTITIS.

    Science.gov (United States)

    Hassan, Ehsan H; Gerges, Shawkat S; Ahmed, Rehab; Mostafa, Zeinab M; Al-Hamid, Hager Abd; Abd El-Galil, Heba; Thabet, Suzan

    2015-12-01

    Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its noninvasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay (EIA) based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. Fifty patients were included presented with symptomatic qholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients (90%) by laparoscopic Cholecystectomy and 5 patients (10%) by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that (82%) were females with mean age (42.6 +/- 1 years). The mean BMI was (29 + 7.2) H. pylori-specific antigen in stool samples was detected in 40% of patients and 38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases.

  4. Two cases of cystic artery pseudoaneurysm rupture due to acute cholecystitis with gallstone impaction in the neck.

    Science.gov (United States)

    Kaida, Shogo; Arahata, Kyouko; Itou, Asako; Takarabe, Sakiko; Kimura, Kayoko; Kishikawa, Hiroshi; Nishida, Jiro; Fujiyama, Yoshiki; Takigawa, Yutaka; Matsui, Junichi

    2016-09-01

    A cystic artery aneurysm is a rare cause of hemobilia. Herein, we report two cases of acute cholecystitis with a ruptured cystic artery pseudoaneurysm. Two patients (a 69-year-old man and an 83-year-old man) were admitted to our hospital because of acute cholecystitis with gallstone impaction in the neck. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed for both patients. After a few days of PTGBD, gallbladder hemorrhage was observed. Abdominal angiography showed cystic artery aneurysm. A transcatheter arterial embolization was therefore performed, followed by an open cholecystectomy.

  5. Infrared thermoimages display of body surface temperature reaction in experimental cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Dong Zhang; Yuan-Gen Zhu; Shu-You Wang; Hui-Min Ma; Yan-Yan Ye; Wei-Xing Fu; Wei-Guo Hu

    2002-01-01

    AIM: To display the thermoirnages of the body surface inexperimental cholecystitis, to observe the body surfacetemperature reaction in visceral disorders, and to study if the theory of body surface-viscera correlation is true and the mechanism of temperature changes along the meridians. METHODS: By injecting bacteria ssuspension into the stricturebile duct and gallbladder, 21 rabbits were prepared as acutepyogenic cholangiocholecystitis models, with another 8rabbits prepared by the same process except withoutinjection of bacteria suspension as control. The body surfaceinfrared thermoimages were continuously observed on thehair shaven rabbit skin with AGA-782 thermovision 24 hbefore, 1-11 d after and (2,3 wk) 4 wk after the operation witha total of over 10 records of thermoimages.RESULTS: Twelve cases out of 21 rabbits with cholecystitisrevealed bi-lsteral longitudinal high temperature lines in itstrunk; with negative findings in the control group. The high-temperature line appeared on d l-d2, first in the right trunk,after the preparation of the model, about 7 d after the modelpreparation, the lines appeared at the left side too,persisting for 4 wk. The hyper-temperature line revealed 1.1-2.7 ℃ higher than before the model preparation, 0.7-2.5 ℃higher than the surrounding skin. The length of the hightemperature line might reach a half length of the body trunk,or as long as the whole body itself.CONCLUSION: The appearance of the longitudinal hightemperature lines st the lateral aspects of the trunk in theexperimental group is directly bound up with theexperimental animals pyogenic cholecystitis, with itsrunning course quite similar to that of the GallbladderChannel of Foot Shaoyang, but different to the zones ofhyperalgesia and site of referred pain in cholecystitis.

  6. Effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    Tian-Xue Wen; Hao Wang

    2016-01-01

    Objective:To investigate the effect of laparoscopic cholecystectomy on inflammatory factors and immunoglobulin in elderly chronic cholecystitis complicated with cholecystolithiasis. Methods: A total of 80 senile chronic cholecystitis complicated with cholecystolithiasis patients were randomly divided into observation group (n=40) and control group (n=40). The observation group was were treated with laparoscopic cholecystectomy while the control group was were treated with open cholecystectomy. Using nephelometry to detect the serum CRP, IgA, IgG and IgM levels, using enzyme-linked immunosorbent assay to detect the IL-6 level. The levels of inflammatory factors (CRP, IL-6) and immunoglobulin indexes (IgA, IgG and IgM) were compared before and after operation between the two groups.Results:Compared with before operation, the inflammatory factors (CRP, IL-6) had no significant difference in observation group, the inflammatory factors (CRP, IL-6) were increased significantly in control group, and there was significant difference on inflammatory factors (CRP, IL-6) in two groups after operation; compared with before operation, the levels of immunoglobulin indexes (IgA, IgG and IgM) had no significant difference in observation group, the levels of IgA, IgG and IgM were decreased significantly in control group, and the levels of IgA, IgG and IgM had significant difference after treatment between the two groups.Conclusion: Laparoscopic cholecystectomy had almost no effect on inflammatory factors and immune function in elderly chronic cholecystitis complicated with cholecystolithiasis.

  7. Radiation-induced cholecystitis after hepatic radioembolization: do we need to take precautionary measures?

    Science.gov (United States)

    Prince, Jip F; van den Hoven, Andor F; van den Bosch, Maurice A A J; Elschot, Mattijs; de Jong, Hugo W A M; Lam, Marnix G E H

    2014-11-01

    Controversy exists over the need to take precautionary measures during hepatic radioembolization to minimize the risk of radiation-induced cholecystitis. Strategies for a variety of clinical scenarios are discussed on the basis of a literature review. Precautionary measures are unnecessary in the majority of patients and should be taken only when single photon-emission computed tomography (CT; SPECT)/CT shows a significant concentration of technetium-99m macroaggregated albumin in the gallbladder wall. In this case report with quantitative SPECT analysis, it is illustrated how an adjustment of the catheter position can effectively reduce the absorbed dose of radiation delivered to the gallbladder wall by more than 90%.

  8. Hemobilia secundaria a colecistitis crónica Hemobilia secondary to chronic cholecystitis

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    R. de Quinta Frutos

    2004-03-01

    Full Text Available The term hemobilia is used to describe the presence of blood in the biliary tract. We report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. We review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. In our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. The clinical condition was resolved by means of a cholecystectomy. The patient had an uneventful recovery.

  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. A case report of acute acalculous cholecystitis due to Salmonella Paratyphi B complicated by biliary peritonitis.

    Science.gov (United States)

    Benjelloun, El Bachir; Chbani, Leila; Toughrai, Iman; Ousadden, Abdelmalek; Mazaz, Khalid; Taleb, Kahlid Ait

    2013-01-01

    Non-typhoidal salmonella are a rare case of acute acalculouscholecystitis (AAC). Salmonella Paratyphi B, which accounts for one of the less invasive NTS serotypes, has rarely been reported to cause cholecystitis. We describe a case of 65-year old previously healthy man, who present with signs of acute abdomen, due to biliary peritonitis as a complication of acute acalculouscholecystitis caused by Salmonella paratyphi B. Our case illustrates the potential severity of infection with Salmonella Paratyphi B especially in older patient. High index of awarenessshould be considered in endemic areas.

  11. 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.

  12. Aberrant activation of Sonic hedgehog signaling in chronic cholecystitis and gallbladder carcinoma.

    Science.gov (United States)

    Xie, Fang; Xu, Xiaoping; Xu, Angao; Liu, Cuiping; Liang, Fenfen; Xue, Minmin; Bai, Lan

    2014-03-01

    Sonic hedgehog (Shh) signaling has been extensively studied and is implicated in various inflammatory diseases and malignant tumors. We summarized the clinicopathological features and performed immunohistochemistry assays to examine expression of Shh signaling proteins in 10 normal mucosa, 32 gallbladder carcinoma (GBC), and 95 chronic cholecystitis (CC) specimens. The CC specimens were classified into three groups according to degree of inflammation. Compared with normal mucosa, CC, and GBC specimens exhibited increased expression of Shh. The immunoreactive score of Shh in the GBC group was higher than that in the mild to moderate CC groups but lower than that in the severe CC group (P cholecystitis to malignant tumors. Compared with CC specimens, GBC specimens showed higher cytoplasmic and membranous expression for Ptch (P < .05). Gli1 staining showed cytoplasmic expression of Gli1 in both CC (60% for mild, 77% for moderate, and 84% for severe) and GBC specimens (97%). Nuclear expression of Gli1 was detected in 16% of severe CC specimens with moderate to poor atypical hyperplasia, and in 62.5% of GBC specimens. Shh expression strongly correlated with expression of Ptch and Gli1. Furthermore, patients with strongly positive Gli1 staining had significantly lower survival rates than those with weakly positive staining. Our data indicate that the Shh signaling pathway is aberrantly activated in CC and GBC, and altered Shh signaling may be involved in the course of development from CC to gallbladder carcinogenesis.

  13. Bubaline Cholecyst Derived Extracellular Matrix for Reconstruction of Full Thickness Skin Wounds in Rats

    Directory of Open Access Journals (Sweden)

    Poonam Shakya

    2016-01-01

    Full Text Available An acellular cholecyst derived extracellular matrix (b-CEM of bubaline origin was prepared using anionic biological detergent. Healing potential of b-CEM was compared with commercially available collagen sheet (b-CS and open wound (C in full thickness skin wounds in rats. Thirty-six clinically healthy adult Sprague Dawley rats of either sex were randomly divided into three equal groups. Under general anesthesia, a full thickness skin wound (20 × 20 mm2 was created on the dorsum of each rat. The defect in group I was kept as open wound and was taken as control. In group II, the defect was repaired with commercially available collagen sheet (b-CS. In group III, the defect was repaired with cholecyst derived extracellular matrix of bovine origin (b-CEM. Planimetry, wound contracture, and immunological and histological observations were carried out to evaluate healing process. Significantly (P<0.05 increased wound contraction was observed in b-CEM (III as compared to control (I and b-CS (II on day 21. Histologically, improved epithelization, neovascularization, fibroplasia, and best arranged collagen fibers were observed in b-CEM (III as early as on postimplantation day 21. These findings indicate that b-CEM have potential for biomedical applications for full thickness skin wound repair in rats.

  14. [A rare case of obstructive jaundice and cholecystitis in hepatic fascioliasis in Italy].

    Science.gov (United States)

    Caprino, Paola; Ferranti, Fabrizio; Passa, Giuseppe; Quintiliani, Alberto

    2007-01-01

    The human infestation caused by Fasciola hepatica is a rare zoonosis, with an incidence of about 10 cases/year in Italy. We report a case of cholecystitis and obstructive jaundice in a patient affected by fascioliasis in which the diagnosis was secondary to the extraction of viable flukes from the bile duct during ERCP. The endoscopic examination permits, in addition to a rapid, correct diagnosis, direct clearance of the bile ducts. Oral drug therapy, when carried out following the endoscopic treatment, is aimed at killing any flukes potentially evading mechanical clearance. The healing achieved is confirmed by normalisation of antibody levels 6-12 months after therapy. Cholecystectomy is indicated and appropriate for the frequent occurrence of biliary colic related to acute and chronic cholecystitis and cholelithiasis, induced by the presence of the flukes. Infestation by Fasciola hepatica has to be considered among the differential diagnoses of obstructive jaundice. ERCP plays a major diagnostic and therapeutic role, and cholecystectomy, considering the pathogenetic effects of flukes on the organ, is mandatory.

  15. Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Miguel Sánchez-Carrasco

    2016-01-01

    Full Text Available Objective. To evaluate if early cholecystectomy (EC is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC. Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1 postoperative hospital morbidity, (2 hospital mortality, (3 days of hospital stay, (4 readmissions, (5 admission to the Intensive Care Unit (ICU, (6 type of surgery, (7 operating time, and (8 reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9% was significantly lower than the DC group (38.7%. EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days, readmission percentage (6.8% versus 21.9%, and percentage of ICU admission (2.3% versus 7.8%, which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  17. 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

  18. A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa.

    Directory of Open Access Journals (Sweden)

    Di Zhou

    Full Text Available 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 pylori could be detected by culture, staining or PCR for Helicobacter 16s rRNA gene in gallbladder mucosa. Positive samples were sequenced for Helicobacter pylori-specific identification. Clinical parameters as well as pathological characteristics including some premalignant lesions and the expression levels of iNOS and ROS in gallbladder were compared between the two groups. RESULTS: Helicobacter pylori infection in gallbladder mucosa was detected in 20.55% of cholecystitis patients. These patients had a higher prevalence of acid regurgitation symptoms (p = 0.001, more histories of chronic gastritis (p = 0.005, gastric ulcer (p = 0.042, duodenal ulcer (p = 0.026 and higher presence of Helicobacter pylori in the stomach as compared to patients without Helicobacter pylori infection in the gallbladder mucosa. Helicobacter pylori 16s rRNA in gallbladder and gastric-duodenal mucosa from the same individual patient had identical sequences. Also, higher incidences of adenomyomatosis (p = 0.012, metaplasia (p = 0.022 and higher enhanced expressions of iNOS and ROS were detected in Helicobacter pylori infected gallbladder mucosa (p<0.05. CONCLUSIONS: Helicobacter pylori infection in gallbladder mucosa is strongly associated with Helicobacter pylori existed in stomach. Helicobacter pylori is also correlated with gallbladder premalignant lesions including metaplasia and adenomyomatosis. The potential mechanism might be related with higher ROS

  19. 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

    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...

  20. A study on relationship of nitric oxide, oxidation, peroxidation, lipoperoxidation with chronic cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Jun Fu Zhou; Dong Cai; Cheng Hong Peng; Yang Hai Yu; You Gen Zhu; Jin Lu Yang

    2000-01-01

    AIM To study relationship of injury induced by nitric oxide, oxidation, peroxidation, lipoperoxidation with chronic cholecystitis. METHODS The values of plasma nitric oxide (PNO), plasma vitamin C (P-VC), plasma vitamin E ( P-VE ), plasma β-carotene ( P-β-CAR ), plasma lipoperoxides (P-LPO), erythrocyte superoxide dismutase (E-SOD), erythrocyte catalase (ECAT), erythrocyte glutathione peroxidase (E-GSHPx) activities and erythrocyte lipoperoxides (ELPO) level in 77 patients with chronic cholecystitis and 80 healthy control subjects were determined, differences of the above average values between the patient group and the control group and differences of the average values between preoperative and postoperative patients were analyzed and compared, linear regression and correlation of the disease course with the above determination values as well as the stepwise regression and correlation of the course with the values were analyzed. RESULTS Compared with the control group, the average values of P-NO, P-LPO, E-LPO were significantly increased ( P < 0.01 ), and of P-VC, P-VE, P-β-CAR, E-SOD, E-CAT and E-GSH-Px decreased ( P < O. 01 ) in the patient group. The analysis of the linear regression and correlation showed that with prolonging of the course, the values of P-NO, P-LPO and E-LPO in the patients were gradually ascended and the values of P-VC, P-VE, P-β-CAR, E-SOD, E-CAT and E-GSH-Px descended (P < 0. 01 ). The analysis of the stepwise regression and correlation indicated that the correlation of the course with P-NO, P-VE and P-β-CAR values was the closest. Compared with the preoperative patients, the average values of PNO, P-LPO and E-LPO were significantly decreased (P < 0.01 ) and the average values of PVC, E-SOD, E-CAT and E-GSH-Px in postoperative patients increased ( P < 0.01) in postoperative patients. But there was no significant difference in the average values of P-VE, P-W-CAR preoperative and postoperative patients. CONCLUSION Chronic cholecystitis

  1. 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.

  2. 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.

  3. 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.

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

    Science.gov (United States)

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

    2017-01-01

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

  5. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  7. [Determination of trace elements in Mongolian medicine Susi-12 curing cholecystitis and gallstone disease by ICP-AES].

    Science.gov (United States)

    E, Er-Deng-sang; Hang, Gai-ba-te-re; Ba, Tu; Duan, Yi-wen

    2009-04-01

    Trace elements in Mongolian medicine Susi-12 for cholecystitis and gallstones were analyzed in order to discuss the relation between Susi-12's drug action and the trace elements. The analysis was carried out using the pressure seal microwave digestion and inductive coupled plasma atomic emission spectrometry (ICP-AES). It was found that the medicine contained great amount of trace elements, especially human-body-needed trace elements, such as Ca, Al, Mg, Fe, Sr, Mn, Zn, Cu etc., whereas heavy metals are very little, e.g. the contents of Pb, Cb, As etc are below the country's limit. The recoveries of standard addition are in the range of 94.63%-106.40%. The relative standard deviation RSDSusi-12 can effectively control and cure cholecystitis and gallstones, and the effective rate reaches 91.2% to 100%. So the trace elements in Susi-12 must have a close connection with the drug action.

  8. 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

    BACKGROUND:: A recent systematic review found early laparoscopic cholecystectomy (ELC) to be safe and to shorten total hospital stay compared with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis. The cost-effectiveness of ELC versus DLC for acute cholecystitis is unknown. METHODS......:: A decision tree model estimating and comparing costs to the UK National Health Service (NHS) and quality-adjusted life years (QALYs) gained following a policy of either ELC or DLC was developed with a time horizon of 1 year. Uncertainty was investigated with probabilistic sensitivity analysis, and 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 per QALY gained...

  9. 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.

  10. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

    Directory of Open Access Journals (Sweden)

    Carina Mari Aparici

    2016-01-01

    Full Text Available We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG-positron emission tomography (PET/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.

  11. Effect of emergency operation combined with somatostatin therapy on inflammatory state and liver function levels in patients with acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Shi-Zhong Li

    2016-01-01

    Objective:To study the effect of emergency operation combined with somatostatin therapy on inflammatory state and liver function levels in patients with acute cholecystitis.Methods:A total of 146 acute cholecystitis patients who accepted laparoscopic cholecystectomy in our hospital from May 2012 to October 2015 were selected as the research subjects and divided into somatostatin group and normal control group. Then the operation, perioperative energy metabolism as well as postoperative inflammatory state and liver function levels of the two groups were analyzed.Results:Operative field exposure of somatostatin group was clearer, local tissue edema and exudation were lighter and conversion rate to laparotomy was lower; perioperative REE of somatostatin group were significantly lower than those of normal control group; the very day after operation, numeration of leukocyte, neutrophil ratio as well as serum resistin, hypersensitive C-reactive protein and tumor necrosis factor-α, interleukin-6, total bilirubin, alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase levels of somatostatin group were significantly lower than those of normal control group while prealbumin level was significantly higher than that of normal control group.Conclusions:Perioperative application of somatostatin can reduce the body's inflammatory response, local tissue edema and liver function injury. It is an ideal treatment for perioperative acute cholecystitis.

  12. [Mini-invasive technologies in treatment of acute cholecystitis in patients with high operational and anesthetic risk].

    Science.gov (United States)

    Ermolov, A S; Guliaev, A A; Ivanov, P A; Samsonov, V T; Rogal', M L; Timerbaev, V Kh; Trofimova, E Iu; Kudriashova, N E; Tlibekova, M A

    2014-01-01

    The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

  13. 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.

  14. 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.

  15. Alcaligenes xylosoxidans cholecystitis and meningitis acquired during bathing procedures in a burn unit: a case report.

    Science.gov (United States)

    Fujioka, Masaki; Oka, Kiyoshi; Kitamura, Riko; Yakabe, Aka; Chikaaki, Nakamichi

    2008-12-01

    The information in this article was presented at the 37th Annual Meeting of the Japan Society of Burn, Nagoya, Japan, June 7-8, 2008. Alcaligenes xylosoxidans, a nonfermentative, Gram-negative rod often found in aqueous environments, has been isolated from respirators, incubators, and disinfectant solutions in the hospital environment. It is known to cause disease in immunocompromised (eg, burn) patients and represents a cross-contamination risk related to wound care. In the authors' burn unit, two patients, admitted with deep dermal burns during a 1-month time period, acquired serious A. xylosoxidans infections. The first involved A. xylosoxidans-associated cholecystitis in an adult with 32% total body surface area (TBSA) burns and the second involved A. xylosoxidans meningitis in an adult with 30% TBSA burns. Both patients received hydrotherapy (bathing) in the same bathing tub, one patient after the other. Culture from environmental sources isolated A. xylosoxidans from the bathing mattress. Bacterial analysis of the isolates, including antimicrobial susceptibility testing and pulsed-field gel electrophoresis, suggested the patients had been infected by the same strain - ie, cross-contaminated - probably during treatment of their burns. The isolated strains were resistant not only to broad-spectrum penicillins and cephalosporins, but also to imipenem, to which past A. xylosoxidans strains have been susceptible. These findings underscore the need for strict infection control to prevent cross-contamination and disease outbreak.

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

    Science.gov (United States)

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

    2008-01-01

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

  17. Importance of nutritional status in recovery from acute cholecystitis: benefit from enteral nutrition supplementation including medium chain triglycerides.

    Science.gov (United States)

    Nomura, Yukinobu; Inui, Kazuo; Yoshino, Junji; Wakabayashi, Takao; Okushima, Kazumu; Kobayashi, Takashi; Miyoshi, Hironao; Nakamura, Yuta

    2007-09-01

    This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum proteinnutrition group (n=71; >5.0 g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0+/-2.2 days) than in the fair nutrition group (27.0+/-8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0+/-7.2 days) than in the fair group (9.4+/-5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1+/-15 days) than in the non-MCT group (35.4+/-12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9+/-7 days) than in the non-MCT group (13.1+/-6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.

  18. 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.

  19. [New approaches to diagnosing and treating hyperkinetic biliary dyskinesia associated with chronic acalculous cholecystitis].

    Science.gov (United States)

    Bartosh, L F; Balakina, I V; Gridneva, L M

    2004-01-01

    Ninety patients aged 21 to 56 years who had chronic non-calculous cholecystitis (CNCC) concurrent with hyperkinetic dyskinesia (HKD) detectable by a stepwise duodenal probing and sonography, by using a choleretic breakfast and by determining the relaxation coefficient (RC) that was equal to the ratio of the volume of the gallbladder (GB) after the use of a spasmolytic to the baseline GB volume. The patients were divided into 3 groups. The authors used as a spasmolytic agent pinaverium bromide (dicetel) in a dose of 50 mg (1 tablet) in Group 1), octylonium bromide (spasmomen) in a dose of 40 mg (1 dragee) in Group 2, and drotaverine (no-spa) in a dose of 40 mg (1 tablet). There was a more significant sonographic increase in the size of GB in Groups 1 and 2 as compared with Group 3. In the acute drug test and during long-term treatment as well, the highest spasmolytic effect was noted in patients receiving dicetel (Group 1) and spasmomen (Group 2) as compared with that in Group 3 patients taking drotaverine. With this, RC was 1.25 +/- 0.2, 1.6 +/- 0.15, and 1.08 +/- 0.1, respectively. No adverse reactions occurred in the patients having selective calcium blockers (SCBs) whereas the patients receiving no-spa were found to have the following side effects: dry mouth (n = 3), transient constipation (n = 1), and numb tongue (n = 1). Thus, the study has provided evidence for the fact that SCBs have some advantage over myotropic spasmolytic agents in the treatment of CNCC with the signs of HKD.

  20. 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.

  1. 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.

  2. 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.

  3. 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.)

  4. 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.

  5. A case of microscopic polyangiitis in an elderly patient presenting predominantly with cholecystitis successfully treated with mizoribine.

    Science.gov (United States)

    Ichinose, Kunihiro; Iwanaga, Nozomi; Okada, Akitomo; Tamai, Mami; Yamasaki, Satoshi; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi

    2014-11-01

    An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 μg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.

  6. Feline cholecystitis and acute neutrophilic cholangitis: clinical findings, bacterial isolates and response to treatment in six cases.

    Science.gov (United States)

    Brain, Philip H; Barrs, Vanessa R; Martin, Patricia; Baral, Randolph; White, Joanna D; Beatty, Julia A

    2006-04-01

    Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.

  7. Etiological Misidentification by Routine Biochemical Tests of Bacteremia Caused by Gordonia terrae Infection in the Course of an Episode of Acute Cholecystitis

    Science.gov (United States)

    Gil-Sande, E.; Brun-Otero, M.; Campo-Cerecedo, F.; Esteban, E.; Aguilar, L.; García-de-Lomas, J.

    2006-01-01

    Gordonia terrae has been reported to be a rare cause of bacteremia. We report the first case of bacteremia associated with acute cholecystitis. Commercial biochemical testing was not able to identify the strain at the genus level, classifying it instead as Rhodococcus sp. Definitive identification was obtained by sequencing of the 16S rRNA gene. PMID:16825404

  8. 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

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

    Science.gov (United States)

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

    2017-01-01

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

  10. Single-port versus multi-port cholecystectomy for patients with acute cholecystitis:a retrospective comparative analysis

    Institute of Scientific and Technical Information of China (English)

    DietmarJacobandRol; Raakow

    2011-01-01

    BACKGROUND: Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS: Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological signs of acute cholecystitis underwent laparoscopic cholecystec-tomy at our institution. Thirty-six patients were operated on with the single-port technique (SP group) and the data were compared with a control group of 37 patients who were treated with the multi-port technique (MP group). RESULTS: The mean age in the SP group was 61.5 (range 21-81) years and in the MP group was 60 (range 21-94) (P=0.712). Gender, ASA status and BMI were not significantly different. The number of white blood cells was different before [SP:9.2 (range 2.8-78.4); MP: 13.2 (range 4.4-28.6); P=0.001] and after the operation [SP: 7.8 (range 3.5-184.8); MP: 11.1 (range 5-20.8); P=0.002]. Mean operating time was 88 (range 34-174) minutes in the SP group vs 94 (range 39-209) minutes in the MP group (P=0.147). Four patients (5%) required conversion to an open procedure (SP: 1; MP: 3; P=0.320). During the follow-up period of 332 (range 29-570) days in the SP group and 428 (range 111-619) days in the MP group (P=0.044), eleven (15%) patients developed postoperative complications (P=0.745) and two patients in the SP group required reoperation (P=0.154). CONCLUSIONS: Trans-umbilical single-port cholecystectomy for beginning acute cholecystitis is feasible and the complication rate is comparable with the standard multi-port operation. In spite of our good results, these operations are difficult to perform and should only be done in high-volume centers for laparoscopic surgery with

  11. 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.

  12. Draft Genome Sequence of Human-Pathogenic Lactococcus garvieae LG-ilsanpaik-gs201105 That Caused Acute Acalculous Cholecystitis.

    Science.gov (United States)

    Kim, Ji Hyung; Kang, Do-Hyung; Park, Se Chang

    2015-06-04

    Lactococcus garvieae, which is generally known as a marine and freshwater fish pathogen, is now considered to be an emerging zoonotic pathogen in both human and veterinary medicine. In recent years, we have reported the infection of L. garvieae LG-ilsanpaik-gs201105 in the gallbladder of an old fisherman. In this study, we present the draft genome sequence of L. garvieae LG-ilsanpaik-gs201105, with a total genome size of 1,960,261 bp in 53 contigs and a 38.1% average G+C content. Interestingly, the capsule gene cluster, which was known as one of the crucial virulence factors in L. garvieae, was not detected in our isolate. This is the first genome sequence of human-pathogenic L. garvieae, which caused acute acalculous cholecystitis.

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

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  14. [The pneumoperitoneum course forecasting and surgery tactic in the group of patients with acute and chronic cholecystitis and concomitant pathology of cardiovascular system].

    Science.gov (United States)

    Korotkyĭ, V M; Soliaryk, S O; Tsyganok, A M; Sysak, O M

    2012-01-01

    The share of elderly and senile patients with acute cholecystitis concomitant cardiovascular pathology whom the laparoscopic cholecystectomy has been provided is increased. The heightened intraabdominal pressure has negative influence at the cardiovascular system, so the alternative ways for treatment of this group of patients are used in clinic. We propose the pneumoperitoneum model using the pneumatic belt which is fixed at the abdomen in preoperative period in patients with an acute and chronic cholecystitis. This model is useful to forecast cardiovascular disorders during future laparoscopic cholecystectomy. The arterial pressure level, pulse score and ECG are monitored during the test (90 min). Myocardial ischemia appearance seems that the risk of laparoscopic cholecystectomy with pneumoperitoneum is high. The alternative method of surgery in such group of patients (no pneumoperitoneum is applied) is laparoscopic assisted cholecystectomya from miniaccess. This method allows to reducing frequency of intra- and postoperative complications connected with pneumoperitoneum negative influence at the patients with concomitant pathology of cardiovascular system.

  15. [Comparative analysis of application of highly intensive laser irradiation and electrocoagulation during laparoscopic cholecystectomy performed for destructive forms of an acute calculous cholecystitis].

    Science.gov (United States)

    Nichitayio, M Yu; Bazyak, A M; Klochan, V V; Grusha, P K; Goman, A V

    2015-02-01

    Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.

  16. 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.

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

    Science.gov (United States)

    Izumi, Manabu; Teraoka, Shoko; Yamashita, Keisuke; Matsumoto, Kenji; Muronoi, Tomohiro; Izawa, Yoshimitsu; Yonekawa, Chikara; Ano, Masaki; Suzukawa, Masayuki

    2011-01-01

    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.

  18. 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

  19. [The echographic assessment of the activity of the inflammatory process in patients with chronic acalculous cholecystitis in the choleretic test].

    Science.gov (United States)

    Ivanov, L A; Barashkov, M N

    1995-01-01

    Ultrasonic investigations of the gallbladder in choleretic test were carried out in 186 patients with chronic acalculous cholecystitis (CAC): 47 with intensive, 76 with moderate and 31 with minimal exacerbation, 32 patients in remission and 36 control subjects. As shown by choleretic test, a reduction of latent period and gallbladder contraction duration, a decrease in discharged bile amount, bile discharge velocity, initial and final gallbladder volumes' ration and increased final gallbladder volume occurred in CAC patients. These changes were parallel to inflammation intensity. Three types of gallbladder contraction were revealed in choleretic test: a 3-phase contraction curve with the initial fast evacuation period, relaxation wave (enlarged gallbladder) and slow evacuation period (type 1); a 2-phase curve with fast and slow evacuation (type 2); a monophasic curve with slow evacuation (type 3). In the patients studied type 1 prevailed, while type 3 was not observed in the controls. With increasing inflammation activity in CAC patients a type-1 contraction frequency declined and disappeared in active exacerbation, whereas type 2 and especially type 3 contractions became more frequent.

  20. 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

  1. [The contingency of the therapeutic effectiveness with the peculiarities of the non-pharmacological treatment of the patients presenting with chronic cholecystitis].

    Science.gov (United States)

    Poddubnaya, O A

    The elaboration of new technologies for the medical rehabilitation of the patients presenting with chronic cholecystitis in combination with chronic opisthorchiasis is a topical problem facing modern clinical gastroenterology. The application of up-to-date non-pharmacological therapeutic modalities, such as ultrahigh-frequency (UHF) therapy concomitantly with group chronophysiotherapy makes it possible to significantly improve the final outcome of the treatment. The results of clinical studies give evidence of the favourable influence of the combined chronorehabilitative treatment including UHF therapy on the characteristics of the functional state of the biliary-hepatic system and of the organism as a whole. The positive dynamics of these characteristics is suggestive of the high (up to 87,5%) therapeutic effectiveness of the proposed treatment. The investigations into the relationship between this effect and the peculiarities of the combined therapeutic modalities have demonstrated their correlation (χ2=104,13; p=0,0001; V-Kramer´s coefficient =0,35) and showed that the use of combined chronorehabilitation including UHF therapy based on the application of phone resonance radiation guarantees (and is a predictor of) high therapeutic effect (percent concordance =95,6%; standard coefficient=2,13; p=0,001) of the treatment of the patients with chronic cholecystitis in combination with chronic opisthorchiasis. The statistical analysis of the results of application of the modern non-pharmacological therapeutic modalities and the chronobiological approach for the purpose of the combined treatment of patients presenting with chronic cholecystitis in combination with opisthorchiasis with the use of contingency table and logit regression, allowed not only to estimate the interdependence and interrelation between the characteristics of interest but also to reveal predictors of therapeutic effectiveness. These findings are of great practical importance since they can be

  2. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft.

    Science.gov (United States)

    Grus, Tomáš; Lambert, Lukáš; Rohn, Vilém; Klika, Tomáš; Grusová, Gabriela; Michálek, Pavel

    2016-01-01

    We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature.

  3. 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

  4. 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.)

  5. Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults—Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Zuhal Yesilbag

    2017-01-01

    Full Text Available Primary Epstein-Barr virus (EBV infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.

  6. Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults—Case Report and Review of the Literature

    Science.gov (United States)

    Karadeniz, Asli; Kaya, Fatih Oner

    2017-01-01

    Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics. PMID:28194287

  7. Analysis the Curative Effect of Laparoscopic Cholecystectomy for Acute Cholecystitis%探析腹腔镜胆囊切除术治疗急性胆囊炎的疗效

    Institute of Scientific and Technical Information of China (English)

    许兴; 黄照果

    2015-01-01

    Objective To analyze the application of laparoscopic resection of acute cholecystitis treated effect. Methods in our hospital 35 cases of patients with acute cholecystitis laparoscopic excision, the other 35 cases patients with acute cholecystitis with conventional open cholecystectomy operation, comparison of two kinds of operation mode effect. Results the curative effect is better than traditional open operation group used laparoscopic resection in the treatment of acute cholecystitis, operation time and bleeding volume less than traditional laparotomy group, there is statistical signiifcance. Treatment of acute cholecystitis resection is safe and reliable, the conclusion of laparoscopic cholecystectomy and exact curative effect, it is worth in clinical application.%目的:分析急性胆囊炎应用腹腔镜切除术进行治疗的疗效。方法对我院收治的急性胆囊炎患者35例应用腹腔镜进行切除,另外35例急性胆囊炎患者应用常规的开腹手术切除胆囊,比较两种手术方式的效果。结果应用腹腔镜切除术治疗急性胆囊炎的疗效优于传统开腹手术组,手术时间与出血量也比传统开腹组少,有显著的统计学意义。结论腹腔镜胆囊切除术治疗急性胆囊炎安全可靠,疗效确切,值得在临床推广应用。

  8. Experience on acute cholecystitis in downlink LC operation%对急性胆囊炎患者行LC手术的心得体会

    Institute of Scientific and Technical Information of China (English)

    黄德波

    2015-01-01

    目的:探讨腹腔镜胆囊切除术(LC)治疗急性胆囊炎患者的效果。方法:2008年2月-2014年3月收治急性胆囊炎患者258例,给予LC进行治疗。结果:258例患者中顺利完成LC手术235例,手术时间45~135 min,平均(90±22.5)min。1例患者由于胆囊穿孔内瘘、坏疽症状而选择中转开腹,2例术中胆总管损伤而选择中转开腹,20例患者由于胆囊三角区域出现广泛粘连现象而选择中转开腹。结论:只有准确把握患者的手术特征、手术时机,并具有大量的临床经验与一定的手术技巧,才能够保证LC手术对急性胆囊炎患者的治疗效果。%Objective:To investigate the treatment effect of laparoscopic cholecystectomy in patients with acute cholecystitis. Methods:258 patients with acute cholecystitis were selected from February 2008 to March 2014.All of them were treated with laparoscopic cholecystectomy(LC).Results:In 258 patients,235 cases were completed LC operation successfully;the operation time were 45~135 min,averaged(90±22.5)min.There were 23 patients conversed to open surgery,in which 1 cases due to perforation of the gallbladder fistula and gangrene symptom,2 cases because of bile duct injury during the operation,and 20 cases due to adhesions phenomenon appears in the gallbladder triangle region.Conclusion:Only through accurately grasping the operation characteristics and operation time of patients,and with a large number of clinical experience and operation skill can ensure the curative effect of LC operation for acute cholecystitis patients.

  9. 急性胆囊炎患者的围手术期护理探析%Study on Perioperative Care of Patients with Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    邓爽

    2015-01-01

    目的:探析急性胆囊炎患者应用围手术期护理的临床价值。方法选取2013年7月~2014年7月间我院收治的急性胆囊炎患者39例,观察组与对照组分别施行围手术期护理和常规护理,对比两组患者护理效果。结果观察组术中出血、术后排气、手术时间、住院时间相对较少,并发症少,两组患者护理效果差异显著,有统计学意义(P<0.05)。结论急性胆囊炎患者应用围手术期护理并发症少、安全性高、效果良好,值得推广。%Objective Clinical value of perioperative care of patients with acute cholecystitis is to be explored. Methods Select 39 patients with acute cholecystitis who are treated in hospital from July 2013 to July 2014; patients in study group and in control group are given perioperative care and conventional treatment respectively and then observe and compare treatment efficacy between two groups. Results Patients’operation bleeding loss,postsurgical exhaust time and surgery time their hospitalization days and even complication incidence in study group are much less than counterparts in control group;there is a treatment efficacy differential between the two groups,and such a differential has statistic value(P<0.05). Conclusion Perioperative care is of efficacy and safety in treatment of patients with acute cholecystitis with less complication incidence;thus,such an effective method is quite worthwhile to be promoted.

  10. Expression of GLUT-1 and GLUT-3 in xanthogranulomatous cholecystitis induced a positive result on ¹⁸F-FDG PET: report of a case.

    Science.gov (United States)

    Sawada, Shigeaki; Shimada, Yutaka; Sekine, Shinichi; Shibuya, Kazuto; Yoshioka, Isaku; Matsui, Koshi; Okumura, Tomoyuki; Yoshida, Toru; Nagata, Takuya; Uotani, Hideyuki; Tsukada, Kazuhiro

    2013-01-01

    Although several reports have revealed that fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is useful for differentiating between benign and malignant lesions in the gallbladder, the positive results of (18)F-FDG PET are not specific for malignancy because (18)F-FDG is also accumulated in inflammatory lesions. It is known that the most important pathway for (18)F-FDG to enter the cell body is mediated by the facilitative glucose transporter-1 (GLUT-1) through GLUT-3. We herein present a case of xanthogranulomatous cholecystitis (XGC) with a positive result on (18)F-FDG PET. In this case, GLUT-1 and GLUT-3 were both positively expressed in inflammatory cells at the gallbladder wall of XGC and this is the first report to reveal GLUT expression in XGC. This report reveals that surgeons should carefully consider the appropriate treatment of gallbladder tumor, even with a positive result on (18)F-FDG PET.

  11. Clinical countermeasures of acute gangrenous cholecystitis by laparoscopic cholecystectomy%腹腔镜下急性坏疽性胆囊炎处理对策

    Institute of Scientific and Technical Information of China (English)

    李旭; 郭鑫; 郭志民

    2015-01-01

    Objective:To analyze the risk factors of the acute gangrenous cholecystitis and discuss the surgical techniques used in laparoscopic treatment of acute gangrenous cholecystitis.Methods:The clinical data of 158 patients with acute gangrenous cholecysti-tis treated with laparoscopic cholecystectomy in People’s Hospital of Yilong County from February 2006 to February 2014 were re-viewed.Results:Among the cases,31 cases had complete resection by conventional cholecystectomy;102 cases had retrograde chole-cystectomy;34 cases had subtotal cholecystectomy and 13 cases converted to open surgey actively.The average operation time was (120.4 ±61 .5)minutes.The average amount of bleeding was (100.5 ±40.9)mL during the operation,and duration of postopera-tive hospital stay was (7.3 ±3.4)days.There was no bile duct damage,gastric duodenal injury,colon injury,postoperative intra-ab-dominal hemorrhage,secondary common bile duct stones and death among 158 cases of patients.Conclusion:To master the risk factors of acute gangrenous cholecystitis,do surgical intervention as soon as possible and apply different methods,such as complete resection, retrograde cholecystectomy,subtotal cholecystectomy and active converting to open surgery,can reduce bile duct injury and other oper-ative complication.%目的:分析急性坏疽性胆囊炎发生的危险因素,并探讨腹腔镜胆囊切除术治疗急性坏疽性结胆囊炎的手术方法和手术技巧。方法:回顾性分析2006年2月至2014年2月我院行急性坏疽性胆囊炎胆囊切除术患者158例患者临床资料。结果:顺行胆囊完整切除31例,逆行胆囊完整切除102例,胆囊大部分切除34例,主动中转开腹13例。平均手术时间(120.4±61.5)min,术中平均出血量(100.5±40.9)mL,术后平均住院时间(7.3±3.4)d。全组158例患者无胆总管损伤、胃十二指肠损伤、结肠损伤,术后腹腔出血、继发性胆总管结石及死亡等

  12. Occurrence of anaplastic large cell lymphoma following IgG4-related autoimmune pancreatitis and cholecystitis and diffuse large B-cell lymphoma.

    Science.gov (United States)

    Ishida, Mitsuaki; Hodohara, Keiko; Yoshida, Keiko; Kagotani, Akiko; Iwai, Muneo; Yoshii, Miyuki; Okuno, Hiroko; Horinouchi, Akiko; Nakanishi, Ryota; Harada, Ayumi; Yoshida, Takashi; Okabe, Hidetoshi

    2013-01-01

    IgG4-related sclerosing disease is an established disease entity with characteristic clinicopathological features. Recently, the association between IgG4-related sclerosing disease and the risk of malignancies has been suggested. IgG4-related autoimmune pancreatitis with pancreatic cancer has been reported. Further, a few cases of extraocular malignant lymphoma in patients with IgG4-related sclerosing disease have also been documented. Herein, we describe the first documented case of anaplastic large cell lymphoma (ALCL) following IgG4-related autoimmune pancreatitis and cholecystitis and diffuse large B-cell lymphoma (DLBCL). A 61-year-old Japanese male, with a past history of DLBCL, was detected with swelling of the pancreas and tumorous lesions in the gallbladder. Histopathological study of the resected gallbladder specimen revealed diffuse lymphoplasmacytic infiltration with fibrosclerosis in the entire gallbladder wall. Eosinophilic infiltration and obliterative phlebitis were also noted. Immunohistochemically, many IgG4-positive plasma cells had infiltrated into the lesion, and the ratio of IgG4/IgG-positive plasma cells was 71.6%. Accordingly, a diagnosis of IgG4-related cholecystitis was made. Seven months later, he presented with a painful tumor in his left parotid gland. Histopathological study demonstrated diffuse or cohesive sheet-like proliferation of large-sized lymphoid cells with rich slightly eosinophilic cytoplasm and irregular-shaped large nuclei. These lymphoid cells were positive for CD30, CD4, and cytotoxic markers, but negative for CD3 and ALK. Therefore, a diagnosis of ALK-negative ALCL was made. It has been suggested that the incidence of malignant lymphoma may be high in patients with IgG4-related sclerosing disease, therefore, intense medical follow-up is important in patients with this disorder.

  13. 浅析急性胆囊炎的外科治疗%A Brief Analysis of Surgical Treatments of Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    古广强

    2015-01-01

    To compare the advantages and disadvantages of diverse surgical treatments of acute cholecystitis. Some released researches and data were analyzed to compare the dif erences of suitability, risk, operation cost in diverse surgical treatments.Cholecystectomy was widely used in treatments of acute cholecystitis. Cholecystostomy was more likely to be used in patients older and have more comorbidities. Laparoscopic cholecystectomy was less-trauma, faster-recovery, lighter-pain. However, Laparoscopic cholecystectomy stil had limitations.%浅析急性胆囊炎的常用外科治疗手段,并对不同手段的利弊进行比较分析。根据已有研究和数据,从患者适应性、术后风险、手术成本等多方面分析不同外科手段治疗急性胆囊炎的利弊。除了无法适应胆囊切除术的患者更倾向于采用胆囊造口术,胆囊切除术应用较广泛。常规胆囊切除术包括开腹胆囊切除术和腹腔镜胆囊切除术,腹腔镜胆囊切除术以创伤小、愈合快、术后恢复快等优势逐渐成为急性胆囊炎外科治疗手段的首选。但腹腔镜胆囊切除术有一定几率转开腹。

  14. 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

  15. The Application of Laparoscopic Cholecystectomy on Elderly Patients with Acute Cholecystitis%腹腔镜胆囊切除术在老年急性胆囊炎中的应用

    Institute of Scientific and Technical Information of China (English)

    姚时伟

    2013-01-01

    目的:研究腹腔镜胆囊切除术在老年人急性胆囊炎病人中的应用价值。方法:回顾性分析我院2009年9月~2013年2月开展的42例65岁以上老年急性胆囊炎行腹腔镜胆囊切除术的临床资料。结果:42例65岁以上老年人急性胆囊炎成功的完成了腹腔镜胆囊切除术40例,有2例中转开腹手术。结论:经过精心的术前准备与手术风险评估后,腹腔镜胆囊切除术适宜于老年人急性胆囊炎胆囊切除术,也能取得安全、有效、创伤小、恢复快的优点。%Objective:to research the applied value of laparoscopic cholecystectomy on elderly patients with acute cholecystitis .Meth-ods:To retrospectively analyse the clinical data of 42 cases of laparoscopic cholecystectomy on elderly patients over age 65 with acute cho-lecystitis from Sep.2009 to Feb.2013.Results:40 cases elderly patients over age 65 with acute cholecystitis were implemented Successful by the laparoscopic cholecystectomy , 2 cases were converted laparoscopic cholecystectomy to laparotomy .Conclusion:After careful preop-erative preparation and operation risk assessment , laparoscopic cholecystectomy was Suitable for the elderly with acute cholecystitis and was safe,effective,less injury, rapid recovery.

  16. 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.

  17. Jiawei Dachaihu Decoction in Treatment of Experimental Study of Cholecystitis%加味大柴胡汤治疗胆囊炎的实验研究

    Institute of Scientific and Technical Information of China (English)

    徐迎涛; 孙雪萍

    2013-01-01

    目的:探讨加味大柴胡汤对实验性豚鼠胆囊炎的影响.方法:取350 ~ 450 g豚鼠50只,给予盐酸林可霉素60 mg· kg-1·d-1,皮下注射,建立胆囊炎模型,将造模成功的动物随机分为模型组,加味大柴胡汤低、中、高剂量(3.83,7.67,15.33 g·kg-1)组及消炎利胆片(0.25 g·kg-1)组,另取10只作为正常对照组,每组10只,均ig给药,每日1次,给药3周.结果:加味大柴胡汤中、高剂量可显著增加动物胆汁量(P<0.05);中、高剂量可显著降低动物血浆白细胞数(P<0.01);低、中、高剂量可显著降低动物胆囊组织中肿瘤坏死因子-α(TNF-α)含量和TNF-αmRNA的表达(P <0.01 ~0.05).结论:加味大柴胡汤具有增加胆囊炎动物胆汁量,降低血浆中白细胞含量和胆囊组织中TNF-α含量和TNF-αmRNA表达的作用,对胆囊炎有一定的治疗作用.%Objective: To observe the influence of Jiawei Dachaihu decoction on experimental guinea pigs cholecystitis. Method: Fifty guinea pigs (weight between 350-450 g) subcutaneouslyinjected by Lincomycin Hydrochloride 60 mg·kg-1·d-1 everyday to establish cholecystitis model, were randomly divided into mdel, Jiawei Dachaihu decoction low, medium and high dose group, Xiaoyan Lidan tablets group and normal group. The control and model group were given 10 mL·kg-1 of distilled water by intragastric administration once everyday; Jiawei Dachaihu Tang low, medium and high dose group were given 3.83, 7.67, 15.33 g ·kg-1 by intragastric administration different concentration decocting with 10 mL·kg-1, Xiaoyan Lidan tablets group was given corresponding concentration decocting with 0.25 g · kg-1 by intragastric administration, once everyday, administration for three weeks. Result: Jiawei Dachaihu decoction of medium and high dose can significantly increase the volume of bile (P <0. 05) , also can significantly reducing the number of white blood cells in plasma (P<0. 01). Jiawei Dachaihu decoction of low, medium

  18. 三孔法腹腔镜胆囊切除术治疗急性胆囊炎%Three Holes Method Laparoscopic Cholecystectomy for Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    赵言明; 李永明

    2012-01-01

      目的:探讨三孔法腹腔镜胆囊切除术治疗急性胆囊炎的应用价值。方法:2003年2月-2012年1月笔者所在医院对150例急性胆囊炎患者尝试三孔法腹腔镜胆囊切除,观察疗效。结果:145例患者顺利完成 LC,2例患者因胆囊周围严重粘连,肝外胆管难以辨认,1例患者胆囊横结肠瘘,2例术中快速病检提示胆囊癌中转开腹。术后住院3~5 d,无结肠,十二指肠及胃损伤,无胆管损伤及腹腔出血,剑突下切口感染5例,门诊换药治愈。结论:三孔法腹腔镜胆囊切除术治疗急性胆囊炎能迅速缓解患者剧烈腹痛及呕吐,终止患者痛苦,降低了发生胆囊穿孔、胆汁性腹膜炎及腹腔脓肿的风险,缩短了住院时间,降低了单病种的治疗费用,降低了并发症的发生及科室的医疗纠纷,减轻了医护人员的劳动强度及心理压力。%  Objective :To investigate three holes method laparoscopic cholecystectomy for acute cholecystitis in application value.Methods :In our hospital from Feb 2003 to Jan 2012150 cases of acute cholecystitis patients try three holes method laparoscopic cholecystectomy.Results :145 patients successfully completed LC,2 patients with gallbladder surrounding severe adhesions,extrahepatic bile duct illegible in 1 cases,gallbladder transverse colon fistula,2 cases of rapid intraoperative pathological examination revealed gallbladder carcinoma laparotomy.The postoperative hospital stay of 3-5 days,without colonic, duodenal and gastric injury,no bile duct injury and intraperitoneal hemorrhage,subxiphoid incision infection in 5 cases,clinic medicine changing cured. Conclusion :Three holes method laparoscopic cholecystectomy for acute cholecystitis can relieve the patient of severe abdominal pain and vomiting,termination of patient pain,reduces the incidence of perforation of the gallbladder,biliary peritonitis and peritoneal abscess risks,shorten hospitalization time,reduce the single disease

  19. 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

  20. 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 ...

  1. Clinical Observation of 50 Cases of Acute Cholecystitis Treated With Laparoscopic Cholecystectomy%腹腔镜胆囊切除术治疗急性胆囊炎50例疗效观察

    Institute of Scientific and Technical Information of China (English)

    崔磊; 瞿建国; 党胜春; 张清; 谢嵘; 黄润生

    2015-01-01

    Objective To investigate the clinical effect of laparoscopic cholecystectomy for acute cholecystitis. Methods 50 cases of acute cholecystitis treated by laparoscopic cholecystectomy were set as the observation group, 50 cases treated with conventional open surgery were set as the control group, and the treatment effect of the two groups was compared. Results The operation time, bleeding volume, postoperative pain score, anal exhaust time, defecation time, hospitalization time and complications in the observation group were statistically significant with the control group (P<0.05). Conclusion Laparoscopic cholecystectomy for acute cholecystitis is beneifcial to postoperative recovery.%目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎的临床疗效。方法将50例采用腹腔镜胆囊切除术治疗的急性胆囊炎患者设为观察组,将同期收治的50例采用常规开腹手术治疗的急性胆囊炎患者设为对照组,比较两组的治疗效果。结果观察组的手术时间、术中出血量、术后疼痛评分、肛门排气时间、排便时间、住院时间、并发症少于对照组,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术治疗急性胆囊炎有利于患者的术后康复。

  2. 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.

  3. Study on Nonage Surgery Treatment of Acute Calculus Cholecystitis%早期手术治疗急性结石性胆囊炎的体会

    Institute of Scientific and Technical Information of China (English)

    吴志辉; 吴康瑞; 黄俊晓

    2011-01-01

    目的:探讨早期手术治疗急性结石性胆囊炎(AGC)的效果和经验.方法:对我院AGC患者26例采取早期手术治疗措施,评估临床治疗效果. 结果:本组患者治愈25例,死亡1例,病死率3.84%,死亡原因为高龄合并术后多脏器功能衰竭.术中并发胆囊床大出血1例,心衰l例,呼吸衰竭1例,肾上腺危象1例,切口感染、切口裂开2例.结论:早期手术治疗急性结石性胆囊炎的效果确切,安全可靠.%Objective: To investigate the effect and experience of nonage surgery treatment of acute calculus choleeystitis. Method: The 26 cases with acute calculus choleeystitis received the nonage surgery treatment, and the clinical effect were evaluated. Result: The 25 cases were cured and the 1 case was dead,and the case fatality rate was 3.84%. The dead reason was older combined with MOF. There was 1 ease complicated by gallbladder bed hemorrhoea after operation, 1 ease complicated bycongestive heart failure after operation, 1 case complicated with respiratory failure after operation, 1 case complicated with adrenal crisis after operation,2 cases complicated with postoperative infection and disruption of wound. Conclusion: The effect of nonage surgery treatment of acute calculus cholecystitis is obvious and safety.

  4. 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.

  5. Laparoscopic Cholecystectomy for Acute Suppurative Cholecystitis:a Report of 452 Cases%腹腔镜治疗急性化脓性胆囊炎452例

    Institute of Scientific and Technical Information of China (English)

    毕保洪; 李华; 李伟; 张朝永

    2014-01-01

    目的:探讨腹腔镜胆囊切除术( laparoscopic cholecystectomy, LC)治疗急性化脓性胆囊炎的处理方法及并发症的预防措施。方法2003年10月~2013年6月我院采用四孔法LC治疗急性化脓性胆囊炎452例,因胆囊三角水肿和(或)粘连严重而无法分离,采用逆行腹腔镜胆囊部分切除术( laparoscopic partial cholecystectomy,LPC),胆囊管不能常规夹闭,采用缝扎或胆囊管开口处直接放置引流管引流,术后均常规放置腹腔引流管引流。结果3例因解剖困难中转开腹手术,382例成功完成LC,67例行LPC。 LC手术时间(55±20) min,术中出血量(80±10) ml;LPC手术时间(61±15) min,术中出血量(75±15) ml。术后胆漏21例,其中19例保守治疗成功,2例开腹治疗成功;切口感染致延期愈合18例。术后住院3~15 d,平均6.5 d。成功实施腹腔镜手术的449例,术后随访6~24个月(平均14个月),21例因其他疾病死亡,余428例无并发症发生。结论 LC治疗急性化脓性胆囊炎是一种安全可靠的方法,但及时中转开腹手术仍是手术医师最明智的选择。%Objective To investigate the management methods and complication prevention of laparoscopic cholecystectomy ( LC) for acute suppurative cholecystitis. Methods From October 2003 to June 2013, we performed 4-port LC on 452 patients with acute suppurative cholecystitis.The patients were given laparoscopic partial cholecystectomy ( LPC) by retrograde dissection because of serious edema and ( or ) adhesion of gallbladder triangle.Because the cystic ducts could not be clipped by conventional methods, primary suture or drainage tube placement was performed near the opening of the cystic duct.An abdominal cavity drainage tube was placed in all the cases. Results Among the 452 patients, LC was performed successfully in 382 patients, conversions to open surgery because of exposure difficulties were

  6. Efficacy and safety of laparoscopy and laparotomy in the treatment of acute cholecystitis%腹腔镜术和开腹术治疗急性胆囊炎的疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    佘明杰; 刘小虎

    2014-01-01

    Objective:To investigate the clinical application value of laparoscopy and laparotomy in the treatment of acute cholecystitis.Methods:129 cases with acute cholecystitis who had been treated by operation from June 2010 to December 2013.We retrospectively analyzed their clinical datas.They were divided into the laparoscopy group(69 cases were treated with laparoscopic cholecystectomy) and the open group(60 cases were treated with conventional open operation) according to the different surgical treatment.We analyzed the operation related index and postoperative condition of the two groups.Results:The operation time, amount of bleeding during operation and postoperative anal exhaust time for the first time of the laparoscopic group were significantly shorter than those of the open group(P<0.01).The postoperative incision infection,bile leakage rate of the laparoscopic group were significantly lower than those in the open group(P<0.05).Conclusion:The laparoscopic cholecystectomy in the treatment of acute cholecystitis with less bleeding,less postoperative complications and other advantages,so it is worthy of clinical application.%目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎的临床应用价值。方法:2010年6月-2013年12月收治行手术治疗的急性胆囊炎患者129例,回顾性分析其临床资料,按照所行治疗术式不同分为腔镜组69例,行腹腔镜下胆囊切除术治疗和开腹组60例,行常规开腹手术治疗,对两组患者手术相关指标及术后情况进行对比分析。结果:腔镜组手术耗时、术中出血量及术后首次肛门排气时间均明显短于开腹组(P<0.01);腔镜组患者术后切口感染、胆汁漏发生率明显低于开腹组(P<0.05)。结论:腹腔镜微创胆囊切除术治疗急性胆囊炎具有出血少、术后并发症少等优势,值得临床推广应用。

  7. 腹腔镜胆囊切除术在急性胆囊炎治疗中的临床价值分析%Analysis Clinical Value of Laparoscopic Cholecystectomy in Treatment of Acute Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    卜德永

    2016-01-01

    Objective Analysis clinical value of laparoscopic cholecystectomy in Treatment of acute cholecystitis.MethodsRandomly selected patients with cholecystitis in our hospital,to differentiate operative time 60 patients were divided into two groups,30 patients in each group,laparotomy cholecystectomy applied to the conventional group,The laparoscopic cholecystectomy applied research group,then the two groups of patients as well as treatment incidence of adverse reactions were compared. ResultsTreatment of patients with disease study group was signiifcantly higher effciency,while the complication rate is lower than the control group,statisticsP<0.05, signiifcant difference.Conclusion Patients with acute cholecystitis laparoscopic cholecystectomy for treatment can improve disease treatment,reduce the incidence of complications,with extensive use value.%目的:研究在急性胆囊炎的治疗中使用腹腔镜胆囊切除术的效果。方法对我院收治的胆囊炎患者进行随机抽取,以手术时间的差异将60例患者分为两组,每组30例,常规组应用开腹胆囊切除术,研究组应用腹腔镜下胆囊切除术,对比两组患者治疗效果以及不良反应发生率。结果研究组疾病治疗有效率高于对照组,同时并发症发生率比对照组低,P<0.05,差异具有统计学意义。结论对急性胆囊炎患者实施腹腔镜胆囊切除术进行治疗能够提高疾病治疗效果,减少并发症的发生。

  8. 腹腔镜胆囊切除术治疗老年急性胆囊炎临床观察%Clinical observation of laparoscopic cholecystectomy in the treatment of elderly cases with acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    陈锟; 沙拉衣丁·沙力克江

    2014-01-01

    目的:探讨针对老年急性胆囊炎患者采取腹腔镜胆囊切除术的临床治疗效果。方法:2011年5月-2013年5月收治老年胆囊炎患者80例,随机分为观察组和对照组,每组40例。对照组采取传统的胆囊切除手术治疗,观察组采取腹腔镜胆囊切除术。比较分析两组术中出血量、手术时间、术后成功率、并发症情况和肠道恢复时间。结果:和对照组比较,观察组在各项指标上都有着更好的疗效,差异具有统计学意义(P<0.05)。结论:腹腔镜胆囊切除术治疗老年人急性胆囊炎,疗效较好,值得临床推广。%Objective:To investigate the clinical effect of laparoscopic cholecystectomy in the treatment of acute cholecystitis in the elderly cases.Methods:80 elderly cases with cholecystitis were selected from May 2011 to May 2013.They were randomly divided into the observation group and the control group with 40 cases in each.The control group adopted conventional cholecystectomy operation treatment,while the observation group adopt laparoscopic cholecystectomy.We compared the amount of bleeding in operation,the operation time,the success rate of operation,the concurrent and intestinal recovery time of the two groups. Results:The curative effect of all indexes of the observation group were better than those of the control group,and the difference is statistically significant(P<0.05).Conclusion:The effect of laparoscopic cholecystectomy in the treatment of elderly cases with acute cholecystitis is better,so it is worth clinical application.

  9. 腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床治疗体会%Clinical experience of laparoscopic cholecystectomy for treatment of acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    顾伟勇

    2015-01-01

    目的:探讨腹腔镜胆囊切除术在急性发作期胆囊炎患者中的治疗效果。方法:收治胆囊炎急性发作期患者48例,随机分为对照组和试验组,试验组采用腹腔镜胆囊切除术治疗,对照组采用常规开腹手术治疗,比较两组的治疗效果。结果:试验组手术时间长于对照组,但术中出血量明显少于对照组(P<0.05)。试验组并发症发生率4.2%,明显低于对照组的25%(P<0.05)。结论:腹腔镜胆囊切除术治疗急性发作期胆囊炎患者效果满意,能减少患者并发症发生率。%Objective:To explore the clinical effect of laparoscopic cholecystectomy for treatment of acute cholecystitis.Methods:48 patients with acute cholecystitis were selected.They were randomly divided into the control group and the experimental group. The experimental group were treated with laparoscopic cholecystectomy.The control group were treated with conventional laparotomy.We compared the treatment effect of the two groups.Results:In the experimental group,the operation time was longer than that of the control group,but the amount of bleeding during the operation was significantly less than that of the control group(P<0.05).In the experimental group,the complication rate of 4.2% was significantly lower than 25% t in the control group(P<0.05).Conclusion:The clinical effect of laparoscopic cholecystectomy for treatment of acute cholecystitis is significant.It can reduce the incidence of complications in patients.

  10. 探讨萎缩性胆囊炎的腹腔镜切除术及临床应用价值%To Explore the Value of Laparoscopic Cholecystectomy and Its Clinical Application in the Treatment of Atrophic Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    田勇涛; 于健

    2016-01-01

    目的:评估腹腔镜下切除术运用在萎缩性胆囊炎治疗中的效果及价值。方法以2013年2月~2015年2月因患有萎缩性胆囊炎而进入本院接受诊治的57例患者为对象,对其施行腹腔镜下切除手术,探究治疗成效及有关情况。结果57例全部顺利结束LC术,没有中途转成开腹手术者。术后的24 h内患者肠道蠕动功能得以恢复,住院时间平均(7.0±1.02)d,没有死亡病例。结论 LC术运用在萎缩性胆囊炎的治疗中时,手术操作者需具备较强的镜下观察、解剖技能,并顺利开展术中Calot三角解剖操作,以提升预后效果。%Objective To evaluate use of laparoscopic resection in the treatment of atrophic cholecystitis effect and value.Methods 57 cases of patients with atrophic cholecystitis were chosen as an object from February 2013 to February 2015 in the hospital, by the laparoscopic surgery, to explore the treatment effect and the related situation.Results 57 cases were all successful conclusion LC, not the way to open operation. Postoperative patients with intestinal peristalsis function was restored in 24 hours, length of hospital stay (7.0±1.02) days on average, no death case.Conclusion LC technique used in the treatment of atrophic cholecystitis, surgery, the operator must have the stronger the microscopic observation, anatomical skills, intraoperative Calot triangle dissection and smoothly carry out the operation, in order to improve the prognosis.

  11. 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.

  12. 术前超声检查预测急性胆囊炎腹腔镜手术难度的受试者工作特征曲线分析%Evaluation of Ultrasonic Predicting Difficulty of Laparoscopic Cholecystectomy in Acute Cholecystitis by Receiver Operator Characteristic Curve

    Institute of Scientific and Technical Information of China (English)

    赵鲁文; 赵洪涛; 于爱军; 史华宁; 张学军; 刘金龙

    2012-01-01

    目的 探讨术前超声检查对急性胆囊炎行腹腔镜手术难度的预测价值.方法 对235例急性胆囊炎腹腔镜胆囊切除术(LC)患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况.应用χ2检验单因素分析筛选出导致手术困难的危险因素,再对危险因素进行Logistic多元回归分析,并分别赋值,建立术前超声预测急性胆囊炎LC难度评分表,进行受试者工作特征(receiver operator characteristic,ROC)曲线分析.结果 胆囊容积增大、胆囊壁增厚、胆囊颈管结石嵌顿和胆囊颈粘连是影响急性胆囊炎腹腔镜手术难度的独立危险因素.应用4项指标建立术前超声预测急性胆囊炎LC难度评分表.经ROC曲线分析,曲线下面积为0.945,与完全随机情况下获得的曲线下面积(0.5)进行比较,差异有统计学意义(P<0.05).结论 术前超声检查可以较好地预测急性胆囊炎行腹腔镜手术的难易程度,对手术适应证的选择有重要指导意义.%Objective To explore the predictive value of ultrasonic appearance for difficulty of laparoscopic cholecystectomy ( LC ) in acute cholecystitis. Methods A total of 235 patients with acute cholecystitis received ultrasonic examination before LC. The parameters were measured pre - operation including the volume of gallbladder, cholecystic wall thickness, gallbladder fossa fluid, stone incarceration and adhesion of gallbladder or Calot's triangle. The risk factors associated with difficult LC was selected by Chi - square test, then multivariable analysis with Logistic regression was performed for the selected risk factors and given scores which formed a scoring system for ultrasonic appearance in acute cholecystitis, predicting technical difficulties during LC. Receiver operator characteristic ( ROC ) curve was then applied to analyze the scoring system. Results Multivari

  13. Clinical Research of the Therapy of Extracorporeal Shock Wave to Chronic Acalculous Cholecystitis%体外冲击波治疗慢性非结石性胆囊炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    唐海涛; 李春恒; 赵红燕

    2015-01-01

    Objective This article aims to conduct the clinical observation and clinical research of extracorporeal shock wave therapy to chronic acalculous cholecystitis .Methods Divide 80 cases of patients of chronic acalculous chole-cystitis into 2 groups, with 40 cases in each group; as for the treatment group , the JDPN -VB model extracorporeal shock wave lithotripter by Shanghai Jiao Tong University is adopted to take the right upper quadrant as the shock wave path, and in prone position , to conduct the extracorporeal shock wave therapy to the gallbladder with the therapy voltage of 8 -10kv and the times of shock wave of 1000, and with the intervals of 2 weeks between two times;2 times are taken as 1 course of treatment; as for the control group , the anti-inflammatory and cholagogic medicines are taken for four weeks.Four weeks after the start of therapy , the two groups of patients are evaluated about the changes of clinical index be-fore and after the chronic acalculous cholecystitis .Results After 4 weeks of therapy , it is found that the single index im-provement degree and comprehensive therapeutic effect such as the clinical symptoms and the change in gallbladder Color Doppler Ultrasound of the treatment group are all obviously superior to that of the control group .Conclusions The extra-corporeal shock wave is a new effective method for the therapy of chronic acalculous cholecystitis ;it has the advantages of rapid effectiveness , safe and reliable and with effective therapy;worthy of clinic popularization and application .%目的:体外冲击波治疗慢性非结石性胆囊炎的疗效观察及临床研究。方法对80例慢性非结石性胆囊炎患者随机分成2组,每组40例;治疗组采用上海交大JDPN-VB型体外冲击波碎石机,以右上腹部为冲击波路径,俯卧位,对病变胆囊进行体外冲击波治疗,每次治疗电压选择8~10 kV,冲击波次数为1000次,间隔2周治疗下一次,2次为1个疗程;对

  14. 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...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

  15. Expression Significance of CD147 and MMP-2 in Tissues of Chronic Cholecystitis and Gallblad-der Carcinoma%CD147和MMP-2在胆囊癌组织中的表达及意义

    Institute of Scientific and Technical Information of China (English)

    矫树华; 温艳惠

    2015-01-01

    【目的】探讨细胞外基质金属蛋白酶诱导因子(CD147)和基质金属蛋白酶2(MMP‐2)在胆囊癌组织中的表达及意义。【方法】采用免疫组织化学法检测30例慢性胆囊炎和21例胆囊癌患者组织中CD147和M M P‐2的表达,并分析其临床意义。【结果】21例胆囊癌组织中 CD147和 M M P‐2的阳性表达率分别为71.4%(15/21)和76.2%(16/21),显著高于慢性胆囊炎组织中的表达13.3%(4/30)和23.3%(7/30)( P <0.01);CD147和M M P‐2的阳性表达与胆囊癌的临床分期和淋巴结转移显著相关( P <0.05),且胆囊癌中CD147与MMP‐2的阳性表达呈正相关( r =0.631,P =0.002)。【结论】CD147和MMP‐2在胆囊癌组织中的阳性表达与其临床分期和淋巴结转移相关,CD147可能通过与M M P‐2的相互作用共同参与调控胆囊癌的进展与转移。%[Objective] To explore the expressions of CD147 and matrix metalloprotease‐2 (MMP‐2) in tissues of chronic cholecystitis and gallbladder carcinoma and examine their clinical significance .[Methods]Immunohistochemistry was used for detecting CD147 and MMP‐2 in 30 chronic cholecystitis tissues and 21 gallbladder carcinoma tissues .And their clinicopathological data were analyzed .[Results] The expressions of CD147 and MMP‐2 was significant higher in 21 gallbladder carcinoma tissues [71 .4% (15/21)& 76 .2% (16/21)] than those in 30 chronic cholecystitis tissues [13 .3% (4/30)& 23 .3% (7/30)]( P<0 .01) .And the pos‐itive expressions of both were correlated with staging and lymph node metastasis ( P<0 .05) .The expressions of CD147 and MMP‐2 had a positive correlation in gallbladder carcinoma ( r =0 .631 ,P =0 .002) .[Conclu‐sion] The expressions of CD147 and MMP‐2 are positively correlated with staging and lymph node metastasis in gallbladder carcinoma .And CD147 may interact with MMP‐2 in regulating the progression of

  16. 开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎对比观察%Comparison observation laparotomy and laparoscopic cholecystectomy treating calculous cholecystitis

    Institute of Scientific and Technical Information of China (English)

    仲杨

    2016-01-01

    ABSTRAC:Objective To compare the effect of open and laparoscopic cholecystectomy in the treatment of gallstone cholecystitis. Methods in our hospital in January 2013 and 2015 January 100 cases of calculus cholecystitis patients were studied with different surgery were randomly divided into open surgery grouPand the laparoscopic group, there were 50 cases of patients in the laparotomy grouPunderwent conventional open cholecystectomy surgery, the laparoscopic grouPunderwent laparoscopic cholecystectomy, of two groups of patients with operation time, incision length, intraoperative bleeding and hospitalization time and other factors compared. Results compared with the open group, the operation time, incision length, blood loss and postoperative pain time of the laparoscopic grouPwere more ideal,P< 0.05, the difference was statistically significant. And, the proportion of complications of open surgery grouPwas 24%, compared with the open group, the probability of complications of laparoscopic grouPwas 12%, significantly lower,P< 0.05, the difference between the two groups was statistically significant.Conclusion laparoscopic cholecystectomy for gallstone cholecystitis can achieve good clinical results, it is worthy of clinical application in the future.%目的:将开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎的效果进行对比。方法选取本院2013年1月至2015年1月收治的100例结石性胆囊炎患者进行研究,以手术方式的不同随机分为开腹组与腹腔镜组,两组均有50例患者,开腹组行传统开腹胆囊切除手术,腹腔镜组行腹腔镜胆囊切除术,对两组患者的手术时间、切口长度、术中出血量以及住院时间等因素进行比较。结果与开腹组相比,腹腔镜组的手术时间、切口长度、术中出血量以及术后疼痛时间等更为理想,P<0.05,差异具有统计学意义。并且,开腹组并发症所占比例为24.0%,与开腹组相比,腹

  17. Timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis%急性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择

    Institute of Scientific and Technical Information of China (English)

    邱明; 吴向未; 杨宏强; 刘国起; 马杰; 张示杰

    2014-01-01

    Objective To investigate thetiming offurtheroperative opportunity for the treatmentofpercutaneous transhepatic gallbladder drainage (PTGD)in patients with acute cholecystitis. Methods Theclinical data of 77 patients with acute cholecystitis who received laparoscopic cholecystectomy after PTGD wereanalyzed retrospectively. According to the interval, Seventy-seven cases weredivided into 3 groups. The patientsin the first (n = 11), second (n = 36), third (n = 30) group performed LC were within 2 m, during 2 ~ 4 m,and beyond 4 m, retrospectively. The rate of conversion to surgery, intraoperative blood, operation time andhospital stay were compared among the three groups. Results There was significant difference in the thicknessof gallbladder wall before LC, conversion to open surgery, intraoperative blood, operation time, hospital stayandpostoperative complications among 3 groups (P < 0.05). Conclusion The timing for LC in patients withacute cholecystitis should be within the 2 ~ 4 mintervalafter PTGD, the thickness of gallbladder wall less than0.42 cm and stable condition. On average LC appearsafe and effective with short operation time , less blood loss,low rate of conversion to open surgery and postoperative complications , reduced hospital stay, and results inbetter quality of life.%目的:探讨急性胆囊炎患者行经皮经肝胆囊穿刺引流术后的进一步手术治疗的时机。方法:回顾性分析我院77例急性胆囊炎患者行经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGD)后联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料。按 PTGD 与 LC 的间隔时间分为三组,组1为 PTGD 后2个月内行 LC 的病例(n =11),组2为 PTGD 后2~4个月内行 LC的病例(n =36),组3为 PTGD 后间隔4个月以上行 LC 的病例(n =30)。比较三组中转率、术中出血量、手术时间、术后住院时间等。结果:三组间,LC

  18. 腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床分析%Clinical Analysis of Laparoscopic Cholecystectomy in the Treatment of Acute Exacerbation of Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    马振刚

    2015-01-01

    目的:探讨腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床效果,为临床诊疗提供依据。方法:选取2012年1月至2014年1月我院收治的80例急性发作期胆囊炎患者为临床研究资料,随机分组获得对照组和观察组,各40例,观察组接受腹腔镜胆囊切除手术,对照组接受传统开腹胆囊切除术,对比分析两组治疗效果及并发症等。结果:观察组40例患者中38例完成腹腔镜胆囊切除手术,2例中转开腹,其中1例为Mirizzi综合征,1例因胆囊三角粘连紧密,均于于术中及时中转开腹以治疗。观察组和对照组在有效率、并发症和手术时间方面,两组比较均存在差异统计学意义(P<0.05),观察组治疗效果优于对照组。结论:腹腔镜胆囊切除术治疗急性发作期胆囊炎的临床较好,安全可行,可有效降低手术意外发生率,提高手术成功率。%Objective: To investigate the treatment of laparoscopic cholecystectomy in acute cholecystitis exacerbation of clinical results,that provide the basis for clinical diagnosis and treatment.Methods:80 cases of cholecystitis patients with acute exacerbation of clinical research data in our hospital from January 2012 toJanuary 2014,randomized to the control group and the observation group to get all 40 cases,the observation group underwent laparoscopic cholecystectomy, the control group received conventional open cholecystectomy, comparative analysis of the effect of treatment, and complications.Results:40 patients of the observation group, 38 cases of laparoscopic cholecystectomy,two cases laparotomy, including one case of Mirizzi syndrome, one case of gallbladder triangle close adhesion, both in laparotomy in patients with timely treatment. The observation group and the control group in an efficient,complications and operative time, the two groups were statistically significant differences (P<0.05), the observation group than the

  19. 小切口胆道镜下保胆取石的临床探索%Clinical Study of Lithotomy with Cholecyst Conservation under Choledochoscope by Small Incision for the Treatment of Cholecystolithiasis

    Institute of Scientific and Technical Information of China (English)

    杜成雄; 冯上利; 许可

    2011-01-01

    Objective To explore the clinical feasibility and value of lithotomy with cholecyst conservation under choledochoscope by small incision for the treatment of gallbladder stones. Methods 25 cases of simple gallstone patients underwent the lithotomy with cholecyst conservation under choledochoscope by small incision. All cases were confirmed the diagnosis of non-sediment type gallstones without extrahepatic bile duct stones by preoperative B-ultrasonography or CT, and the gallbladder wall thickness was less than 0. 5cm and postprandial cholecyst contraction was greater than 30%. And the patients were willing to bear the risk of the gallstone recurrence. Before operation, the surface positioning of the gallbladder was performed by B-ultrasonography. Under continuous epidural anesthesia, a 2 ~4cm small incision was cut in the margin of the rib and then the fundus of gallbladder was cut open for 1 cm. Under direct vision by the choledochoscope, the bile cyst stones were taken out and then the bottom of the gallbladder incision was sutured by continuous suture with muscular layer embedded. Thus, the functional gallbladder got retained. Results The mean operation time was 42 (35-65) min and blood loss was minimal. No transit cholecystectomy. 1 case suffered from a small amount of fluid at the gallbladder area and was cured by conservative treatment. There was no bile leakage, bleeding, wound infection, nor other complications. No perioperative death. No recurrence case during the 15 to 40 months follow-up. Conclusion It is safe and feasible of the lithotomy under choledochoscope by small incision for the treatment of gallbladder stones, with advantages of small trauma, safe, rapid postoperative recovery and functional gallbladder remain.%目的 探索小切口保胆取石术治疗胆囊结石的临床可行性及其价值.方法 25例单纯性胆囊结石患者,术前B超或CT证实为非泥沙型胆囊结石,胆囊壁厚小于0.5cm且高脂餐后胆囊收缩大于30%,

  20. Clinical Observation and Analysis of Pregnancy Complicating Cholecystitis and Gallstone Disease%妊娠合并胆囊炎及胆石症的临床观察与分析

    Institute of Scientific and Technical Information of China (English)

    王世平

    2015-01-01

    Objective To observe the pregnancy with cholecystitis,cholelith disease clinical therapeutic effect.MethodsConservative treatment(including fast, and use of antibiotics,gastrointestinal decompression,stimulative bile excretion drugs,etc.). Operative treatment,resection of the galbladder and common bile duct drainage,cases first ful-term pregnancy cesarean section,then galbladder excision,common bile duct exploration. Results 32 cases pregnant women and fetal deaths,conservative treatment of 27 cases,4 cases were threatened abortion,precursor 3 cases of premature,surgical treatment in 5 cases,no incision infection,complications such as abdominal wal hernia. Conclusion For pregnancy with cholecystitis and galstone disease,according to the different during pregnancy,choose conservative treatment combined with surgical treatment respectively,and can decrease the rate of miscarriage,premature birth rate and mortality.%目的:观察分析妊娠合并胆囊炎、胆石症的临床治疗效果。方法保守治疗(包括禁食,应用抗生素,胃肠减压,促进胆汁排泄药物等)。手术治疗:胆囊切除及胆总管引流术,足月妊娠病例先行剖宫产术,随即行胆囊切除,胆总管探查术。结果本组32例无孕妇及胎儿死亡;保守治疗27例,先兆流产4例,先兆早产3例,手术治疗5例,无切口感染,腹壁疝等并发症。结论对于妊娠合并胆囊炎及胆石症,根据孕期不同,选择分别保守治疗与手术治疗相结合,可以降低流产率、早产率及死亡率。

  1. 20例新式微创保胆取石术的应用体会%The application of new mini-invasive surgery for removement of calculus and preservation of cholecyst to 20 patients

    Institute of Scientific and Technical Information of China (English)

    徐明; 卢明柱

    2012-01-01

    目的 探讨新式微创保胆取石术的临床应用价值.方法 回顾分析我院2009年12月至2011年6月采用新式微创保胆取石术治疗20例胆囊结石患者的临床资料.结果 20例均成功取尽结石,结石最大直径约3.5 cm,平均手术时间75 min,出血10~20 ml,平均住院5d,无出血、胆漏等并发症发生.结论 新式微创保胆取石术具有安全性高,操作简单,患者创伤小、痛苦轻、康复快、并发症少等优点,同时保持了胆道的完整性及胆囊功能,但术后结石复发有待更进一步的研究和长期随访.%Objective To explore the clinical application of new mini- invasive surgery for removement of calculus and preservation of chole- cyst. Methods The clinical data of 20 patients with cholecystolithiagis who underwent new mini-invasive surgery for removement of calculus and preservation of cholecyst was analyzed retrospectively from December 2009 to June 2011. Results All stones were removed successfully. The biggest stone was 3.5cm in diameter. Average operative time was 75 min,blood loss was 10 -20 ml,mean hospitalization Was 5d. No bleeding,bile leakage and so on occurred. Conclusions The new mini-invasive surgery for removement of calculus and preservation of cholecyst is safe and feasible,it has advantages of simplicity .little wound and pain,quick recovery, and few complication. It keeps the integrity of biliary tract and the function of gallbladder,but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.

  2. Relationship between ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy%急性胆囊炎术前超声征象与腹腔镜胆囊切除术转开腹的关系

    Institute of Scientific and Technical Information of China (English)

    于爱军; 赵洪涛; 赵鲁文; 史华宁; 张学军; 刘金龙

    2011-01-01

    Objective To explore the relationship between preopertive abdominal ultrasonic features of acute cholecystitis and conversion from laparoscopic to open cholecystectomy. Methods A total of 226 patients with acute cholecystitis received ultrasonic examination before LC. The parameters measured pre-operatively included the gallbladder volume, cholecystic wall thickness, gallbladder fossa fluid, stone impaction in gallbladder neck,adhesions of gallbladder to arourd tissue or adhensions of Calot's triangle. The relationship between the imaging results and conversion to laparotomy in LC were analyzed. Results LC was successfully performed in 208 patients, but 18 were converted to open surgery. Univariate analysis showed that enlarged gallbladder,cholecystic wall thickness, stone impaction in gallbladder neck and adhesions of Calot's triangle were significantly correlated with the conversion to open cholecystectomy ( P < 0. 05 ). Multivariate analysis showed that cholecystic wall thickness and adhesion of Calot's triangle were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery. Conclusions Preoperative ultrasonography for predicting conversion from laparoscopic to open cholecystectomy in acute cholecystitis is simple, and has important significance for selection of laparoscopic operation in acute cholecystitis.%目的 探讨急性胆囊炎术前腹部超声检查征象与腹腔镜胆囊切除术(laparosccpic cholecystectomy,LC)中转开腹的关系.方法 对226例急性胆囊炎LC患者术前行腹部超声检查,记录胆囊容积,胆囊壁厚度,胆囊窝有无积液,胆囊颈管是否有结石嵌顿,胆囊与周围粘连,胆囊三角粘连情况.分析超声显像与LC转开腹的关系.结果 208例成功完成LC,18例中转开腹.单因素分析显示超声检查胆囊容积增大,胆囊壁增厚,胆囊颈管结石嵌顿,胆囊颈粘连是中转开腹的危险因素(P<0.05).多因素回归分析显示胆囊壁增

  3. Clinical comparison of laparoscopic surgery and open surgery in the treat-ment of chronic atrophic cholecystitis%腹腔镜与开腹手术治疗慢性萎缩性胆囊炎的临床对比

    Institute of Scientific and Technical Information of China (English)

    周鹏

    2015-01-01

    目的:对比分析腹腔镜与开腹手术治疗慢性萎缩性胆囊炎的临床疗效。方法回顾性分析2011年7月—2014年5月间在该院治疗的96例慢性萎缩性胆囊炎患者的临床记录资料。结果治疗组的手术时间、平均出血量、胃肠功能恢复时间以及住院时间均明显少于对照组,治疗组止痛药应用率和不良反应发生率也均低对照组,满意率高于对照组,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗慢性萎缩性胆囊炎的临床疗效显著,值得临床推广应用。%Objective To investigate clinical efficacy of laparoscopic surgery and open surgery in the treatment of chronic atrophic cholecystitis. Methods Clinical records data of 96 patients with chronic atrophic cholecystitis in our hospital from July 2011 to May 2014 were reviewed. Results After treatment,the operative time, mean blood loss , gastrointestinal function recovery time and hospital stay of treatment group were significantly less than that of the control group (P<0.05). The painkillers application rate and incidence of adverse events of treatment group were also lower than that in the control group , the satisfaction rate was higher that in the control group (P<0.05 ). Conclusion The clinical efficacy of laparoscopic surgery for chronic atrophic cholecystitis is signifi-cant.

  4. 超声引导下经皮胆囊造瘘术姑息治疗急性胆囊炎的应用价值%Ultrasound Guided Percutaneous Gallbladder Fistula Surgery of Palliative Treatment of Acute Cholecystitis Application Value

    Institute of Scientific and Technical Information of China (English)

    尹明; 王中阳; 钱月萍

    2014-01-01

    目的:探讨超声引导下经皮胆囊造瘘术(PC)姑息治疗急性胆囊炎的应用价值。方法回顾性分析2009年~2013年我院40例超声引导下经皮胆囊造瘘术治疗急性胆囊炎。结果40例患者均一次性穿刺成功,临床症状均明显好转,其中26例梗阻性急性胆囊炎患者择期手术胆囊切除,13例非梗阻性急性胆囊炎患者拔管后保守治疗,1例拔管后胆漏行急诊胆囊切除手术。讨论在姑息治疗急性胆囊炎中,PC具有重要的临床应用价值%Objective To investigate the ultrasound guided percutaneous cystic colostomy surgery (PC) the importance of pal iative treatment for acute cholecystitis. Methods Retrospective analysis of 2010~2013, 40 cases of ultrasound guided percutaneous cystic fistula surgery in treatment of acute cholecystitis. Results 40 patients were succeeded in puncture, and clinical symptoms were significantly improved, in which 30 patients undergoing elective surgery gal bladder excision, 1 case of bile leakage after extubation underwent emergency patients with gal bladder surgery, 1 case drainage tube imaging found in patients with cystic duct obstruction gal bladder surgery, 8 patients were treated conservatively.Conclusion On the pal iative treatment of acute cholecystitis, PC has important clinical value.

  5. 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)

  6. Curative effect observation on 225 case of self-simulation Chaihushuganlidan therapeutic treatment on cholecystitis%自拟柴胡疏肝利胆汤治疗胆囊炎225例疗效观察

    Institute of Scientific and Technical Information of China (English)

    张成军; 朱琳; 刘玉芳

    2012-01-01

    目的观察柴胡疏肝利胆汤治疗胆囊炎的疗效.方法将符合条件的450例患者随机分为治疗组和对照组各225例,治疗组服用柴胡疏肝利胆汤,对照组采用西医常规治疗,两组均治疗3个疗程(7天为1个疗程)后观察疗效.结果两组患者均获不同程度的疗效,但治疗组的疗效明显优于对照组(P<0.05),差异有统计学意义.结论柴胡疏肝利胆汤具有疏肝利胆、行气止痛、化湿清热、利胆排石的功效,且无副作用,便于推广.%Purpose: observation the curative effect of Chaihushuganlidan therapeutic treatment on cholecystitis. Method: random distribution 450 standard patients into two groups with respectively with 225 cases as curative group and control group. The curative group is offered with chaihushudanlidan therapeutic, while the control group is offered with western medical curative treatment. Those two groups both have three courses of treatment (one course of treatment has seven days), then the observation could begin. Result: both two groups of patients get the curative effect with different extent, however, the curative effect of curative group is better than that of control group(p<0.05), that difference has significance of statistics. Conclusion: Chaihushuganlidan therapeutic has the effect of shuganlidan, work qi and remove the pain, disappear the dampness and hotness, benefit the gallbladder and remove the gallstone, with no side effect and convenient to expand.

  7. Use of MRI and MRCP in preoperative evaluation of patients undergoing laparoscopic cholecystectomy for acute cholecystitis%MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术前评估中的应用

    Institute of Scientific and Technical Information of China (English)

    汪建初; 浦涧; 宋斌; 陆涛; 马日海; 吴贤建; 卓臣义; 路远; 王存川

    2015-01-01

    目的 探讨MRI及MRCP在急性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术前评估中的作用.方法 前瞻性搜集我院收治的术前行MRI检查的159例急性胆囊炎资料,记录LC中暴露胆囊三角、胆囊三角解剖、胆囊床剥离所需时间,分析MR表现如胆囊壁厚度、胆囊大小、胆囊壁连续性、胆囊周围积液、胆囊管与肝总管角度等与手术时间关系.结果 手术时间> 90 min的有98例(98/159,61.64%);胆囊壁厚度≥5 mm的患者,胆囊三角解剖及胆囊自胆囊床剥离所需时间较多(P =0.001);胆囊≥4 cm及胆囊黏膜断裂的患者在暴露胆囊三角、胆囊三角解剖、胆囊自胆囊床剥离所需时间均较长(P=0.001),胆囊周围有积液的患者,在暴露胆囊三角、胆囊三角解剖、胆囊床剥离阶段所需时间均较长(P =0.001).胆囊管与肝总管角度<60.的患者,在解剖胆囊三角方面所占时间较长(P =0.001).在暴露胆囊三角方面,胆囊≥4 cm、胆囊黏膜断裂、胆囊周围积液等所需时间较长(P =0.001);全组无中转开腹病例,1例胆总管误夹,无其他严重并发症.结论 MRI及MRCP检查可以预测急性胆囊炎LC手术难度,为急性胆囊炎LC提供指导.%Objective To study MRI and MRCP in preoperative evaluation of laparoscopic cholecystectomy for acute cholecystitis.Methods This is a prospective study,159 acute cholecystitis cases with MRI preoperative evaluation between May 2011 and May 2014 were treated by laparoscopic cholecystectomy (LC).Time required for exposing gallbladder triangle,dissecting gallbladder triangle,and resection of gallbladder was recorded.The relationship between MRI finding and thickness and size of gallbladder wall,gallbladder effusion,and the angle between hepatic duct and cystic duct < 60° was analyzed.Results The time length for LC was more than 90 minutes in 98 out of the 159 cases; In cases with gallbladder wall thickness ≥ 5 mm the time required

  8. 黄色肉芽肿性胆囊炎影像学表现及其病理学基础%Correlation of Imaging Findings and Pathology in Xanthogranulomatous Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    马黎斌; 夏进东; 林江; 王伟时; 曹纪芳; 孙纬纬

    2013-01-01

    目的 探讨黄色肉芽肿性胆囊炎(XGC)的CT与MRI表现及其病理学基础.方法 回顾经手术及病理证实的27例XGC患者影像学资料,27例行CT检查,其中20例行MRI检查.分析CT及MRI影像学表现特征,并与病理结果对照分析.结果 胆囊扩大(CT 93%、MR90%),所有患者(100%)均有胆囊壁增厚.局限性增厚(CT 37%、MR 50%),广泛性增厚(CT 63%、MR 50%).增强扫描见增厚胆囊壁内多发低密度(或信号)结节(CT74%、MR 100%),壁内强化结节(CT 18.5%、MR 15%)胆囊结石(CT 74%、MR 100%).肝脏及胆囊间隙不清(CT74%、MRI90%),胆囊内见点状气体(CT7% MRI 0%).增强扫描胆囊黏膜线连续(CT 44%、MRI 60%),中断(CT56%、MRI 40%),术前准确诊断XGC(CT 67%、MRI75%),误诊为胆囊癌(CT 26%、MRI 15%).结论 胆囊壁广泛或局限增厚,增强扫描增厚胆囊壁呈“三明治征”或“夹心饼干征”、囊壁内见强化和/或低密度(信号)结节,黏膜线连续或部分中断可能为XGC特征性CT及MRI表现,有助于该病的准确诊断.%Objective To discuss image and pathology features of xanthogranulomatous cholecystitis (XGC).Methods Image data of 27 cases with XGC surgically and pathologically confirmed were analyzed retrospectively.All cases received routine CT examination,20 of them received MRI examination.CT and MRI imaging features,as well as pathological results were analyzed Results The image features included:gallbladder distention (CT 93%,MR 90%),gallbladder wall thickening (100%),limited wall thickening (CT 37%,MR 50%),diffuse wall thickening (CT 63%,MR 50%),multiple or single intramural hypodensity or hypointensity nodules (CT 74%,MR 100%),hyperdensity or hyperintensity intramural nodules (CT l8.5%,MR 15%),gallbladder calculus (CT 74%,MR 100%),unclear demarcation between the gallbladder and liver (CT 74%,MRI 90%),gallbladder gas (CT 7% MRI 0%),continuous gallbladder mucosa

  9. 冲击波对慢性非结石性胆囊炎患者胆囊收缩功能影响的临床观察%Clinical Observation of the Influence of Shock Wave to the Gallbladder Systolic Function of Chronic Acalculous Cholecystitis Patients

    Institute of Scientific and Technical Information of China (English)

    唐海涛; 李春恒; 赵红燕

    2015-01-01

    Objective This article aims to discuss about the influence of extracorporeal shock wave on the gallbladder systolic function of chronic acalculous cholecystitis patients. Methods Adopt the JDPN - VB model extracorporeal shock wave lithotripter by Shanghai Jiaotong University for the 40 cases of chronic acalculous cholecystitis patients;take the right upper quadrant as the shock wave path,and in prone position,to conduct the extracorporeal shock wave therapy to the cholelithiasis;with the therapy voltage of 8~ 10 kv and the times of shock wave of 1000,to conduct statistics to the changes of gallbladder systolic percentage before and one month after the shock wave therapy. Results The gallbladder systolic percentage is obviously increased for the 40 cases of chronic acalculous cholecystitis patients after the extracorporeal shock wave therapy than before,with obvious difference and the statistical sig-nificance(P ﹤ 0. 05). Conclusion The extracorporeal shock wave can effectively improve the gallbladder systolic function.%目的:探讨体外冲击波对慢性非结石性胆囊炎病人胆囊收缩功能的影响。方法对40例慢性非结石性胆囊炎患者采用上海交大 JDPN - VB 型体外冲击波碎石机,以右上腹部为冲击波路径,俯卧位,对病变胆囊进行体外冲击波治疗,治疗电压选择8~10 KV,冲击波次数为1000次,于治疗前及冲击波治疗后一个月统计胆囊收缩率变化情况。结果40例慢性非结石性胆囊炎患者经体外冲击波治疗后胆囊收缩率较治疗前明显升高,差异具有统计学意义( P ﹤0.05)。结论体外冲击波可以有效地改善胆囊的收缩功能。

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

    Institute of Scientific and Technical Information of China (English)

    张安红; 马杰; 张宝民; 胡孝祯; 姜远辉

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李文彬

    2015-01-01

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

  12. 传统开腹手术与腹腔镜手术治疗慢性萎缩性胆囊炎效果对比分析%Comparing the Effect of Traditional Open Surgery and Laparoscopic Surgery for Chronic Atrophic Cholecystitis

    Institute of Scientific and Technical Information of China (English)

    廖方; 廖锦岐; 方永平; 段进东; 游锦华

    2016-01-01

    Objective:To compare analyzing clinical effects of the traditional open surgery and laparoscopic surgery for chronic atrophic cholecystitis. Methods:To select 86 cases of chronic atrophic cholecystitis patients were randomly divided into observation group and control group. They were given lapa-roscopic surgery and traditional open surgery. To compare sur-gery, postoperative complications were pain killers and usage of the two groups of patients. Results:Observation group were op-eration time, flatus time, hospital stay, time to extubation com-pared with the control group were significantly reduced blood loss compared with the control group were significantly lower hospital costs but significantly increased incidence of postoper-ative complications in patients in the observation group only 2.33%, painkiller usage of only 6.98%, while the incidence of postoperative complications in patients in the control group 20.93%painkiller usage up 27.91 percent, the differences were statistically significant (P <0.05). Conclusion:Laparoscopic surgery for chronic atrophic cholecystitis than conventional open surgery significantly improved clinical efficacy, shorten the operation time, reduce the amount of blood transfusion, and promote the rehabilitation of patients after surgery to reduce the incidence of complications, worthy of further application in clin-ical practice.%目的:对比分析传统开腹手术与腹腔镜手术治疗慢性萎缩性胆囊炎的临床效果。方法:选取86例慢性萎缩性胆囊炎患者随机分为观察组和对照组,分别采用腹腔镜手术和传统开腹手术治疗,比较两组患者手术情况,术后并发症发生情况及止痛药使用情况。结果:观察组患者手术时间、肛门排气时间、住院时间、拔管时间较对照组患者显著缩短,术中出血量较对照组患者显著降低,但住院费用显著提高,观察组患者术后并发症发生率仅为2.33%,止痛药使用率仅为6

  13. Investigate of cause and opportunity of alternative laparotomy in laparoscopic cholecystectomy for ;cholecystitis complicated with gallbladder stone patients%胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术中转开腹的原因及时机探讨

    Institute of Scientific and Technical Information of China (English)

    孔锡根; 万里鹏; 王继阳

    2015-01-01

    Objective To investigate cause and opportunity of alternative laparotomy in laparoscopic cholecystectomy(LC) for cholecystitis complicated with gallbladder stone patients. Methods Clinical data of 83 cholecystitis complicated with gallbladder stone patients were retrospectively analyzed. The patients were divided by surgery condition into laparoscopic cholecystectomy group (group A, n=30), active alternative laparotomy group (group B, n=26), and passive alternative laparotomy group (group C, n=27). Differences of risk factors for alternative laparotomy were compared in the three groups, and their operation process, intraoperative bleeding volume, postoperative exhaust time, and hospital stay were recorded. Results ①Groups B and C had much higher white blood cell count, thickness of gallbladder wall, and history of epigastrium operation than the group A. Their difference had statistical significance (P<0.05). ②After treatment, group A had the shortest operation process, intraoperative bleeding volume, postoperative exhaust time, and hospital stay among the three groups. Those were in middle levels in group B, and those of group C were the longest ones. Their differences had statistical significance (P<0.05). Conclusion Thickness of gallbladder wall, history of epigastrium operation, and white blood cell count are the risk factors of alternative laparotomy in laparoscopic cholecystectomy for cholecystitis complicated with gallbladder stone patients. Active alternative laparotomy according to intraoperative probing status is helpful for improving prognosis quality of patients.%目的:探讨胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术(LC)中转开腹的原因及时机。方法回顾性分析83例胆囊炎合并胆囊结石患者临床病历资料,根据其实际手术情况分成成功完成腹腔镜胆囊切除术组(A组, n=30)、主动中转开腹组(B组, n=26)和被动中转开腹组(C组, n=27)三组。分析三组患者中转开腹危险

  14. Operational Management and Complication Prevention of Laparoscopic Cholecystectomy for Gangrenous Cholecystitis Caused by Incarcerated Gallstones:Report of 36 Cases%结石嵌顿坏疽性胆囊炎腹腔镜手术处理与并发症预防(附36例报告)

    Institute of Scientific and Technical Information of China (English)

    秦建民; 倪雷; 赵威; 张敏; 陈诚; 潘刚; 陈腾

    2015-01-01

    Objective To explore the operational management and complication prevention of laparoscopic cholecystectomy for gangrenous cholecystitis caused by incarcerated gallstones . Methods Laparoscopic cholecystectomy was urgently performed in 36 patients with gangrenous cholecystitis caused by incarcerated gallstones .The puncture was performed to decompress the gallbladder at the bottom of the gallbladder in order to reveal the gallbladder ampulla .The gallbladder wall was opened to take out stones when the gallbladder ampulla could not be revealed after decompression .The front and rear gallbladder triangles were bluntly dissected adjacent to the gallbladder ampulla to reveal the cystic duct .Then the cystic duct was clipped and cut off near the gallbladder ampulla .The cystic duct was closed with 4-0 absorbed stitches or left open with residual gallbladder mucosa in the gallbladder neck . Results Laparoscopic cholecystectomy was performed in 35 patients, with a conversion to open cholecystectomy performed in 1 patient.The operation time was 45-150 min, with a mean of 55 min.The mean intraoperative blood loss was 80 ml (range, 50-250 ml).The hospital stay was 3 -10 d, with a mean of 4.5 d.The bile leakage occurred in 1 patient after operation , which was cured with conservative treatment .There were no complications such as abdominal bleeding or infection in all the patients .A total of 31 patients were followed up for 6-18 months ( mean, 11 months ) .No abdominal pain , jaundice , bile duct stricture , or secondary bile duct calculus occurred in all the patients . Conclusion It is crucial in laparoscopic cholecystectomy for gangrenous cholecystitis caused by incarcerated gallstones that preoperative imaging examination , fine intraoperative performance , and rational management are emphasized.%目的:探讨结石嵌顿坏疽性胆囊炎腹腔镜胆囊切除术的技巧与并发症预防。方法2009年6月~2014年6月急诊LC治疗结石嵌顿坏疽性胆囊炎36

  15. Analysis of the effect contrast of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of patients with acute cholecystitis%腹腔镜胆囊切除和传统开腹胆囊切除治疗急性胆囊炎的效果对比

    Institute of Scientific and Technical Information of China (English)

    高国强; 戴季蓬

    2015-01-01

    目的:对比分析腹腔镜胆囊切除术和传统开腹胆囊切除术治疗急性胆囊炎的临床疗效。方法:收治急性胆囊炎患者160例,随机分成两组,腹腔镜组采取腹腔镜胆囊切除术治疗,传统组采取传统开腹胆囊切除术治疗,比较两组治疗效果。结果:腹腔镜组术中出血量、术中引流量均少于传统组;手术时间、切口长度、住院时间、术后下床时间、肠鸣音恢复时间均短于传统组;疼痛评分低于传统组;并发症发生率明显低于传统组,差异有统计学意义(P<0.05)。结论:腹腔镜手术相较于传统开腹手术不仅疗效具有优势,也使患者术后恢复更快。%Objective:To analyze the contrastive effect of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of patients with acute cholecystitis.Methods:160 patients with acute cholecystitis were selected.They were randomly divided into the two groups.Patients in the laparoscopic group treated with laparoscopic cholecystectomy.Patients in the traditional group were taken the conventional open cholecystectomy treatment.We compared the treatment effect of the two groups.Results:The intraoperative blood loss and intraoperative lead flow of the laparoscopic group were less than those of the traditional group. The operation time,incision length,hospitalization time,postoperative ambulation time,recovery time of bowel sounds were shorter than those of the traditional group.The pain score was lower than the traditional group.The complication rate was significantly lower than that of the traditional group,and the difference was statistically significant(P<0.05).Conclusion: Laparoscopic operation not only has the efficacy advantages compared to the traditional open surgery,but it also can make the patients recover faster.

  16. Analysis of Curative Effect of Treating Acute Cholecystitis With Fifteen Kinds of Bucket Purcell Pill by Combination With Cefmetazole and Gatifloxacin%十五味赛尔斗丸结合头孢美唑、加替沙星治疗急性胆囊炎的疗效分析

    Institute of Scientific and Technical Information of China (English)

    额尔敦

    2016-01-01

    Objective Analyze the effect of fifteen kinds of bucket purcell pill in the treatment of acute cholecystitis by combination of cefmetazole and gatifloxacin. Methods 96 patients were two groups for the control group and the observation group, while the control group adopted conventional bed resting, fasting, rehydration nursing method, using the combination of intravenous cefmetazole, gatifloxacin treatment method. The observation group in the control group, with fifteen kinds of purcell bucket pill. Results The treatment effect of the observation group is more significant, the body temperature, nausea and vomiting in patients with significantly lower probability of occurrence. The probability of comparing the two groups of body temperature,pain, fever, vomiting, the difference was statistically significant (P<0.05). Conclusion Patients with acute cholecystitis by fifteen kinds of purcell bucket pill combined with cefmetazole, reducing the incidence of adverse reactions in patients, improve the quality of life of patients.%目的:分析十五味赛尔斗丸结合头孢美唑、加替沙星治疗急性胆囊炎的疗效。方法96例患者随机分为对照组与观察组,对照组采取常规的卧床休息、禁食、补液和解痉止痛护理方法,加上静脉结合头孢美唑、加替沙星的治疗方法。观察组在对照组的基础上,加十五味赛尔斗丸。结果观察组的治疗效果更为显著,患者的体温、恶心呕吐发生概率更低。比较两组患者的体温、腹痛、发热等不良反应的发生概率,差异具有统计学意义(P <0.05)。结论对急性胆囊炎患者采用十五味赛尔斗丸结合头孢美唑、加替沙星治疗,降低了患者不良反应的发生率,提高了患者的生活质量。

  17. 慢性萎缩性胆囊炎采用腹腔镜胆囊切除术治疗的临床价值探析%Analysis of Clinical Curative Value of the Treatment of Chronic Atrophic Cholecystitis With Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    靳洪申

    2015-01-01

    目的:探讨慢性萎缩性胆囊炎采用腹腔镜胆囊切除术治疗的临床价值。方法本次医学研究选择我院2011年1月~2014年12月之间收治的200例慢性萎缩性胆囊炎患者为观察对象,将其分为对照组和实验组,对照组接受常规开腹手术治疗,实验组接受腹腔镜胆囊切除术治疗,回顾分析两组患者临床治疗效果。结果两组观察对象并发症发生率对比无明显的统计学差异(P>0.05);实验组术后腹腔引流量、术中出血量、手术时间均少于对照组(P0.05). The abdominal cavity drainage flow,bleeding volume and operation time in experimental group were less than in control group(P<0.05). Conclusion By the medical research results,Laparoscopic cholecystectomy is a more effective clinical treatment of chronic atrophic cholecystitis.

  18. Effects of Acupuncture of Jianjing (GB 21) on Gallbladder Volume and Symptoms of Cholecystitis Patients%针刺肩井穴对慢性胆囊炎患者胆囊收缩功能影响的随机对照研究

    Institute of Scientific and Technical Information of China (English)

    温峰云; 李双成; 王国明; 李丽霞; 宋永强

    2012-01-01

    Objective To observe the effect of acupuncture of Jianjing (GB 21) and non-acupoint on gallbladder volume and clinical symptoms of chronic cholecystitis patients. Methods Sixty cases of chronic cholecystitis patients were equally randomized into Jianjing (GB 21) group and non-acupoint group. A filiform needle was inserted into Jianjing (GB 21) or non-acupoint (2 cun lateral to the mid-point between the spinous processes of the 6thand 7th cervical vertebrae) on the right side, manipulated for a while till "Deqi", and retained for 30 min. A color Doppler ultrasound scanner was used to detect the volume of the gallbladder before and 15 min after acupuncture stimulation and 30 min after withdrawal of the acupuncture needle. Changes of the patients' symptoms of shoulder-back pain, stomachache, distension and nausea were evaluated according to the patients' complaints. Results After acupuncture intervention, the remission rates of shoulder-back pain and stomachache in non-acupoint and GB21 groups were 56. 67% and 90. 00% respectively, while the effective rates of the patients' gastric distention and nausea in non-acupoint and GB 21 groups were 16. 67% and 23. 33% , respectively. The therapeutic effect of Jianjing (GB 21) was apparently superior to that of non-acupoint in pain relief (P0. 05). Conclusion Acupuncture stimulation of Jianjing (GB 21) can effectively relieve shoulder-back pain and stomachache, and regulate the volume of the deflated and expanded gallbladder in cholecystitis patients. The effect of acupuncture of non-acupoint is relatively poorer in relieving the cholecystitis pa- tients' symptoms and regulating the gallbladder volume.%目的:观察针刺肩井穴与非经非穴对胆囊炎患者胆囊收缩功能的影响,探讨肩井-胆囊之间的内在联系.方法:将60例慢性胆囊炎患者随机分为肩井组和非穴组,每组30例.肩井组针刺右侧肩井穴,非穴组针刺第6与第7颈椎棘突间右侧旁开2寸处,均留针30 min.

  19. 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

  20. Comparative Analysis of the Clinic Effect Between Laparoscopic Cholecys-tectomy and Open Cholecystectomy on Acute Cholecystitis%腹腔镜与传统开腹式治疗急性胆囊炎的临床效果对比分析

    Institute of Scientific and Technical Information of China (English)

    蔡建平

    2014-01-01

    目的:比较分析腹腔镜与传统开腹术治疗急性胆囊炎的临床效果。方法收集该院收治的524例急性胆囊炎患者资料作为分析对象,其中285例行腹腔镜胆囊切除术,239例行传统开腹胆囊切除术。比较两组患者的术中指标:如切口长度、术中出血量、术中引流量、手术时间;术后各项恢复指标,如肠鸣音恢复时间、疼痛视觉模拟评分、止痛药使用例数、术后下床时间和住院时间;以及并发症情况。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标:切口长度、术中出血量、术中引流量、手术时间分别为(3.5±0.7) cm,(45.2±8.4) mL,(63.8±12.9) mL,(52.7±15.3) mL,均低于于传统开腹胆囊切除术的(11.2±2.7)cm,(89.1±16.6) mL,(97.6±14.2) mL,(85.1±14.6) mL;两组间差异有统计学意义(P<0.05)。同时,术后各项恢复指标,如肠鸣音恢复时间、疼痛评分、止痛药使用例数、术后下床时间和住院时间分别为(23.2±3.5) h,(2.3±0.6)分,203例,(27.1±4.2)h,(5.0±1.5)d,差异有统计学意义(P<0.05)低于于传统开腹胆囊切除术的(43.6±6.8) h,(4.7±1.4) h,236例,(48.3±7.5) h,(12.5±4.0) d。同时,腔镜胆囊切除术患者的并发症发生率(3.5%)显著低于传统开腹式(11.3%)(P<0.05)。结果腹腔镜胆囊切除术治疗急性胆囊炎的术中各项指标、术后各项恢复指标均显著优于传统开腹胆囊切除术(P<0.05)。同时,腔镜胆囊切除术患者的并发症发生率显著低于传统开腹式(P<0.05)。结论腹腔镜胆囊切除术是一种治疗急性胆囊炎的安全、有效的手术方式,值得在临床上推广。%Objective To compare and analyze the clinic effect between laparoscopic cholecystectomy and open cholecystectomy on acute cholecystitis. Methods The clinical data of 524 patients with acute

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  2. Effect of Sophora Alopecuroides on Contraction of Isolated Cholecyst Smooth Muscle Strips inGuinea Pigs in Vitro%苦豆子总碱对豚鼠离体胆囊平滑肌条收缩功能的影响

    Institute of Scientific and Technical Information of China (English)

    苏丽梅; 戴贵东; 丁娟; 聂黎虹; 周旭

    2011-01-01

    目的 观察苦豆子总碱对豚鼠离体胆囊平滑肌运动功能的影响并初步探讨其作用机制.方法 将28只豚鼠随机分为7组,每只豚鼠胆囊制备3条肌条,共84条.将12条胆囊肌条置于灌流肌槽内,采用累积加药方式,苦豆子总碱终浓度分别为1.00×10-5、1.10×10-4和1.10×10-3mmol·L-1.按随机法将其余72条胆囊肌条分为6组:阿托品+苦豆子总碱组、酚妥拉明+苦豆子总碱组、异搏定+苦豆子总碱组、苯海拉明+苦豆子总碱组、消炎痛+苦豆子总碱组、六烃季铵+苦豆子总碱组,每组12条.分别加入拮抗剂阿托品10-6mmol·L-1、酚妥拉明10-6 mmol·L-1、异搏定10-7mmol·L-1、苯海拉明10-6 mmol·L-1、消炎痛10-6mmol·L-1、六烃季铵10-5 mmol·L-1后2min再依次加入前述累积加药苦豆子总碱溶液.通过FT-100生物张力传感器将信号输出BL-420E+生物机能实验系统记录标本的张力、收缩波平均振幅及收缩频率的变化值.结果 苦豆子总碱1.10×10-6和1.10×10-3mmol·L-1可使胆囊平滑肌肌条张力增高(P<0.01);异搏定(10-7mmol·L-1)能明显降低苦豆子总碱(1.10×10-4和1.10×10-3 mmol·L-1)对豚鼠胆囊平滑肌条收缩张力的影响(P<0.01).表明苦豆子总碱拮抗异搏定抑制钙离子的内流.结论 苦豆子总碱可提高胆囊肌条的张力,这种作用可能与Ca2+通道有关.%Objectiye To observe effect and mechanism of sophora alopecuroides on isolated cholecyst smooth muscle strips in guinea pigs in vitro. Methods 28 guinea pig were randomly divided into 7 group. 3 muscular strips of smooth muscle were established in each cholecyst with 84 in total. 12 muscle strips were put in perfused muscle chamber. Using the cumulative administration, Sophora alopecureides final concentration were 1.00 × 10-5,1.10 × 10-4 and 1.10 × 10-3 mmol · L-1 respectively. 72 muscular strips were randomly divided into 6 groups: atropine + sophora alopecuroides groups, phenolamine + sophora

  3. Study on the relationship of acute lithic cholecystitis with nitric oxide,oxidation and lipoperoxidation%急性结石性胆囊炎与一氧化氮、氧化和脂质过氧化关系的研究

    Institute of Scientific and Technical Information of China (English)

    施小燕; 陈鹏; 周君富; 彭承宏; 沈宏伟; 朱友根; 杨金禄

    2001-01-01

    Objective In order to study the relationship of nitric oxide,oxidation and lipoperoxidation with acute lithic cholecystitis with free radical medicine.Methods Plasma levels of nitric oxide(P-NO),vitamin C (P-VC),vitamin E(P-VE),β-carotene(P-β-CAR) and lipoperoxides (P-LPO) as well as erythrocyte activities of superoxide dismutase(E-SOD),catalase(E-CAT),glutathione peroxidase(E-GSH-Px) and level of lipoperoxides (E-LPO)were determined spectrophotometrically. In 97 patients with acute lithic cholecystitis (the ALC group) and 100 healthy volunteers (the HVT group).Results Compared with the above determined average values (AV) of the HVT group,the AV of P-NO,P-LPO and E-LPO in the ALC group were significantly increased (P=0.001),the AV of PVC,P-VE,P-β-CAR,E-SOD,E-CAT and E-GSH-Px were significantly decreased(P=0.001).Compared with the AV in preoperative ALC group,the AV of P-NO,P-LPO and E-LPO in postoperative ALC group were significantly decreased (P<0.001),the AV of P-VC,E-SOD,E-CAT and E-GSH-Px were significantly increased (P<0.001),but there was no significant difference in the AV of P-VE and that of P-β-CAR between pre-operation and post-operation.Conclusion In the ALC patients' bodies the metabolism of nitric oxide was grave turbulence,a series of free radical chain reactions were pathologically aggravated,the balance between oxidation and antioxidation was serious disorder.%目的从自由基医学的角度探讨一氧化氮、氧化和脂质过氧化与急性结石性胆囊炎之间的关系。方法用分光光度法检测了97例急性结石性胆囊炎患者(ALC)和100例健康志愿者(HVT)血浆中的一氧化氮(P-NO)、维生素C(P-VC)、维生素E(PVE)、β-胡萝卜素(P-β-CAR)和过氧化脂质(P-LPO)含量及红细胞超氧化物歧化酶(E-SOD)、过氧化氢酶(E-CAT)、谷胱甘肽过

  4. Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis

    NARCIS (Netherlands)

    Keus, F.; Broeders, I. A. M. J.; van Laarhoven, C. J. H. M.

    2006-01-01

    Indications for cholecystectomy are limited to clearly symptomatic gallstones. Relatively high failure rates of pain relief are probably caused by incorrect selection of patients for the operation. Contraindications for (laparoscopic) cholecystectomy are related to anaesthesiological considerations.

  5. Acalculous cholecystitis: complication of pediatric systemic lupus erythematosus.

    Directory of Open Access Journals (Sweden)

    Consuelo de Rovetto

    2009-11-01

    Full Text Available Se describe un caso de una niña de 12 años con diagnóstico previo de lupus eritematoso sistémico (LES de tres años de evolución, que se presentó con dolor abdominal epigástrico tipo cólico. En la evaluación se demostró activación de la enfermedad por clínica y serología. La ecografía abdominal inicial fue normal y la endoscopia digestiva alta mostró gastritis antral, por lo cual se inicio omeprasol con dieta. Por persistencia del dolor y no mejoría con manejo medico para gastritis se repitió la ecografía abdominal 6 días después, que mostró engrosamiento de las paredes de la vesícula sin cálculos en su interior. Se hizo colecistectomía laparoscópica con mejoría de la paciente. La patología mostró evidencia de vasculitis de las arterias medias de las paredes de la vesícula. La colecistitis acalculosa por vasculitis es una complicación raramente descrita en adultos con LES; en la literatura consultada se encontró un solo caso pediátrico. Como este caso es de interés, se informa y se revisa la literatura.

  6. Acalculous cholecystitis: complication of pediatric systemic lupus erythematosus.

    OpenAIRE

    Consuelo de Rovetto; Andrés Felipe Ortiz; Ricardo Zarama; Luis Eduardo Bravo

    2009-01-01

    Se describe un caso de una niña de 12 años con diagnóstico previo de lupus eritematoso sistémico (LES) de tres años de evolución, que se presentó con dolor abdominal epigástrico tipo cólico. En la evaluación se demostró activación de la enfermedad por clínica y serología. La ecografía abdominal inicial fue normal y la endoscopia digestiva alta mostró gastritis antral, por lo cual se inicio omeprasol con dieta. Por persistencia del dolor y no mejoría con manejo medico para gastritis se repitió...

  7. 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

    -old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients...

  8. Emphysematous Cholecystitis: A Rare Complication of Hepatitis A Virus Infection

    Directory of Open Access Journals (Sweden)

    Ahmet KARAKAS

    2015-03-01

    Full Text Available Hepatitis A virus (HAV causes an acute hepatitis associated with significant elevatation in liver enzymes. The liver is main target of HAV and extrahepatic manifestations are scarce. The diagnosis of acute HAV infection is made by the detection of anti-HAV IgM antibody in patients with the typical clinical presentation.. Here in, we present a 22-year old male presented with malaise, fever, nause, and intensive stomach ache. In physical examination, the patient had fever, jaundice, and hepatomegaly. Laboratory tests resulted in elevated liver enzymes. Abdominal ultrasonography demonstrated thickening of the gallbladder wall, and intramural air. As the patient's symptoms failed to regress in follow up laparoscopic cholecystectomy was performed. To sum up, HAV infection can be seen in all age groups, in developing countries, such as our country. It must be kept in mind that, although very rarely, HAV infections may exhibit extrahepatic complications. [Dis Mol Med 2015; 3(1.000: 5-7

  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

    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

  10. Color Doppler flow imaging in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomy%急性胆囊炎腹腔镜胆囊切除术前彩色多普勒超声对其难度的预测价值

    Institute of Scientific and Technical Information of China (English)

    王川予; 蒋文莉; 马娜

    2010-01-01

    Objective To evaluate the value of preoperative color Doppler flow imaging findings for predicting possible difficuulties encountered during laparoscopic cholecystectomy (LC).Methods Eighty-six Datients with acute cholecystitis underwent color Doppler flow imaging examination were divided into operation difficult group(67 cases)and operation easy group(19 cases)according to the diffculty score.The parameters were measured pre-operation including the volume of gallbladder,the thickness of the gallbladder wall,the condition of arterial flow in the gallbladder wall,the conditions of gallbladder cavity and gallbladder fossa and the intra-and extra-hepatic bile duet.The relationships among imaging results,operation difficulties and operation findings were investigated.Results Gallbladder volume,gallbladder wall thickness.the presence rates of plentiful arterial flow in the gallbladder wall,adhesion of gallbladder and stone incarceration In operation difficult group were significantly different from those in operation easy group [(52.6±14.6)mm~3 vs(32.6±10.4)mm~3,(9.7±4.1)mm vs(3.8±0.9)mm,89.5%(17/19)vs 17.9%(12/67),78.9%(15/19)vs 11.9%(8/67),10.5%(2,19)vs 0(0/67)](P<0.05 or<0.01).The accurate rate was 94.2%(81/86)in predicting.Conclusion Preoperative color Doppler flow imaging is helpful in predicting difficulties of LC.%目的 探讨术前彩色多普勒超声检查对急性胆囊炎腹腔镜胆囊切除术难度的预测价值.方法 86例急性胆囊炎腹腔镜胆囊切除术患者,根据术中实际难度评分分为困难组(67例)和容易组(19例),比较两组术前行彩色多普勒超声检查指标,包括胆囊容积、胆囊壁厚度及血流、胆囊腔、胆囊床和肝内外胆管情况,评价术前超声检测指标与手术难度之间的关系.结果 困难组与容易组超声检测胆囊容积分别为(52.6 4±14.6)mm~3和(32.6±10.4)mm~3,胆囊壁厚度分别为(9.7±4.1)mm和(3.8±0.9)mm,胆囊壁血流信号丰富的发生率分别为89

  11. 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

  12. 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.

  13. Radiological evidences from emphysematous cholecystitis. Manifestaciones radiologicas de la colecistitis enfisematosas

    Energy Technology Data Exchange (ETDEWEB)

    Martin Garcia, V.; Ganado Diaz, T.; Cabeza Martinez, B.; Montoro Martos, E.; Contreras Cecilia, E. (Hospital Clinico Universitario ' ' San Carlos' ' . Servicio de Radiodiagnostico. Madrid (Spain))

    1993-05-01

    Emphysematous cholecystitits is an uncommon clinical disorder, the diagnosis of which is based on the demonstration of the presence of gas in the vesicular wall and/or lumen. We present 9 cases studied by means of simple radiography, ultrasonography and abdominal CT scan. The diagnosis was based in every case on imaging methods and was confirmed surgically. (Author)

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

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  15. Duplex gall bladder associated with choledocholithiasis, cholecystitis, gall bladder rupture and septic peritonitis in a cat.

    Science.gov (United States)

    Moores, A L; Gregory, S P

    2007-07-01

    A 10-year-old cat was presented with a history of inappetence, pyrexia and weight loss. Clinical investigations showed anaemia, hyperbilirubinaemia, septic peritonitis and a double gall bladder with choleliths in an extrahepatic duct. Initial medical stabilisation was performed. At laparotomy, a duplex gall bladder with two separate cystic ducts was identified. The left gall bladder was thickened and had ruptured at the apex. Multiple choleliths were identified in the left cystic duct. The right gall bladder and cystic duct were grossly normal. The ruptured gall bladder was repaired, the gallstones were removed via a choledochotomy of the left cystic duct and a choledochoduodenostomy was created from the dilated left cystic duct. The cat remained depressed and anorexic, and it was euthanased 72 hours postoperatively at the owners' request. This is the first ante-mortem investigation of extrahepatic biliary disease associated with gall bladder duplication in the cat.

  16. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Feza Y Karakayali; Aydincan Akdur; Mahir Kirnap; Ali Harman; Yahya Ekici and Gökhan Moray

    2014-01-01

    BACKGROUND: In low-risk patients with acute cholecystitis who  did  not  respond  to  nonoperative  treatment,  we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic  cholecystectomy  and  43  patients  were  treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared  with  the  patients  who  had  emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy  had  a  lower  frequency  of  conversion  to open surgery [19 (40%) vs 8 (19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16 (33%) vs 4 (9%); P=0.006], a mean postoperative hospital stay (5.3±3.3 vs 3.0±2.4 days; P=0.001), and a frequency of complications [17 (35%) vs 4 (9%); P=0.003]. CONCLUSION: In  patients  with  acute  cholecystitis  who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic chole-cystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.

  17. 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.

  18. Gallstones

    Science.gov (United States)

    ... may cause swelling or infection in the: Gallbladder (cholecystitis) Tube that carries bile from the liver to ... Elsevier Saunders; 2012:chap 55. Read More Acute cholecystitis Bile Cholangitis Choledocholithiasis Chronic cholecystitis Gallbladder removal - laparoscopic ...

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.)

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

    OpenAIRE

    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...

  5. 急性胆囊炎的腹腔镜手术治疗

    Institute of Scientific and Technical Information of China (English)

    刘朝晖; 黄武飙

    2004-01-01

    Objective To summarize the operating experience in the treatment of acute cholecystitis. Methods The clinical data and therapeutic outcome of 63 cases with acute cholecystitis in lapanoscopic cholecystectomy (LC)were reviewed. Results All of the cases were cured by LC, no serious postoptative complications and death occurred.Conclusion It is salty for laparoacopic cholecyst ectomy in treating acute cholecystitis.

  6. 急性胆囊炎及合并症的超声诊断分析

    Institute of Scientific and Technical Information of China (English)

    张元芬

    2004-01-01

    Objective To study the ultrasonic diagnosis value of acute cholecystitis and its complication. Methods The ultrasonic images of 148 cases with acute cholecystitis and its complication were retrospective analysised. Result Fifteen cases with simplicity acuteness cholecystitis, thirty-three cases with purulent acuteness cholecystitis, three cases with acuteness gangrenous cholecystits. Ninety- seven cases was chronic cholecystitis with acute attack merging gallbladder calculous. In them, four cases with biliary tract roundworm, nine cases with gallbladder polypus, two cases with perforation of gallbladder. Conclusion The ultrasonic has very high detectable rate and diagnose exactness rate in acute cholecystitis and its complication.

  7. Clinical analysis of biliary peritonitis patients due to cholecystitis%胆囊炎症致胆汁性腹膜炎临床分析

    Institute of Scientific and Technical Information of China (English)

    孙志刚

    2006-01-01

    自1989—2004年,在胆囊炎并发胆汁性腹膜炎手术中,发现7例患者胆囊标本经肉眼检查未发现明显穿孔,但手术中可见腹腔积聚大量胆汁,现总结报告如下。

  8. Hepatobiliary

    Science.gov (United States)

    ... by a sudden inflammation of the gallbladder called cholecystitis pain or fever following surgery on the gallbladder ... Related Articles and Media General Nuclear Medicine Gallstones Cholecystitis X-ray, Interventional Radiology and Nuclear Medicine Radiation ...

  9. Diagnostic laparoscopy

    Science.gov (United States)

    ... in other areas ( endometriosis ) Inflammation of the gallbladder (cholecystitis) Ovarian cysts or cancer of the ovary Infection ... Elsevier Saunders; 2014:1403-1405. Read More Acute cholecystitis Appendicitis Cancer Ectopic pregnancy Endometriosis Ovarian cysts Pelvic ...

  10. Abdominal Pain Syndrome

    Science.gov (United States)

    ... of the stomach) Pancreatitis (inflammation of the pancreas) Cholecystitis (inflammation of the gall bladder) Choledocholithiasis (passage of ... correct a problem. For example, pain due to cholecystitis (inflammation of the gall bladder) is usually treated ...

  11. Gallbladder radionuclide scan

    Science.gov (United States)

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

  12. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

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

  13. 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.)

  14. 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).

  15. 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...... cholecystitis....

  16. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases

    DEFF Research Database (Denmark)

    Zubair, M; Habib, L; Mirza, M R;

    2010-01-01

    .5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved...

  17. Disease: H01213 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01213 Gallbladder disease; Cholecystitis; Cholelithiasis Gallbladder disease is on...e of the most common digestive disorders. Cholecystitis is an inflammation of the gallbladder wall, that is ...almost always associated with cholelithiasis, or gallstones. Cholecystitis and cholelithiasis appear to be c

  18. 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.

  19. The Medical Implications of Women On Submarines

    Science.gov (United States)

    2001-11-26

    to duty. The exact percentage of patients with gallstones that develop attacks of biliary colic or of acute cholecystitis is unknown. Patients may...have cholecystitis without the presence of gallstones. The ratio for acute cholecystitis is 3:1 women to men up to age 50.41 Orthopedic Injuries...sunlight and of diet to the circulationg concentrations of 25- hydroxyvitamin D in an elderly nursing home population in Boston. American Journal of

  20. 生物蛋白胶在急性胆囊炎LC术中的应用体会%Application Experience of Organism Albumin Glue in Acute Cholecystitis in Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    张小红; 贾晓巍; 黄秋林; 杨林

    2002-01-01

    目的:探讨生物蛋白胶(biomedical fibrin glue,BFG)在急性胆囊炎LC术中应用价值.方法:随机选取生物蛋白胶治疗组96例患者和87例对照组患者.通过比较术中止血时间、术后腹腔引流量及引流时间、胆瘘发生情况、术后右上腹不适情况、住院时间等6项指标来说明其有效性.结果:除胆瘘发生情况,治疗组与对照组无显著差异外,其余5项均有显著性差异.结论:在急性胆囊炎LC术中应用生物蛋白胶,使手术止血时间缩短,防止创面出血和渗出,预防组织粘连,减少了患者痛苦并缩短了住院时间,减少了住院费用.

  1. Application of Posterior Triangulation Approach with Drawing Cholecyst Ampulla and Observing Rouviere Ditch in Laparoscopic Cholecystectomy%提壶腹看Rouviere沟后三角入路法在腹腔镜胆囊切除中的应用

    Institute of Scientific and Technical Information of China (English)

    刘斌; 刘坤; 黄侣新; 柏磊; 陈江

    2013-01-01

    目的 探讨腹腔镜胆囊切除术(LC)中采用提胆囊壶腹、看Rouviere沟、胆囊后三角入路法切除胆囊,对成功完成LC和预防胆管、血管损伤的临床意义.方法 2009年7月至2011年12月期间应用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法(研究组)切除胆囊112例,同期常规方法(对照组)行LC 55例,比较2组的临床疗效.结果 2组一般临床资料比较差异无统计学意义(P>0.05),具有可比性.研究组112例成功完成了LC,无中转开腹及并发症发生.对照组55例LC发生并发症3例,其中2例胆管损伤及1例左肝动脉损伤.研究组的并发症发生率明显低于对照组[0(0/112)比5.45% (3/55),P<0.05],研究组和对照组间术中出血量、手术时间、住院时间及中转开腹率差异均无统计学意义[术中出血量:(8.95±3.95) mL比(8.09±3.91) mL,P-0.189;手术时间:(84.72±37.15) min比(77.05±37.22) min,P-0.212;住院时间:(6.40±2.39)d比(7.02±3.41)d,P=0.178].结论 在LC中,采用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法,相对容易精准解剖壶腹部与胆囊管移行区,完整显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉,既是成功完成LC的保证,又可有效避免术中胆管和血管的损伤.

  2. 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

  3. 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...... who were operated on for acute cholecystitis decreased from 14% in 1996 to 12% in 2003 (p

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

    Directory of Open Access Journals (Sweden)

    Shrestha KR

    2010-05-01

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

  5. 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....

  6. 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.

  7. 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

  8. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man

    OpenAIRE

    Mirrakhimov, Aibek E.; Gopika Chandra; Prakruthi Voore; Maliha Khan; Oleksandr Halytskyy; Ahmed Elhassan; Ali, Alaa M.

    2014-01-01

    Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  9. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man.

    Science.gov (United States)

    Mirrakhimov, Aibek E; Chandra, Gopika; Voore, Prakruthi; Khan, Maliha; Halytskyy, Oleksandr; Elhassan, Ahmed; Ali, Alaa M

    2014-01-01

    Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  10. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man

    Directory of Open Access Journals (Sweden)

    Aibek E. Mirrakhimov

    2014-12-01

    Full Text Available Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  11. A Computer-Based Diagnostic/Information Patient Management System for Isolated Environments. MEDIC Ten Years Later

    Science.gov (United States)

    1987-02-04

    the provider is a non-physician, such as a nurse , corpsman, or paramedic. The computer, with its capabilities to store and process large data bases... CHOLECYSTITIS ) SMALL BOWEL OBSTRUCTION ) OTHER (specify): MARK YOUR RECOMMENDATION: ( ) EVACUATION ( ) NO EVACUATION YOUR TREATMENT: ( ) OBSERVE... Cholecystitis , Small Bowel Obstruction, and Non-Specific Abdominal Pain. These diagnoses are presented to the corpsman as shown in Figure 2. This display

  12. 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。

  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. Clinical Relationship between Steatocholecystitis and Gallbladder Contractility Measured by Cholescintigraphy

    Directory of Open Access Journals (Sweden)

    Chang Seok Bang

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alexandre N Odashiro

    2005-01-01

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

  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. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N;

    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)....

  19. 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.

  20. 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

  1. Allocating Inpatient Expenses to Each DRG in All Clinical Services at Darnall Army Community Hospital

    Science.gov (United States)

    1993-08-01

    BC/BS implements drg system. Health Care Advocate Diomede, B., (1985). DRGs and surgical procedures. Association of Operatinq Room Nurses Journal...PROCEDURES WITH CC 4.4412 15.5 1 48 192 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC 1.7379 8.5 1 41 193 BILIARY TRACT PROC W CC EXCEPT ONLY CHOLECYST W OR W/G...C.D.E. 3.0275 14.0 1 46 194 BILIARY TRACT PROC W/O CC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. 1.6189 8.8 1 41 195 CHOLECYSTECTOMY WITH C.D.E. WITH CC

  2. 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

    included 20,307 patients (82% of all cholecystectomies). The conversion rate was 7.6%. Male sex, acute cholecystitis, and previous upper abdominal surgery were risk factors for conversion, with respective odds ratios of 1.50, 4.61, and 3.54. The mean LOS was 1.5 days, and 37.3% of the patients had same...... 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....

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

    Directory of Open Access Journals (Sweden)

    Elena M. Sanchiz-Cárdenas

    2015-11-01

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

  4. Porcine cholecyst–derived scaffold promotes full-thickness wound healing in rabbit

    Directory of Open Access Journals (Sweden)

    Deepa Revi

    2013-12-01

    Full Text Available Graft-assisted healing is an important strategy for treating full-thickness skin wounds. This study evaluated the properties of porcine cholecyst–derived scaffold and its use for treating full-thickness skin wound in rabbit. The physical properties of cholecyst-derived scaffold were congenial for skin-graft application. Compared to a commercially available skin-graft substitute made of porcine small intestinal submucosa, the cholecyst-derived scaffold was rich in natural biomolecules like elastin and glycosaminoglycans. When used as a xenograft, it promoted healing with excess cell proliferation at early phases and acceptable collagen deposition in the later remodelling phases.

  5. 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.

  6. U.S. Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Aeromedical Evacuation In-Flight Kit (FFQDM)

    Science.gov (United States)

    2011-05-04

    medically-related item not modeled was lamivadine 150 mg-zidovadine 300 mg HIV, which is used after an accidental needle stick and provided to the clinician...THROMBOPHLEBITIS NOS 1 592.90 URINARY CALCULUS NOS 1 575.10 CHOLECYSTITIS NOS 1 436.00 CEREBROVASCULAR ACCIDENT 1 250.00 DIABETES MELLITUS W/O

  7. 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.

  8. 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.

  9. Tactical Surgical Intervention with Temporary Shunting of Peripheral Vascular Trauma Sustained during Operation Iraqi Freedom: One Unit’s Experience

    Science.gov (United States)

    2006-10-01

    sufficient recovery and communication with the receiving facility, casualties underwent MEDEVAC accom- panied by an en-route care nurse who continued...failure requiring 1 month of dialysis Acalculous cholecystitis Wound infections (abdominal wall and disarticulation sites) Pneumonia Line sepsis 16

  10. 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.

  11. 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.

  12. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis

    NARCIS (Netherlands)

    Keus, F.; de Jong, J. A. F.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    2006-01-01

    Background Cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s. Objectives To compare the beneficial and harmful effects of laparoscopic versus open cholecyste

  13. Unusual presentation of gallbladder perforation

    Directory of Open Access Journals (Sweden)

    G. Jayasinghe

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    30 days between week time and weekend time. A longer postoperative length of stay was observed for patients operated on Fridays 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...

  15. Hospital Readmission After Delivery : Evidence for an Increased Incidence of Nonurogenital Infection in the Immediate Postpartum Period EDITORIAL COMMENT

    NARCIS (Netherlands)

    Belfort, Michael A.; Clark, Steven L.; Saade, George R.; Kleja, Kacie; Dildy, Gary A.; Van Veen, Teelkien R.; Akhigbe, Efe; Frye, Donna R.; Meyers, Janet A.; Kofford, Shalece

    2010-01-01

    OBJECTIVE: The purpose of this study was to analyze reasons for postpartum readmission. STUDY DESIGN: We conducted a database analysis of readmissions within 6 weeks after delivery during 2007, with extended (180 day) analysis for pneumonia, appendicitis, and cholecystitis. Linear regression analysi

  16. 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.

  17. Computed tomography demonstration of cholecystogastric fistula

    Directory of Open Access Journals (Sweden)

    Chung Kuao Chou, MD, MPH

    2016-06-01

    Full Text Available Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints.

  18. 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.

  19. Perkutan kolecystolitotripsi

    DEFF Research Database (Denmark)

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

    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...

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

    DEFF Research Database (Denmark)

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

    1993-01-01

    being more precise. The absolute deviation was independent of the size of the volume and of the shape of the gallbladder. In vivo Simpson's method was validated on 11 patients with cholecystitis. The gallbladder volumes (mean 65 mL; Range 20 mL to 130 mL) measured by sonography differed from...

  1. 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)

  2. The “invisible cholecystectomy”: A transumbilical laparoscopic operation without a scar

    NARCIS (Netherlands)

    Cuesta, Miguel; Berends, Frits; Veenhof, Alexander

    2007-01-01

    Background Looking to further reduce the operative trauma of laparoscopic cholecystectomy, we developed, in patients with no history of cholecystitis and a normal BMI, a scarless operation through the umbilicus. The operative technique, along with the results of the first 10 patients operated in

  3. Taenia saginata: A Rare Cause of Gall Bladder Perforation

    Directory of Open Access Journals (Sweden)

    Suhail Yaqoob Hakeem

    2012-01-01

    Full Text Available We report a case of biliary peritonitis caused by gall bladder perforation due to Taenia saginata induced gangrenous cholecystitis. Although parasites are not unusual causes of biliary tract disorders, especially in disease endemic areas, but this is for the first time that Taenia saginata has been reported to cause gall bladder perforation.

  4. Chronic granulomatous disease in an adolescent with recurrent impetigo and cholecystectomy.

    Science.gov (United States)

    Scholnicoff, Ellen T; MacGinnitie, Andrew J; Lin, Philana Ling; Darville, Toni

    2009-03-01

    Chronic granulomatous disease is a rare primary immunodeficiency disorder resulting from a defect in the microbicidal activity of phagocytes. Patients are susceptible to certain bacterial and fungal infections, as well as other inflammatory complications. We report the case of a 12-year-old girl with recurrent impetigo whose history of cholecystitis triggered an evaluation that revealed chronic granulomatous disease.

  5. 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.

  6. Drug: D07004 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available 78], Scutellaria root [DR:D06688], Peony root [DR:D06739], Jujube [DR:D06758], Immature orange [DR:D06706], Rhubarb [DR:D06756], Ging...er [DR:D06744] Cholelithiasis; Cholecystitis; Icterus; Disorder of hepatic function

  7. 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.

  8. ABDX A Decision Support System for the Management of Acute Abdominal Pain. Version 3.0. Programmer’s Manual

    Science.gov (United States)

    1989-10-31

    with inflammation. Incidence is highest in adolescents and young adults, peaking between ages 15 and 24. Typically, the pain is initially poorly...common ones follows: a. gastritis b. gastroenteritis c. cholecystitis d. pancreatitis e. hepatitis a. Gastritis is a diffuse more superficial

  9. Medic - Abdominal Pain: A Decision Support Program for the Management of Acute Abdominal Pain. (User’s Manual)

    Science.gov (United States)

    1989-10-11

    appendicitis results from a bacterial invasion of the appendix with inflammation. Incidence is highest in adolescents and young adults, peaking between ages 15...epigastrium. A partial list of the more ccimmxon ones follows: a. gastritis b. gastroenteritis c. cholecystitis d. pancreatitis e. hepatitis a. Gastritis is

  10. 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.)

  11. 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...

  12. The Impact of NATO/Multinational Military Missions on Health Care Management (l’Impact des missions OTAN/militaires internationales sur la gestion des soins de sante)

    Science.gov (United States)

    2001-05-01

    injury collaboration - manning issues CJ2 Intelligence --Disease threats --Polio, TB , Hepatitis A CJ4 Logistics 2-4 establish an overall MASCAL plan, in...3.0 9 Diseases of digestion system 30 3.0 10 Cholecystitis 28 2.8 11 Diseases of urogenital system 22 2.2 12 Traumas 12 1.2 13 Diseases of nervous

  13. 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.

  14. 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

  15. 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

  16. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention

    Institute of Scientific and Technical Information of China (English)

    Huseyin Bakkaloglu; Hakan Yanar; Recep Guloglu; Korhan Taviloglu; Fatih Tunca; Murat Aksoy; Cemalettin Ertekin; Arzu Poyanli

    2006-01-01

    AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia.METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases.RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients.Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7× 103± 1.3× 103μg/L vs 13× 103± 1× 103μg/L,P<0.05 for 24 h after PC; 13.7 × 103 ± 1.3 × 103 μg/L vs8.3 × 103 ± 1.2 × 103 μg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2 ± 18.5 mg/L vs 27.3 ±10.4 mg/L, P < 0.05 for 24 h after PC; 51.2 ± 18.5 mg/Lvs 5.4 ± 1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38 ± 0.35℃ vs 37.3 ± 0.32℃, P < 0.05 for 24h after PC; 38 ± 0.35℃ vs 36.9 ± 0.15℃, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients.After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications.Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter.CONCLUSION: As an alternative to surgery, percutaneous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality

  17. 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.

  18. 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

  19. Human gallbladder pressure and volume

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  20. 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.

  1. 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.

  2. Computed tomography of the gallbladder.

    Science.gov (United States)

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

    1978-06-01

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

  3. 胆囊切除术的治疗体会

    Institute of Scientific and Technical Information of China (English)

    龚青山

    2005-01-01

    Objective To explore the method of cholecystectomy. Methods Chose three different notches to expose the cholecyst as soon as possible, gave different treatment according to pathological changes and prevent the complications. Among the all the eases ,there were 1238 eases of direct and regular eholecysteetomy, 1572 eases of regular cholecystectomy after sever the conglutination and expose the cholicyst. There were still 47 cases with serious conglutination,since their cholecysts were hard to he exposed, irregular cholecystectomy were carried out. Results All the cases recovered and leave the hospital. Conclusions Pure cholecystectomy, estimation of pathological changes and choosing of notches are in favor of exporsing the cholecystectomy clearly and in time and reducing the occurrence of complications.

  4. [Serum lipid spectrum in patients with obstructive jaundice].

    Science.gov (United States)

    Makarov, V K; Mokhov, E M; Mosiagin, A V

    2007-11-01

    The study was undertaken to determine the serum lipid profile in patients with obstructive jaundice (OJ) of various genesis versus those with chronic viral hepatitis B (CVHB). The serum lipid profile was studied in 50 patients with OJ whose cause was cancer diseases and calculous cholecystitis in 20 and 30 patients, respectively. Thirty patients with CVHB were examined as a control group. In patients with OJ, the relative serum content of phospholipids was found to be twice less than that in patients with CVHB. In patients with OJ, hyperlipemia was mainly caused by free cholesterol or cholesterol esters. As compared with the patients with calculous cholecystitis and CVHB, the patients with cancer diseases had low sphingomyelin levels; this fact may be used as an additional measure in detecting OJ of cancer genesis.

  5. Primary Gallbladder Lymphoma in a Male Patient with No Risk Factors Detected Incidentally by CT Colonography

    Science.gov (United States)

    Karia, Monil; Mitsopoulos, Grigorios; Patel, Ketan; Rafique, Akkib; Sheth, Hemant

    2015-01-01

    Primary gallbladder lymphoma, although rare, usually presents in females with symptoms mimicking cholecystitis. We present a rare case of primary gallbladder in an 81-year-old male with no risk factors whose only symptom was weight loss. Routine blood tests including liver function tests were unremarkable. A CT colonography was carried out to exclude colonic malignancy. Unilateral gallbladder wall thickening and lymphadenopathy were incidentally detected and confirmed by ultrasound and a decision for the patient to undergo laparoscopic cholecystectomy and intraoperative cholangiogram was made. Histology confirmed extranodal marginal zone lymphoma with follow-up staging and biopsy of the bone marrow not demonstrating spread. Cholecystectomy was therefore deemed curative and no adjuvant therapy was necessary. Thickening of the gallbladder wall on any imaging with or without symptoms should not be ignored or assumed to be cholecystitis, even in males with no risk factors. In these patients urgent cholecystectomy with intraoperative cholangiogram is indicated with histology and haematology follow-up. PMID:26587306

  6. Quantification of Circulating Free DNA as a Diagnostic Marker in Gall Bladder Cancer.

    Science.gov (United States)

    Kumari, Swati; Tewari, Shikha; Husain, Nuzhat; Agarwal, Akash; Pandey, Anshuman; Singhal, Ashish; Lohani, Mohtashim

    2017-01-01

    Gall bladder Carcinoma (GBC) is the fifth most common cancer of the digestive tract and frequently diagnosed in late stage of disease. Estimation of circulating free DNA (cfDNA) in serum has been applied as a "liquid biopsy" in several deep seated malignancies. Its value in diagnosis of gall bladder carcinoma has not been studied. The present study was designed to assess the role of cfDNA in the diagnosis of GBC and correlate levels with the TNM stage. Serum was collected from 34 patients with GBC and 39 age and sex matched controls including 22 cholecystitis and 17 healthy individuals. Serum cfDNA levels were measured through quantitative polymerase chain reaction (qPCR) by amplification of β-globin gene. Performance of the assay was calculated through the receiver operating characteristic (ROC) curve. The cfDNA level was significantly lower in healthy controls and cholecystitis (89.32 ± 59.76 ng/ml, 174.21 ± 99.93 ng/ml) compared to GBC (1245.91 ± 892.46 ng/ml, p = <0.001). The cfDNA level was significantly associated with TNM stage, lymph node involvement and jaundice (0.002, 0.027, and 0.041, respectively). Area under curve of ROC analysis for cancer group versus healthy and cholecystitis group was 1.00 and 0.983 with sensitivity of 100 %, 88.24 % and specificity of 100 % respectively. Quantitative analysis of cfDNA may distinguish cholecystitis and gall bladder carcinoma and may serve as new diagnostic, noninvasive marker adjunct to imaging for the diagnosis of GBC.

  7. Readmissions due to acute biliary edematous pancreatitis in patients without cholecystectomy

    Directory of Open Access Journals (Sweden)

    Eva Barreiro-Alonso

    Full Text Available Objectives: Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. Materials and methods: Prospective observational study conducted at a tertiary hospital (Hospital de Cabueñes. Gijón, Asturias. Spain from July to November 2014. The study has consecutively included inpatients suffering from ABEP who: a had suffered a previous episode of mild acute gallstone pancreatitis or cholecystitis at least 2 weeks before readmission; and b had not undergone cholecystectomy despite the lack of contraindications. Results: During the research period, 9 patients (7 females and 2 males with a mean age of 65.3 years (standard deviation [SD] 19.2 were readmitted. The median number of days between the previous episode of ABEP or cholecystitis and the readmission was 114 days (interquartile range [IQR] 111.0. Reported median overall length of hospital stay was 10 days (IQR = 2.0. Patients underwent a mean of 2.8 (SD = 1.2 ultrasound scans, 1.3 (SD = 0.9 abdominal and pelvic CT, 0.8 (SD = 1.0 MRCP and 0.2 (SD = 0.4 ERCP. The mean cost per patient for each readmission, including hospital stay (143.0 €/day, Emergency Service (332.31 € and tests performed was 2,381.70 €/patient. Conclusions: Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.)

  13. Restructuring Military Medical Care

    Science.gov (United States)

    1995-07-01

    personnel—rapid deployment physicians, general or specialized surgeons from all services (including the reserves), senior medics, and nurses —would...for more than 1,500 medical personnel—such as nurses or physicians—assuming that about 12 military medical personnel are rotated annually at each...Displacement Without Myelopathy, Lumbar 21. Calculus of Gallbladder with Other Cholecystitis 22. Alcohol Dependence, Other and Unspecified, Unspecified Use

  14. Endoscopic ultrasound for chronic abdominal pain and gallbladder disease.

    Science.gov (United States)

    Dill, B; Dill, J E; Berkhouse, L; Palmer, S T

    1999-01-01

    Endoscopic ultrasound (EUS) is a major advance in gastrointestinal endoscopy. EUS, which is invaluable in the diagnosis and staging of gastrointestinal cancer, is now being used in the diagnosis of chronic upper abdominal pain. EUS combined with stimulated biliary drainage (EUS/SBD) aids in the diagnosis of choledocholithiasis, cholecystitis, microlithiasis, and various conditions of the upper gastrointestinal tract. This article describes the EUS/SBD procedure and nursing care. Two case histories illustrating potential benefits to patients are presented.

  15. 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;

    2016-01-01

    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 cholecystecto...... 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....

  16. 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....

  17. An incidental case of triple gallbladder

    Institute of Scientific and Technical Information of China (English)

    Banu Alicioglu

    2007-01-01

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

  18. 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

  19. 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.)

  20. The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

    Science.gov (United States)

    Freeman, Michael H; Mullen, Matthew G; Friel, Charles M

    2016-06-01

    Gallstone ileus is a rare cause of small bowel obstruction, classically occurring in patients with recurrent cholecystitis. The incidence of biliary enteric fistula and gallstone ileus in patients with large, asymptomatic gallstones is not known. We report a case of gallstone ileus, which occurred in the setting of a large, asymptomatic gallstone. This case suggests that large gallstones may warrant cholecystectomy, even in asymptomatic patients.

  1. 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.

  2. Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

    Institute of Scientific and Technical Information of China (English)

    Alexander; C; Allori; I; Michael; Leitman; Elizabeth; Heitman

    2010-01-01

    Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of...

  3. Emerging pathogen: a case and review of Raoultella planticola.

    Science.gov (United States)

    Ershadi, A; Weiss, E; Verduzco, E; Chia, D; Sadigh, M

    2014-12-01

    Raoultella planticola has been considered a relatively harmless Gram-negative bacteria, rarely associated with clinical infection. However, in recent years, the frequency at which severe infection by R. planticola and drug-resistant strains are reported in literature has increased. Here, we present one case of acute cholecystitis caused by R. planticola, and review all previously reported cases of the infection in an attempt to identify new trends in biological and clinical features of R. planticola infections.

  4. [Some aspects of the complex treatment of acute suppurative perionitis].

    Science.gov (United States)

    Kovalev, M M; Roĭ, V P; Zaritskiĭ, I; Konovalenko, V V; Mellin, V M

    1976-10-01

    The authors present an analysis of the results of complex treatment in 4318 patients operated upon for acute peritonitis, caused by acute appendicitis, perforating gastric and duodenal ulcers, acute cholecystitis, ruptures and perforations of the intestine and other surgical and gynecological diseases. Patients with diffuse purulent peritonitis showed marked disorders in protein-aminoacid, nitrogen, and water electrolyte metabolism, acid-base balance, a reduced nonspecific immune responsiveness of the organism. Therpeutic tactics was delineated taking into account the revealed changes.

  5. Role of Abdominal Ultrasound in the Diagnosis of Typhoid Fever in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Niranjan Sahu

    2016-12-01

    Full Text Available An early diagnosis of typhoid fever caused by Salmonella typhi is difficult because of several spectra of clinical findings, identical to those of several other types of infections. A definitive diagnosis of typhoid fever is made by hemoculture as well as the Widal test. With pediatric patients, this life-threatening infection remains inherently long enough, demanding urgent attention. In typhoid fever, splenomegaly, enlarged mesenteric lymph nodes (MLNs, bowel wall thickening, acalculus cholecystitis, and hepatomegaly occur, which are diagnosed by the ultrasonography (USG test. USG is a noninvasive, easily available, economical, fairly acceptable, and fairly sensitive test. The high-resolution real-time gray-scale USG method has simplified the evaluation of pathologic conditions, with remarkable clarity; consequently, an accurate assessment of the associated lesions can be done. In typhoid-endemic areas, USG findings as cited above could be used for diagnosis of typhoid fever, particularly when serology is equivocal and hemocultures are negative or not available. It was evident from USG studies that 12 of 52 patients had calculus cholecystitis; these individuals as well as eight patients without cholecystitis having hemocultures negative for S. typhi were excluded from the study. The rest of the cases (n=32 were included in this USG-based study for evaluation of features specific for typhoid fever. The following observations were recorded: splenomegaly in 32 patients, enlarged MLNs in 30 patients, bowel wall thickening in 25 patients, acalculus cholecystitis in 20 patients, and hepatomegaly in 10 patients. It can be concluded that these USG features—hepatosplenomegaly, enlarged MLNs, bowel wall thickening, and acalculus cholecystitis—should strongly favor the diagnosis of typhoid.

  6. Colecistitis aguda por Streptococcus constellatus

    OpenAIRE

    M Sandra Gómez-Canosa; Cristina Lijó-Carballeda; Begoña Vázquez-Vázquez; M José Bello-Peón

    2016-01-01

    Presentamos el caso de una paciente de edad avanzada y significativa comorbilidad que se diagnosticó de colecistitis aguda por Streptococcus constellatus. El drenaje de la vesícula biliar por colecistostomía percutánea, asociado a penicilinas, ha conseguido una evolución favorable. We report the case of a patient of advanced age and significant comorbidity diagnosed acute cholecystitis by Streptococcus constellatus. Gallbladder drainage by percutaneous cholecystostomy associated ...

  7. Rare entity: Ectopic liver tissue in the wall of the gallbladder - A case report

    OpenAIRE

    Arslan, Yusuf; Altintoprak, Fatih; Serin, Kursat R; Kivilcim, Taner; Yalkin, Omer; Ozkan, Orhan V; Celebi, Fehmi

    2014-01-01

    Ectopic liver tissue (ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter EL...

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

    Science.gov (United States)

    Wang, Jun; Pan, Yang-Lin; Xie, Yan; Wu, Kai-Chun; Guo, Xue-Gang

    2013-09-28

    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 sphincterotomy in some regions where ascariasis is epidemic.

  9. 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.

  10. Bile duct hamar tomas-the von Meyenburg complex

    Institute of Scientific and Technical Information of China (English)

    Valdemir José Alegre Salles; Alexandre Marotta; Jorge Miguel Kather Netto; Manlio Basílio Speranzini; Marcos Roberto Martins

    2007-01-01

    Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by ifbrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

  11. 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).

  12. 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.)

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. A Prediction Rule for Risk Stratification of Incidentally Discovered Gallstones

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue; Jørgensen, Torben

    2016-01-01

    % confidence interval [CI], 1.45-3.69), acute cholecystitis (HR, 9.49; 95% CI, 2.05-43.92), and uncomplicated events (HR, 2.55; 95% CI, 1.38-4.71), including cholecystectomy (HR, 2.69; 95% CI, 1.29-5.60). Multiple stones were associated with all events (HR, 1.68; 95% CI, 1.00-2.81), complicated events (HR, 2.......52; 95% CI, 1.05-6.04), and common bile duct stones (HR, 11.83; 95% CI, 1.54-91). There was an association between gallstones more than 5 years old and acute cholecystitis. Female sex was associated with all and uncomplicated events. We found a negative association between participant age and all events......, uncomplicated events, and acute cholecystitis. Comorbidities and female-associated factors (intake of birth control pills or estrogens and number of births) were not associated with events. Compared with men with a single stone of 10 mm or smaller (reference), women with multiple stones greater than 10 mm had...

  16. 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.

  17. Universal safe procedure of laparoscopic cholecystectomy standardized by exposing the inner layer of the subserosal layer (with video).

    Science.gov (United States)

    Honda, Goro; Hasegawa, Hiroshi; Umezawa, Akiko

    2016-09-01

    An incorrect approach to the critical view of safety can cause bile duct and/or vascular injury. However, only superficial anatomical features have been proposed as surgical landmarks to initiate laparoscopic cholecystectomy (LC) safely in previous reports. Accordingly, we have proposed a novel surgical anatomical definition of the gallbladder wall, in which the subserosal (SS) layer is divided into the inner layer of the SS (SS-Inner) layer consisting of vasculature and fibrous tissue, and the outer layer of the SS (SS-Outer) layer consisting of abundant fat tissue. By dissecting the gallbladder along the SS-Inner layer after exposure at a safe region, bile duct and/or vascular injury can be avoided, even in cholecystitis cases. Furthermore, recognition of this surgical anatomy reveals several aspects. In cholecystitis cases associated with severe fibrotic change, completion of LC by dissecting along the SS-Inner layer is impossible, resulting in abandonment of regular LC. An abscess in the liver bed associated with acute cholecystitis usually forms in the SS-Outer layer, thus, the gallbladder can be dissected easily. In the dome-down technique, the right hepatic duct is endangered by whole-layer dissection, in which the SS-Outer layer is also removed. The proposed procedure should become the universal standard for LC.

  18. Nationwide epidemiological study of severe gallstone disease in Taiwan

    Directory of Open Access Journals (Sweden)

    Lin Jou-Wei

    2009-08-01

    Full Text Available Abstract Background Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged ≥20. Methods A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997–2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP] that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI were estimated assuming a Poisson distribution. Results The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI per 1000 population was 0.60 (0.59–0.60 for men and 0.59 (0.59–0.60 for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20–39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged ≥60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy. Conclusion This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20–39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged ≥60.

  19. 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.

  20. 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.

  1. Laparoscopic retrograde (fundus first cholecystectomy

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    Kelly Michael D

    2009-12-01

    Full Text Available Abstract Background Retrograde ("fundus first" dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation. Methods A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle. Results 1041 LCs were carried out including 148 (14% emergency operations and 131 (13% associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%. Retrograde LC was attempted successfully in 11 patients (1.1%. The age ranged from 28 to 80 years (mean 61 and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2 with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1. Conclusions In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.

  2. 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.

  3. 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.)

  4. Monoclonal gammopathy in hereditary spherocytosis: Possible pathogenetic relation

    Energy Technology Data Exchange (ETDEWEB)

    Schafer, A.I. (Univ. of Chicago); Miller, J.B.; Lester, E.P.; Bowers, T.K.; Jacob, H.S.

    1978-01-01

    Two cases of monoclonal gammopathy in patients with hereditary spherocytosis led us to consider the possible pathogenetic relation between these two disorders. Twelve adult patients with hereditary spherocytosis had significant hypergammaglobulinemia in comparison to normal subjects. Retrospective analysis of previous illness in 140 patients with multiple myeloma showed a significant association between IgA myeloma and previous gallbladder disease. We propose that the chronic reticuloendothelial stimulation due to extravascular hemolysis, possibly potentiated by the inflammation associated with cholelithiasis and cholecystitis, may foster neoplastic transformation of immunocytes in patients with hereditary spherocytosis, ultimately leading to the development of monoclonal gammopathy.

  5. 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.

  6. 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

  7. 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.

  8. Rare entity: Ectopic liver tissue in the wall of the gallbladder - A case report.

    Science.gov (United States)

    Arslan, Yusuf; Altintoprak, Fatih; Serin, Kursat R; Kivilcim, Taner; Yalkin, Omer; Ozkan, Orhan V; Celebi, Fehmi

    2014-12-16

    Ectopic liver tissue (ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter ELT was detected in the anterior gallbladder wall and a laparoscopic cholecystectomy was performed. The case is presented due to the rare nature of ELT and as a reminder of ELT-related complications.

  9. 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.

  10. The Reliability of Highly Elevated CA 19-9 Levels

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    B. R. Osswald

    1993-01-01

    Full Text Available CA 19-9 is used as a tumour marker of the upper gastrointestinal tract. However, extremely elevated CA 19-9 levels are found also in patients with benign diseases. Cholestasis was present in 97.1 % of patients with high elevated CA 19-9, independent of their primary disease. 50% of patients with non-malignant diseases and increased CA 19-9 levels showed liver cirrhosis, cholecystitis, pancreatitis and/or hepatitis. In 8.8% no explanation was found for the extremely high CA 19-9 level. The results provide evidence of different factors influencing the CA 19-9 level.

  11. Cholecystoenteric Fistule and Laparoscopic Repair

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    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.

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

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    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.

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

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    Yao Liu

    2016-01-01

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

  14. The use of intraoperative cholangiogram during laparoscopic double cholecystectomy

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    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.

  15. [Prospects of intraoperative dynamic cholangio-manometry by tensor detectors with graphic recording of pressure function].

    Science.gov (United States)

    Tsatsanidi, K N; Pugaev, A V; Gordeev, P S; Sandrikov, V A; Mukha, A V; Gambarian, A R

    1991-02-01

    Intraoperative cholangio-manometry with a miniature tensor sensor and graphic recording of the results were conducted to study the function of the major duodenal papilla in 53 patients. A periodical activity of the ampulla of the papilla was revealed, which was characterized by certain values of the peak and basal pressure, and duration of contraction and relaxation periods. The numerical values and the pattern of the pressure curve differed in patients with obstructive cholecystitis, biliary pancreatitis, and a concrement incarcerated in the ampulla of the papilla. The informativeness of the study increases with the use of the glucagon test.

  16. First case reported of Bouveret's syndrome associated to duodenal and biliary perforation to retroperitoneum

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    María Victoria Vieiro-Medina

    Full Text Available We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection.

  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. A Rare Cause of Abdominal Pain: Primary Epiploic Appendagitis (PEA

    Directory of Open Access Journals (Sweden)

    Gulbanu Erkan

    2016-07-01

    Full Text Available Primary epiploic appendagitis (PEA is a rare disease caused by torsion or spontaneous thrombosis of the central vein that drains epiploic appendages (EA. Primary Epiploic Appendagitis (PEA is an ischemic infarction. Although PEA is a self-limiting disease and does not require surgical intervention in most cases, it may mimic diseases that require surgical intervention or aggressive medical therapy, such as appendicitis, diverticulitis, or cholecystitis. In order to avoid unnecessary surgical intervention, PEA should be kept in mind when patients present with acute abdominal pain. In this report, we present a PEA case admitted with abdominal pain.

  19. Colecistitis aguda por Streptococcus constellatus

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    M Sandra Gómez-Canosa

    2016-03-01

    Full Text Available Presentamos el caso de una paciente de edad avanzada y significativa comorbilidad que se diagnosticó de colecistitis aguda por Streptococcus constellatus. El drenaje de la vesícula biliar por colecistostomía percutánea, asociado a penicilinas, ha conseguido una evolución favorable. We report the case of a patient of advanced age and significant comorbidity diagnosed acute cholecystitis by Streptococcus constellatus. Gallbladder drainage by percutaneous cholecystostomy associated with penicillins has achieved a favorable outcome.

  20. Hemobilia secundaria a colecistitis crónica

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    R. de Quinta Frutos

    Full Text Available The term hemobilia is used to describe the presence of blood in the biliary tract. We report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. We review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. In our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. The clinical condition was resolved by means of a cholecystectomy. The patient had an uneventful recovery.

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Gall bladder perforation and biliary peritonitis in a young pregnant lady.

    Science.gov (United States)

    Sharma, D K; Panwar, R S; Kumari, K

    2001-11-01

    A rare event of acute free perforation of gall bladder with biliary peritonitis in a case of calculous cholecystitis in a 28 years old pregnant lady occurring in the absence of the usual factors associated with gall stone disease is reported. The clinical features resembled acute appendicitis and a pre-operative diagnosis could not be made. It is suggested that a thorough attempt should be made to exclude conditions mimicking appendicitis, including those of the biliary system, on finding a normal appendix at emergency appendicectomy without hesitating to convert to full laparotomy if required.

  3. Bacteriological examination of gallbladder contents

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    Petaković Goran

    2002-01-01

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

  4. Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism.

    Science.gov (United States)

    Rastegar, Mandana; Levine, Barton S; Felsenfeld, Arnold J

    2014-06-01

    A 58-year-old man with Stage 3b chronic kidney disease and primary hyperparathyroidism treated with cinacalcet was admitted for acute cholecystitis. A cholecystostomy tube was placed, estimated glomerular filtration rate decreased, metabolic acidosis developed and ionized calcium increased from 1.33 to 1.76 mM despite cinacalcet administration. A sodium bicarbonate infusion corrected the metabolic acidosis restoring ionized calcium to normal despite no improvement in renal function. The correlation between the increase in serum bicarbonate and decrease in ionized calcium was r = -0.93, P metabolic acidosis increasing calcium efflux from bone while renal failure decreased the capacity to excrete calcium.

  5. The clinical analysis of the risk factor of convertion from emergency laparoscopic cholecystectomy to laparotomy%急症腹腔镜胆囊切除术中转开腹危险因素的分析

    Institute of Scientific and Technical Information of China (English)

    张立明

    2011-01-01

    目的:分析术前预测急症腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的可能性,以期找到客观、实用、准确率高的预测LC手术难易度的方法,并选择适当的手术方式.方法:回顾分析2005~2009年120例急症LC中38例中转开腹患者的临床资料.从胆囊炎、胆囊结石疾病病理方面提取胆囊炎发作时间、胆囊三角解剖层次、胆囊壁厚度、胆囊结石是否嵌顿、是否为坏疽性胆囊炎等5种因素.用Stata 10.0统计软件分析,单因素分析找出影响急症LC中转开腹的危险因素,多因素分析建立Logistic回归方程,进行急症腹腔镜胆囊切除术中转开腹可能性预测,并评估预测效能.结果:120例患者行急症LC,其中38例中转开腹,中转率31.67%.单因素分析表明,胆囊炎发作>72h,胆囊三角解剖不清,胆囊壁厚度>0.5cm,坏疽性胆囊炎均是腹腔镜胆囊切除术中转开腹的相关危险因素.Logistic回归分析结果表明,胆囊炎发作>72h,胆囊三角解剖不清,胆囊壁厚度>0.5cm,坏疽性胆囊炎为腹腔镜胆囊切除术中转开腹的危险因素.建立Logistic回归方程进行预测,预测效能0.9519.结论:胆囊炎发作>72h,胆囊三角解剖不清,胆囊壁厚度>0.5cm,坏疽性胆囊炎是中转开腹的危险因素.患者含有上述危险因素越多,手术难度越大,中转开腹的可能性越大.因此,术前综合评估患者具有的危险因素对选择手术方案,降低中转开腹率有较高的临床指导意义,可避免单纯追求LC带来的严重并发症.%Objective: To investigate the predictive possibility of convertion from emergency laparoscopic cholecystectomy (LC) to open operation to find a practical and effective approach to select appropriate patients for LC. Methods: Medical data of 120 patients who underwent emergency LC from 2005 to 2009 were analyzed retrospectively. From the pathological aspects and of cholecystitis and gallbladder stone disease onset

  6. 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.

  7. Pain and dyspepsia after elective and acute cholecystectomy

    DEFF Research Database (Denmark)

    Middelfart, H V; Kristensen, J U; Laursen, C N;

    1998-01-01

    BACKGROUND: Postcholecystectomy pain occurs in 20-30%. The main cause of this pain remains unclear. Whether the underlying gallbladder disease influences the outcome after cholecystectomy is not fully established. METHODS: A multicenter questionnaire study comparing the occurrence of abdominal pain....... 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...

  8. Complicated intra-abdominal infection caused by extended drug-resistant Achromobacter xylosoxidans.

    Science.gov (United States)

    Teng, Sing-On; Ou, Tsong-Yih; Hsieh, Yu-Chia; Lee, Wuan-Chan; Lin, Yi-Chun; Lee, Wen-Sen

    2009-04-01

    Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.

  9. Pitfalls and Limitations of Radionuclide Hepatobiliary and Gastrointestinal System Imaging.

    Science.gov (United States)

    Low, Chen Sheng; Ahmed, Haseeb; Notghi, Alp

    2015-11-01

    Radionuclide imaging for the hepatobiliary and gastrointestinal system covers a wide range of different indications and imaging techniques. This wide variety allows the different functional assessments of both systems. Therefore, the understanding of each technique and its indications is essential. Cholescintigraphy is a well-established method in the assessment of acute and chronic cholecystitis. It also has a role in the detection of biliary atresia. The assessment of gastrointestinal transit is also well-established in radionuclide imaging for functional investigation of the gastrointestinal tract. Furthermore, detection of acute gastrointestinal bleeding with radionuclide imaging is also standard practice. This article aims to review the pitfalls and limitations in all of these areas.

  10. [Study of crystalline structures of the bile in the diagnosis of cholelithiasis].

    Science.gov (United States)

    Postolov, P M; Bykov, A V; Mishin, S G

    1990-10-01

    Under analysis were results of polarization microscopy of bile in 111 patients with cholelithiasis, 8 patients with acalculous cholecystitis and 8 practically healthy people. It was found that in healthy people there are no crystalline structures in the initial state of bile. The composition of bile from patients with cholelithiasis is characterized by the presence of three types of crystals: solid crystals of cholesterol monohydrate, calcium bilirubinate granules and calcium carbonate microspherolites. Polarization microscopy of bile may be used as a sufficiently simple method of diagnostics of stone disease.

  11. 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.

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

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    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.

  13. 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.)

  14. 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.

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

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    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.)

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

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    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.)

  17. [Biliary lithiasis in patients over 75. 100 cases operated upon (author's transl)].

    Science.gov (United States)

    Moreaux, J; Bonnet, J L; Gerum, A

    1982-02-27

    This is a retrospective study of 100 elderly patients (36 men and 64 women aged 75 years or more) operated upon for biliary tract calculi. Thirty-one patients had one or several underlying visceral diseases and 5 had associated carcinoma of the digestive tract. Calculi of the common bile duct were present in 48 cases, and 41 patients had acute infection, including cholecystitis (14) and cholangitis (27). Surgery included cholecystectomy in every case and opening of the common bile duct in 49 cases with either choledocho-duodenal anastomosis (31 cases) or external biliary drainage (18 cases). Only one patient with gastric carcinoma died. The morbidity rate was low (11 post-operative complications) and each group of patients spent about the same time in hospital. Neither mortality nor morbidity were aggravated by the presence of calculi in the common bile duct and/or acute infection. In uncomplicated lithiasis the surgical indications mainly depend upon the severity of underlying visceral diseases. Early intervention seems desirable in most patients with acute cholecystitis or cholangitis. Surgery of the biliary tract is basically the same in elderly and in young patients, but the operation must be simple and, if possible, complete. The quality of medical surveillance and nursing has considerable influence on the results.

  18. Acute gastrointestinal complications after cardiac surgery.

    Science.gov (United States)

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  19. Association of pseudomembranous colitis with Henoch-Schönlein purpura.

    Science.gov (United States)

    Hayakawa, Takehiko; Imaeda, Hiroyuki; Nakamura, Mitsuyasu; Komoto, Shunsuke; Maruta, Kazuo; Shiozu, Hidetoshi; Ogata, Haruhiko; Iwao, Yasushi; Ishii, Hiromasa; Hibi, Toshifumi

    2005-06-01

    A 79-year-old man was admitted because of cholecystitis that occurred about 40 days after sigmoidectomy had been performed for colonic cancer. Though antibiotics improved his condition, the patient had hematochezia, diarrhea, and left lower abdominal pain. Colonoscopic findings showed multiple ring-like areas of redness and petechiae in the rectosigmoid colon and marked edema from the descending to the transverse colon. The patient then developed purpura on the extensor surfaces of the legs and bilateral gonalgia, and exacerbation of the hematochezia. A second colonoscopy (CS) showed multiple ring-like areas of redness and ecchymosis throughout the colon. The patient was diagnosed with Henoch-Schönlein purpura (HSP), and the symptoms were attenuated after the administration of prednisolone. However, diarrhea recurred in about a week; stool culture confirmed Clostridium difficile, and a third CS revealed pseudomembranes throughout the colon. The patient was diagnosed with pseudomembranous colitis (PMC), and the administration of vancomycin attenuated the symptoms. In conclusion, we have reported a rare adult case of PMC that occurred during prednisolone treatment for HSP. The PMC may have been caused by changes in the intestinal bacterial flora after the sigmoidectomy and by the intestinal lesions of HSP, as well as by the administration of antibiotics after the sigmoidectomy and for the treatment of cholecystitis, and by the use of prednisolone for the treatment of the HSP.

  20. Single-Incision Cholecystectomy in about 200 Patients

    Directory of Open Access Journals (Sweden)

    Roland Raakow

    2011-01-01

    Full Text Available Background and Aims. We describe our experience of performing transumbilical single-incision laparoendoscopic cholecystectomy as standard procedure for acute and chronic gallbladder diseases. Methods. Between September 2008 and March 2010, 220 patients underwent laparoscopic single-incision surgery. A single port was used for 196 patients and two conventional 5 mm and one 10 mm port in 24 cases. All operations were performed with straight instruments. Results. Single-incision surgery was successfully performed in 215 patients (98%. Three patients (1.4% required conversion to a three-port technique and two patients (0.9% to an open procedure. Average age of 142 women (65% and 78 men (35% was 47 years (range: 15–89, average ASA status 2 (range: 1–3 and BMI 28 (range: 15–49. Mean operative time was 62 minutes (range: 26–174 and 57 patients (26% had histopathological signs of acute cholecystitis. Eleven patients (5% developed to surgery-related complications and nine (4% of these required a reoperation. The mean followup was 331.5 (range: 11–590 days. Conclusion. Transumbilical single-incision cholecystectomy is a feasible and safe new approach for routine cholecystectomy. After a short learning curve, operation time and complication rate are comparable with standard multiport operation. In addition, most cases of acute cholecystitis can be performed with this technique.

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

    Science.gov (United States)

    Alpuerto, Aldrin C.; Mora, Maximo E.

    2017-01-01

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

  2. The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy

    Science.gov (United States)

    Yun, Jong Hyuk; Jung, Hae Il; Lee, Hyoung Uk; Baek, Moo-Jun

    2017-01-01

    Purpose Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy. Methods We performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC. Results A total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7–10] days vs. 2 [1–3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0–3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates. Conclusion Emergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline. PMID:28289668

  3. 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.

  4. 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.

  5. Case Report: Modified Laparoscopic Subtotal Cholecystectomy: An Alternative Approach to the “Difficult Gallbladder”

    Science.gov (United States)

    Segal, Michael S.; Huynh, Richard H.; Wright, George O.

    2017-01-01

    Patient: Male, 56 Final Diagnosis: Acute cholecystitis Symptoms: Abdominal pain Medication:— Clinical Procedure: Laparoscopic subtotal cholecystectomy Specialty: Surgery Objective: Unusual clinical course Background: Laparoscopic cholecystectomy is a commonly performed surgical procedure. In certain situations visualization of the Callot triangle can become difficult due to inflammation, adhesions, and sclerosing of the anatomy. Without being able to obtain the “critical view of safety” (CVS), there is increased risk of damage to vital structures. An alternative approach to the conventional conversion to an open cholecystectomy (OC) would be a laparoscopic subtotal cholecystectomy (LSC). Case Report: We present a case of a 56-year-old male patient with acute cholecystitis with a “difficult gallbladder” managed with LSC. Due to poor visualization of the Callot triangle due to adhesions, safe dissection was not feasible. In an effort to avoid injury to the common bile duct (CBD), dissection began at the dome of the gallbladder allowing an alternative view while ensuring safety of critical structures. Conclusions: We discuss the potential benefits and risks of LSC versus conversion to OC. Our discussion incorporates the pathophysiology that allows LSC in this particular circumstance to be successful, and the considerations a surgeon faces in making a decision in management. PMID:28220035

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

    Directory of Open Access Journals (Sweden)

    Aldrin C. Alpuerto

    2017-01-01

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

  7. Multidetector CT of emergent biliary pathologic conditions.

    Science.gov (United States)

    Patel, Neel B; Oto, Aytekin; Thomas, Stephen

    2013-01-01

    Various biliary pathologic conditions can lead to acute abdominal pain. Specific diagnosis is not always possible clinically because many biliary diseases have overlapping signs and symptoms. Imaging can help narrow the differential diagnosis and lead to a specific diagnosis. Although ultrasonography (US) is the most useful imaging modality for initial evaluation of the biliary system, multidetector computed tomography (CT) is helpful when US findings are equivocal or when biliary disease is suspected. Diagnostic accuracy can be increased by optimizing the CT protocol and using multiplanar reformations to localize biliary obstruction. CT can be used to diagnose and stage acute cholecystitis, including complications such as emphysematous, gangrenous, and hemorrhagic cholecystitis; gallbladder perforation; gallstone pancreatitis; gallstone ileus; and Mirizzi syndrome. CT also can be used to evaluate acute biliary diseases such as biliary stone disease, benign and malignant biliary obstruction, acute cholangitis, pyogenic hepatic abscess, hemobilia, and biliary necrosis and iatrogenic complications such as biliary leaks and malfunctioning biliary drains and stents. Treatment includes radiologic, endoscopic, or surgical intervention. Familiarity with CT imaging appearances of emergent biliary pathologic conditions is important for prompt diagnosis and appropriate clinical referral and treatment.

  8. Diagnosis and treatment of gallbladder perforation

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  9. Massive right-sided Bochdalek hernia with two unusual findings: a case report

    Directory of Open Access Journals (Sweden)

    Deb Subrato J

    2011-10-01

    Full Text Available Abstract Introduction In this report, the case of an adult patient with a massive right-sided Bochdalek hernia with multiple displaced abdominal organs, including the liver and gallbladder, is described. This patient presented with acute cholecystitis of the malpositioned gallbladder. During surgery, nodular regenerative hyperplasia of the liver was also found. To the best of this author's knowledge, these two entities have never been reported in association with this rare condition. Case presentation A 54-year-old Caucasian man presented with nausea and epigastric pain. He had a known history of right-sided Bochdalek hernia which was being managed expectantly. A computerized tomogram revealed the massive hernia with displaced stomach, liver, intestine and omentum into his right thorax. It was believed that our patient had bowel incarceration and he was therefore taken to surgery, where acute cholecystitis and a macronodular liver was identified. A thoracoabdominal approach was used to remove his gallbladder, reduce the herniated viscera and reconstruct his diaphragm. A liver biopsy identified nodular regenerative hyperplasia of the ectopic liver. There were no postoperative complications and at 12 month follow-up, our patient continues to do well. Conclusion This case report describes two unusual findings associated with a congenital Bochdalek diaphragmatic hernia that have never been reported. In addition, unique caveats to the surgical management of this complex rare condition are discussed.

  10. 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.

  11. Cooperative study with sup(99m)Tc diisopropyl-IDA on biliary tract diseases

    Energy Technology Data Exchange (ETDEWEB)

    Mitta, A.E.A.; Mollerach, F; Almeida, C.A. (Complejo Medico Policial Churruca Visca, Buenos Aires (Argentina). Servicio de Medicina Nuclear)

    1982-07-01

    The results of a cooperative study on the investigation of the biliary tract with sup(99m)Tc diisopropyl-IDA are presented. 15 normal volunteers and 75 patients with acute cholecystitis (AC), chronic cholecystitis (CC), hepatocellular jaundice (HCJ), incomplete extrahepatic biliary obstruction (IEBO) and complete extrahepatic biliary obstruction (CEBO) were studied. The biological behaviour of the radiopharmaceutical in the two groups was determined through the measurement of the uptake times and of the times of arrival in the hepatic parenchyma, in the intra and extrahepatic bile ducts, in the gallbladder, in the duodenum and in the kidneys. The pathophysiologic features found in the AC, CC, HCJ, IEBO and CEBO are described. It is concluded that the procedure has a selective indication in the AC, that its value is limited in the CC, and that in jaundice, except in very special situations, the method gives very little information of clinical value. The possibility of performing cooperative scientific studies between Latin-American Departments, increasing their efficiency, is emphasized.

  12. 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.

  13. 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.

  14. [Celioscopic cholecystectomy. A survey of the French Society of Endoscopic Surgery and Operative Radiology. Apropos of 937 cases].

    Science.gov (United States)

    Collet, D

    1992-01-01

    Twenty-eight surgeons, members of the Société Française de Chirurgie Endoscopique et de Radiologie Opératoire, took part in this multicenter study, carried out between March 1989 and January 1991. Nine hundred and thirty-seven patients were entered into the study, 934 of whom presented with biliary lithiasis and 3 with gallbladder polyps. Biliary colic was found in 918 (98 percent) of patients. One hundred and twenty-five patients (13.3 percent) presented with acute cholecystitis. Laparoscopic cholecystectomy had to be converted to traditional laparotomy in 50 cases (5.3 percent). The most frequent causes of conversion were the presence of cholecystitis (34 percent) and the occurrence of hemorrhage which could not be controlled laparoscopically (18 percent). There was one death (mortality rate: 0.1 percent) and there were 37 postoperative complications (morbidity rate: 3.9 percent) which required reoperation in 11 instances: 4 laparatomies, 5 laparoscopies and 2 ultrasonography guided drainages. The mean duration of postoperative hospital stay for patients without complications or conversion was 3.8 days. These results show both the limits and the advantages of laparoscopic cholecystectomy. This new technique is now well established and should be added to other therapies used in the treatment of patients with biliary lithiasis.

  15. The clinical significance of abdominal right lower paramedian incision inrectal cancer operation

    Institute of Scientific and Technical Information of China (English)

    Chong Shu Wang; Shou Jiang Wei; Jing Dong Li

    2000-01-01

    AIM The incision in rectal cancer operation is adopted commonly in the left mid-lower abdomen. But thereare some defects for the incision, which is close to the artificial colotomy, readily be contaminated by feces,difficult to treat the lesions in hepatic and cholecystic area at the same time and in the weakened area ofabdominal wall. So, we employed the abdominal right lower paramedian incision to solve these problems.METHODS The abdominal right lower paramedian incision is from publc tubercle upward to 3 cm- 4 cmabove navel. The incision should be extended upward if individual need of performing hepatic and cholecysticoperation, or placing catheter or pump in hepatic artery or portal vein for chemotherapy at the same time.RESULTS One hundred and eighty three cases with rectal cancer were adopted this incision in differentoperation procedure, and out of them 41 patients were taken different operation on hepatic and cholecysticlesions and place a catheter or pump to hepatic artery or portal vein. Operators feel that the incision dose nothinder exploring and operating in all of the patients.CONCLUSION The right lower paramedian incision of abdomen is far away from the artificial colotomy,and it can reduce the feces contamination, lower down the rate of incision hernia and paramedian hernia orfistula. Furthermore, it is easy to treat the complicated hepatic and cholecystic lesion. So, authors suggestthat this incision is useful for the operation of rectal cancer, and it is worth to populize in clinical practice.

  16. Postoperative abdominal complications after cardiopulmonary bypass

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    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  17. Primary Gallbladder Lymphoma in a Male Patient with No Risk Factors Detected Incidentally by CT Colonography

    Directory of Open Access Journals (Sweden)

    Monil Karia

    2015-01-01

    Full Text Available Primary gallbladder lymphoma, although rare, usually presents in females with symptoms mimicking cholecystitis. We present a rare case of primary gallbladder in an 81-year-old male with no risk factors whose only symptom was weight loss. Routine blood tests including liver function tests were unremarkable. A CT colonography was carried out to exclude colonic malignancy. Unilateral gallbladder wall thickening and lymphadenopathy were incidentally detected and confirmed by ultrasound and a decision for the patient to undergo laparoscopic cholecystectomy and intraoperative cholangiogram was made. Histology confirmed extranodal marginal zone lymphoma with follow-up staging and biopsy of the bone marrow not demonstrating spread. Cholecystectomy was therefore deemed curative and no adjuvant therapy was necessary. Thickening of the gallbladder wall on any imaging with or without symptoms should not be ignored or assumed to be cholecystitis, even in males with no risk factors. In these patients urgent cholecystectomy with intraoperative cholangiogram is indicated with histology and haematology follow-up.

  18. Oral lichen planus: A retrospective study of 633 patients from Bucharest, Romania

    Science.gov (United States)

    Parlatescu, Ioanina; Gheorghe, Carmen; Tovaru, Mihaela; Costache, Mariana; Sardella, Andrea

    2013-01-01

    Objective: In this retrospective study, patients’ medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. Material and Methods: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. Results: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. Conclusions: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients. Key words:Oral lichen planus, oral mucosal diseases, retrospective study. PMID:23229244

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

    Science.gov (United States)

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

    2004-02-01

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

  20. 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

  1. 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

  2. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

    Science.gov (United States)

    Zubair, M; Habib, L; Mirza, M R; Channa, M A; Yousuf, M

    2010-07-01

    This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in

  3. Two potentially zoonotic parasites infecting Philippine brown deer (Cervus mariannus desmarest, 1822 in Leyte Island

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    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.

  4. The best management for 'crescendo biliary colic' is urgent laparoscopic cholecystectomy.

    Science.gov (United States)

    Robertson, G S; Wemyss-Holden, S A; Maddern, G J

    1998-11-01

    Gallbladder disease due to stones is well recognised as falling into two categories, presenting with either chronic symptoms or developing acute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) presenting with 4-14 days of at least daily attacks of resolving biliary colic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either at laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patients with 'crescendo biliary colic' are often young women who can rarely afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally managed by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvement.

  5. 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.

  6. 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.

  7. 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)

  8. 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.)

  9. Caring for the woman with acute fatty liver of pregnancy.

    Science.gov (United States)

    Holub, Karen; Camune, Barbara

    2015-01-01

    Acute fatty liver of pregnancy, although rare, is usually a third trimester of pregnancy occurrence that may be life threatening for both the pregnant woman and the fetus. Often, the onset resembles gastroenteritis or cholecystitis and correct diagnosis is delayed. Because it can also present with preeclampsia and eclampsia, it may be mistakenly diagnosed as hemolysis, elevated liver enzymes, low platelet syndrome. This article presents diagnostic differences between liver conditions that can complicate pregnancy and management strategies for treating and maintaining the well-being of pregnant women, fetuses, and infants who are affected by acute fatty liver of pregnancy. Early recognition and rapid intervention from antepartum diagnosis through delivery and the postpartum period are required by the nursing team and medical providers to reduce maternal and neonatal morbidity and mortality.

  10. Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

    Science.gov (United States)

    McCurdy, Heather M

    2013-01-01

    Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

  11. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock

    Science.gov (United States)

    Dicpinigaitis, Peter V.; De Aguirre, Manuel; Divito, Joseph

    2015-01-01

    Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen. PMID:26417465

  12. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock

    Directory of Open Access Journals (Sweden)

    Peter V. Dicpinigaitis

    2015-01-01

    Full Text Available Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen.

  13. Dengue shock syndrome

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sodalagunta, Mahesh Babu; Sepehrar, Mona; Bangalore Raja, Shiva Kumar; Nataraju, Aravinda Settikere; Kumbhat, Mounica; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Dengue fever is a mosquito-borne arthropod-borne viral (arboviral) tropical disease in humans affecting 50–528 million people worldwide. The acute abdominal complications of dengue fever are acute appendicitis, acute pancreatitis, acute acalculous cholecystitis and non-specific peritonitis. Acute pancreatitis with new onset diabetes in dengue shock syndrome (DSS) is very rarely reported. We describe a case of 30-year-old man admitted in intensive care unit and was diagnosed with DSS with RT-PCR, NS1 antigen and dengue IgM antibody being positive. Abdominal ultrasound and computerized tomography confirmed acute pancreatitis. Patient required insulin after recovery. Diabetes mellitus caused by DSS is under-reported and lack of awareness may increase mortality and morbidity. PMID:28031845

  14. 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.

  15. 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.

  16. Loss of efficacy of pasireotide after its re-administration: is there a reason why?

    Directory of Open Access Journals (Sweden)

    Stylianos Mandanas

    2016-12-01

    Full Text Available Pasireotide is a recently approved medical treatment for persistent or recurrent Cushing’s disease (CD. However, an escape from the initial successful response has not yet been described. A 42-year-old female presented with several symptoms indicative of hypercortisolism. Biochemical evaluation and imaging were consistent with CD due to a pituitary adenoma. Surgical excision of the adenoma was unsuccessful and gamma-knife radiosurgery was followed. Our patient remained hypercortisolemic thus treatment with pasireotide (900 ug subcutaneously twice daily was decided. Biochemical and clinical remission was noted shortly thereafter. Moderate adverse events led to dose reduction to 600 ug subcutaneously twice daily. The patient remained in remission for 6 months, when treatment was discontinued due to cholecystitis. One month after cholecystectomy, pasireotide was restarted with no clinical or biochemical benefit that time. Pasireotide is an effective medical treatment for CD. Nevertheless, a loss of its initial efficacy may rarely be described.

  17. Opisthorchis viverrini:The carcinogenic human liver fluke

    Institute of Scientific and Technical Information of China (English)

    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 experimental and epidemiological evidences strongly implicate liver fluke infection as the major risk factor in cholangiocarcinoma,cancer of the bile ducts.The liver fluke infection is 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.The health education programs to prevent and control opisthorchiasis are still required in the high-risk areas.

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

    Directory of Open Access Journals (Sweden)

    Sonia López-Cuenca

    2016-09-01

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

  19. Therapy of umbilical hernia during laparoscopic cholecystectomy.

    Science.gov (United States)

    Zoricić, Ivan; Vukusić, Darko; Rasić, Zarko; Schwarz, Dragan; Sever, Marko

    2013-09-01

    The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic cholecystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures.

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

    Institute of Scientific and Technical Information of China (English)

    Vui Heng Chong; Kian Soon Lim; Varkey Vallickad Mathew

    2009-01-01

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