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Foles AI, Valsassina R, Garcia AM. ACUTE ACALCULOUS CHOLECYSTITIS RELATED TO HEPATITIS A VIRUS: REPORT OF 3 CASES. Pediatr Infect Dis J 2024:00006454-990000000-00902. [PMID: 38900086 DOI: 10.1097/inf.0000000000004437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Hepatitis A virus commonly affects children in developing countries. Usually, it presents as an asymptomatic infection or a self-limited acute hepatitis. We report 3 rare pediatric cases of acute acalculous cholecystitis associated with to hepatitis A virus. Conservative treatment was successful, with complete clinical, analytical and imaging remission.
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Affiliation(s)
- Ana Isabel Foles
- From the Pediatric Infectious Disease Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Lisboa, Portugal
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Wang H, Gong J, Chen J, Zhang W, Sun Y, Sun D. Intestinal microbiota and biliary system diseases. Front Cell Infect Microbiol 2024; 14:1362933. [PMID: 38558851 PMCID: PMC10978682 DOI: 10.3389/fcimb.2024.1362933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The incidence of biliary system diseases has been continuously increasing in the past decade. Biliary system diseases bring a heavy burden to humanity and society. However, the specific etiology and pathogenesis are still unknown. The biliary system, as a bridge between the liver and intestine, plays an indispensable role in maintaining the physiological metabolism of the body. Therefore, prevention and treatment of biliary diseases are crucial. It is worth noting that the microorganisms participate in the lipid metabolism of the bile duct, especially the largest proportion of intestinal bacteria. Methods We systematically reviewed the intestinal microbiota in patients with gallstones (GS), non-calculous biliary inflammatory, and biliary tract cancer (BTC). And searched Pubmed, Embase and Web of science for research studies published up to November 2023. Results We found that the abundance of Faecalibacterium genus is decreased in GS, primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and BTC. Veillonella, Lactobacillus, Streptococcus and Enterococcus genus were significantly increased in PSC, PBC and BTC. Interestingly, we found that the relative abundance of Clostridium was generally reduced in GS, PBC and BTC. However, Clostridium was generally increased in PSC. Discussion The existing research mostly focuses on exploring the mechanisms of bacteria targeting a single disease. Lacking comparison of multiple diseases and changes in bacteria during the disease process. We hope to provide biomarkers forearly diagnosis of biliary system diseases and provide new directions for the mechanism of intestinal microbiota in biliary diseases.
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Affiliation(s)
- Hua Wang
- Department of Health, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
| | - Junfeng Gong
- Department of General Surgery, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
| | - Jingyi Chen
- Department of Pharmacy, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
| | - Wei Zhang
- Department of Health, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
| | - Yanjun Sun
- Department of General Surgery, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
| | - Dengqun Sun
- Department of General Surgery, The Chinese People’s Armed Police Forces Anhui Provincial Corps Hospital, Hefei, China
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Gao C, Cao L, Mei X. Clinical analysis of infectious mononucleosis complicated with acute acalculous cholecystitis. Front Pediatr 2024; 12:1339920. [PMID: 38523838 PMCID: PMC10957744 DOI: 10.3389/fped.2024.1339920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
Objective This study aimed to investigate specific clinical diagnostic methods for children with infectious mononucleosis (IM) complicated by acute acalculous cholecystitis (AAC). Methods We conducted a retrospective analysis of 171 cases of IM diagnosed in the infectious disease ward of Children's Hospital of Nanjing Medical University between January 2020 and December 2020. All IM patients underwent abdominal ultrasound examinations to assess the liver, gallbladder, and spleen. Fourteen patients with symptoms of AAC underwent a follow-up assessment one week later. Results The estimated incidence of AAC in hospitalized IM children was 8.2%. Both groups of patients presented with fever, abdominal pain, and eyelid edema upon admission. Characteristic radiological findings of AAC were observed, including gallbladder (GB) distention, increased GB wall thickness and increased common bile duct diameter. Analysis of laboratory results revealed no statistically significant differences in leukocyte, absolute lymphocyte count, CD3+, CD3 + CD4+, CD3+ CD8+, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), or Gamma-Glutamyl Transferase (GGT) levels between the AAC(+) and AAC(-) groups on admission. However, these parameters were not significant risk factors for AAC. After discharge, relevant indicators in non-AAC patients gradually decreased to normal levels, while those in AAC(+) patients did not show a significant decrease. Conclusion While cases of IM complicated by AAC are relatively uncommon, the utilization of abdominal ultrasound offers a reliable tool for confirming this diagnosis. Routine abdominal ultrasound examinations are recommended for IM patients to improve early detection and treatment of associated conditions.
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Affiliation(s)
- Caijie Gao
- Department of Infectious Disease, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liming Cao
- Department of Infectious Disease, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoli Mei
- Department of Infectious Disease, Children's Hospital of Nanjing Medical University, Nanjing, China
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Pathak SJ, Ji H, Nijagal A, Avila P, Dai SC, Arain MA, Kouanda A. Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients. Surg Endosc 2024; 38:1351-1357. [PMID: 38114877 PMCID: PMC10881756 DOI: 10.1007/s00464-023-10632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adult patients with cholecystitis who do not undergo cholecystectomy on index admission have worse outcomes, however, there is a paucity of data of the role of cholecystectomy during index hospitalization in the pediatric population. Our aim was to determine outcomes and readmission rates among pediatric patients with cholecystitis who underwent index cholecystectomy versus those who did not. METHODS We performed a retrospective study of pediatric (< 18 years old) admitted with acute cholecystitis (AC) requiring hospitalization using the 2018 National Readmission Database (NRD). Exclusion criteria included age ≥ 18 years and death on index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmissions. RESULTS We identified 550 unique index acute cholecystitis admissions. Mean age was 14.6 ± 3.0 years. Majority of patients were female (n = 372, 67.6%). Index cholecystectomy was performed in (n = 435, 79.1%) of cases. Thirty-day readmission rate was 2.8% in patients who underwent index cholecystectomy and 22.6% in those who did not (p < 0.001). On multivariable analysis, patients who did not undergo index cholecystectomy had higher odds of 30-day readmission than those who did not (OR 10.66, 95% CI 5.06-22.45, p < 0.001). Female patients also had higher odds of 30-day readmission compared to males (OR 3.37, 95% CI 1.31-8.69). CONCLUSIONS Patients who did not undergo index cholecystectomy had over tenfold increase in odds of 30-day readmission. Further research is required to understand the barriers to index cholecystectomy despite society recommendations and clear clinical benefit.
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Affiliation(s)
- Sagar J Pathak
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Hyun Ji
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Amar Nijagal
- Department of Surgery, University of California, San Francisco, CA, USA
- Liver Center, University of California, San Francisco, CA, USA
- The Pediatric Liver Center, UCSF Benioff Children's Hospital, San Francisco, CA, USA
- Eli and Edythe Broad Center of Regeneration Medicine, University of California, San Francisco, CA, USA
| | - Patrick Avila
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mustafa A Arain
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology, Department of Medicine, Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
| | - Abdul Kouanda
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Simmons CL, Harper LK, Patel MC, Katabathina VS, Southard RN, Goncalves L, Tran E, Biyyam DR. Biliary Disorders, Anomalies, and Malignancies in Children. Radiographics 2024; 44:e230109. [PMID: 38358937 DOI: 10.1148/rg.230109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Biliary abnormalities in children are uncommon, and the spectrum of biliary disorders is broader than in adult patients. Unlike in adults, biliary disorders in children are rarely neoplastic and are more commonly rhabdomyosarcoma rather than cholangiocarcinoma. Pediatric biliary disorders may be embryologic or congenital, such as anatomic gallbladder anomalies, anomalous pancreaticobiliary tracts, various cholestatic processes, congenital cystic lesions, or genetic conditions. They may also be benign, such as biliary filling anomalies, biliary motility disorders, and biliary inflammatory and infectious disorders. Distinguishing these entities with a single imaging modality is challenging. US is the primary imaging modality for initial evaluation of biliary abnormalities in children, due to its wide availability, lack of ionizing radiation, and low cost and because it requires no sedation. Other examinations such as MRI, CT, and nuclear medicine examinations may provide anatomic and functional information to narrow the diagnosis further. Hepatobiliary-specific contrast material with MRI can provide better assessment of biliary anatomy on delayed images than can traditional MRI contrast material. MR cholangiopancreatography (MRCP) allows visualization of the intra- and extrahepatic biliary ducts, which may not be possible with endoscopic retrograde cholangiopancreatography (ERCP). Suspected biliary atresia requires multiple modalities for diagnosis and timely treatment. Determining the type of choledochal cyst calls for a combination of initial US and MRCP. Many benign and malignant biliary masses require biopsy for definitive diagnosis. Knowledge of the imaging appearances of different pediatric biliary abnormalities is necessary for appropriate imaging workup, providing a diagnosis or differential diagnosis, and guiding appropriate management. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Curtis L Simmons
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Laura K Harper
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Mittun C Patel
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Venkat S Katabathina
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Richard N Southard
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Luis Goncalves
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Evelyn Tran
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Deepa R Biyyam
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
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Leung AKC, Wong AHC, Hon KL. Childhood Obesity: An Updated Review. Curr Pediatr Rev 2024; 20:2-26. [PMID: 35927921 DOI: 10.2174/1573396318666220801093225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is an important and serious public health problem worldwide. OBJECTIVE This article aims to familiarize physicians with the evaluation, management, and prevention of childhood. METHODS A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article. RESULTS Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition. CONCLUSION Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, China
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Sejeeni NF, Alfhmi S, Aljahdali S, Alzahrani S, Jaha R. Kawasaki Disease With Acute Acalculous Cholecystitis: A Case Report. Cureus 2023; 15:e49789. [PMID: 38161523 PMCID: PMC10757816 DOI: 10.7759/cureus.49789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammatory disease of the gallbladder in the absence of gallstones. AAC has been linked to various systemic illnesses including Kawasaki disease (KD). We report a case of a five-year-old male brought to the emergency department (ED) with a history of fever and vomiting for four days. He was admitted as a case of KD. Then, we discovered that he had AAC, which was well managed by intravenous immunoglobulin (IVIG) as the fever subsided, C-reactive protein (CRP) decreased, and repeated abdominal ultrasound showed a decrease in gallbladder thickness without any evidence of coronary artery aneurysms.
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Affiliation(s)
| | - Sumaiah Alfhmi
- Pediatric Medicine, Maternity and Children Hospital, Makkah, SAU
| | | | | | - Rahaf Jaha
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
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Chang C, Wang Y, Shi W, Xu H, Huang X, Jiao Y. Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen? Medicine (Baltimore) 2023; 102:e34662. [PMID: 37656996 PMCID: PMC10476726 DOI: 10.1097/md.0000000000034662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
Patients with acute acalculous cholecystitis (AAC) often present with acute abdominal symptoms. However, recent clinical studies have suggested that some patients with AAC and an acute abdomen, especially when caused by viruses or rheumatic disease, may not require cholecystectomy and that conservative treatment is adequate. Whether cholecystectomy is superior to conservative treatment for patients with AAC presenting with a severe acute abdomen is still uncertain. This was a case series study of AAC-related literature published between 1960 and 2022. In total, 171 cases (104 viral infection-associated AAC and 67 rheumatic disease-associated AAC) were included. The prognoses of patients receiving cholecystectomy or conservative treatment were compared. To account for confounding factors, etiological stratification and logistic regression were performed. The prognosis was similar for patients undergoing cholecystectomy and conservative treatment (P value .364), and virus infection-associated AAC had a better prognosis than rheumatic disease-associated AAC (P value .032). In patients with AAC caused by viruses or rheumatic disease, the acute abdomen can be adequately managed by conservative treatment of the underlying etiology and does not mandate surgical intervention.
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Affiliation(s)
- Chuheng Chang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youyang Wang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoming Huang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Yang L, Fang Y, Pu Y, Wang D, Song E, Wang L, Wu Q. Clinical Efficacy of Laparoscopic Cholecystectomy via Cystic Plate Approach for Gallstone Patients with Chronic Cholecystitis. J Laparoendosc Adv Surg Tech A 2023; 33:852-858. [PMID: 37449814 DOI: 10.1089/lap.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Introduction: Chronic cholecystitis has evolved into one of the digestive system diseases that negatively affect the quality of life of patients. This study was conducted to explore the clinical efficacy of laparoscopic cholecystectomy via cystic plate approach for the treatment of gallstones with chronic cholecystitis. Materials and Methods: Totally 184 gallstone patients with chronic cholecystitis who underwent laparoscopic cholecystectomy in The First People's Hospital of Wuhu from January 2021 to October 2022 were randomly divided into a control group (n = 92) and an observation group (n = 92). In the observation group and control group, the gallbladder was removed using the cystic plate approach and traditional approach, respectively. Surgical indicators and complications of patients were compared. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were measured by enzyme-linked immunosorbent assay. The quality of life of patients was assessed using the SF-36 scale. Results: The recovery time of gastrointestinal function, intraoperative blood loss, and postoperative drainage volume in the observation group were significantly lower than those in the control group (P < .05). At 24 hours after surgery, the serum levels of IL-6, TNF-α, and CRP in the observation group were much lower than those in the control group (P < .05). Three months after surgery, the observation group showed a much higher quality of life score than the control group (P < .05). Conclusion: Laparoscopic cholecystectomy via cystic plate approach can effectively treat chronic gallstones with chronic cholecystitis. It shortened the recovery time of gastrointestinal function, reduced postoperative inflammation, and improved the quality of life.
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Affiliation(s)
- Laizhi Yang
- Department of Emergency Surgery, The First People's Hospital of Wuhu, Wuhu, China
| | - Yin Fang
- Department of Emergency Surgery, The First People's Hospital of Wuhu, Wuhu, China
| | - Yan Pu
- Department of Hepatobiliary Surgery, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, China
| | - Dong Wang
- Department of Hepatobiliary Surgery, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, China
| | - Endong Song
- Department of Emergency Surgery, The First People's Hospital of Wuhu, Wuhu, China
| | - Lei Wang
- Department of Emergency Surgery, The First People's Hospital of Wuhu, Wuhu, China
| | - Qiang Wu
- Department of Emergency Surgery, The First People's Hospital of Wuhu, Wuhu, China
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Salajegheh F, Shafieipour S, Najminejad Z, Pourzand P, Nakhaie M, Jahangiri S, Sarmadian R, Gilani A, Rukerd MRZ. HAV-induced acalculous cholecystitis: A case report and literature review. Clin Case Rep 2023; 11:e7254. [PMID: 37113636 PMCID: PMC10127462 DOI: 10.1002/ccr3.7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Hepatitis A virus (HAV) has some life-threatening extrahepatic complications, such as acute acalculous cholecystitis (AAC). We present HAV-induced AAC in a young female, based on clinical, laboratory, and imaging findings, and conduct a literature review. The patient became irritable, which progressed to lethargy, as well as a significant decline in liver function, indicating acute liver failure (ALF). She was immediately managed in the intensive care unit with close airway and hemodynamic monitoring after being diagnosed with ALF (ICU). The patient's condition was improving, despite only close monitoring and supportive treatment with ursodeoxycholic acid (UDCA) and N-acetyl cysteine (NAC).
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Affiliation(s)
- Faranak Salajegheh
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Sara Shafieipour
- Physiology Research Center, Institute of NeuropharmacologyKerman University of Medical SciencesKermanIran
| | - Zohre Najminejad
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical Sciences KermanKermanIran
| | - Pouria Pourzand
- School of MedicineZahedan University of Medical SciencesZahedanIran
| | - Mohsen Nakhaie
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
| | - Samaneh Jahangiri
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Roham Sarmadian
- Infectious disease research centerArak University of Medical SciencesArakIran
| | - Abolfazl Gilani
- Department of pediatric surgeryTehran university of Medical SciencesTehranIran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
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12
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Shehzad I, Nelson N, Vora N, Wills H, Birkemeier K, Govande V. Acute acalculous cholecystitis in an infant after gastroschisis closure. Proc AMIA Symp 2023; 36:256-258. [PMID: 36876258 PMCID: PMC9980476 DOI: 10.1080/08998280.2022.2153353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gastroschisis is a common type of congenital anterior abdominal wall defect with intraabdominal organs exposed outside the abdominal cavity. With modern neonatology and surgical practices, the overall prognosis for infants with gastroschisis is excellent. However, a subset of infants with gastroschisis will develop complications, requiring repeat surgical interventions. We present a case of a female infant with complicated gastroschisis who developed acute perforated acalculous cholecystitis, which was accurately diagnosed with abdominal ultrasound and successfully treated with medical management and a percutaneous cholecystostomy tube.
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Affiliation(s)
- Irfan Shehzad
- Department of Neonatology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Nicholas Nelson
- Department of Radiology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Niraj Vora
- Department of Neonatology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Hale Wills
- Department of Pediatric Surgery, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Krista Birkemeier
- Department of Radiology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Vinayak Govande
- Department of Neonatology, Baylor Scott & White Medical Center - Temple, Temple, Texas
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13
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Acalculous cholecystitis associated with Ebstein-Barr virus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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14
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Dargham TB, Moumneh MB, Atallah C, Zaghal A. A scoping review on acute gastrointestinal surgical complications in immunocompromised pediatric patients. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management.
Main body
This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions.
Conclusion
Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.
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Trbojević T, Crnković Ćuk M, Marleku F, Perše B, Slatina P, Žaja O. ANOTHER FACE OF EPSTEIN-BARR VIRUS INFECTION: ACUTE ACALCULOUS CHOLECYSTITIS WITH CHOLESTASIS IN A PREVIOUSLY HEALTHY FIVE-YEAR-OLD GIRL WITH PRIMARY INFECTION. Acta Clin Croat 2022; 61:711-716. [PMID: 37868175 PMCID: PMC10588380 DOI: 10.20471/acc.2022.61.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 10/10/2021] [Indexed: 10/24/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare disease, particularly in children. The clinical and laboratory presentation of AAC is variable. The diagnosis is based on radiological criteria. AAC is an atypical and rare complication of Epstein-Barr virus (EBV) infection, therefore we present a girl with AAC and cholestasis due to EBV primary infection. Conservative treatment and careful monitoring was followed by clinical, radiological and laboratory improvement, and finally complete recovery. Our aim was to highlight the importance of recognizing AAC as a differential diagnosis in children with abdominal pain and/or acute cholestasis.
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Affiliation(s)
- Tena Trbojević
- Department of Pediatrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Matea Crnković Ćuk
- Department of Pediatrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Frane Marleku
- Division of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Barbara Perše
- Department of Pediatrics, Division of Pediatric Gastroenterology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Paula Slatina
- Division of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Orjena Žaja
- Department of Pediatrics, Division of Pediatric Gastroenterology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- University of Split, School of Medicine, Split, Croatia
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16
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Synchronous gallbladder perforation and appendicitis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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17
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Suleman M, Sadiq A, Amsi P, Lodhia J. Gallbladder perforation: An uncommon cause of peritonitis in a child. Int J Surg Case Rep 2022; 100:107765. [PMID: 36302315 PMCID: PMC9614562 DOI: 10.1016/j.ijscr.2022.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance Gallbladder perforations are infrequently encountered in the pediatric group but can be a cause of peritonitis with significant morbidity and mortality if not diagnosed and managed promptly. Case presentation We present a case of a 10-year-old female who presented with peritonitis due to a perforated gallbladder diagnosed by CT-scan. She was managed surgically successfully. Clinical discussion Gallbladder perforation due to cholecystitis is usually seen in the elderly population but is uncommon among the pediatric population. Mortality rate can be as high as 26 % hence early diagnosis is vital. Management is mostly surgical as seen in the index case. Conclusion Clinicians should keep gallbladder perforation in mind as a differential diagnosis of acute abdomen in children although uncommon. Gallbladder perforation is uncommon to the pediatric population. If encountered in children, causes significant morbidity and mortality Clinicians should keep it as a differential diagnosis of peritonitis with a high index of suspicion. Prompt management through surgery yields favourable outcome.
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Affiliation(s)
- Mujaheed Suleman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Radiology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Patrick Amsi
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Pathology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania.
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18
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Celiac Disease and Gallbladder: Pathophysiological Aspects and Clinical Issues. Nutrients 2022; 14:nu14204379. [PMID: 36297063 PMCID: PMC9612360 DOI: 10.3390/nu14204379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Celiac Disease (CD) is an immune-mediated disorder which primarily affects the small intestine; however, extra-intestinal organs are often affected by the pathological process, too. As regards the digestive system, liver alterations in CD patients have been widely described, which can also extend to the biliary tract. Notably, gallbladder function can be altered in CD patients. In this review, we specifically analyze and summarize the main pathophysiological aspects and clinical evidence of gallbladder dysfunction in CD patients, in order to discuss the potential medical complications and clinical research gaps. In addition to some perturbations of bile composition, CD patients can develop gallbladder dysmotility, which mainly expresses with an impaired emptying during the digestive phase. The main pathophysiological determinant is a perturbation of cholecystokinin secretion by the specific duodenal enteroendocrine cells in response to the appropriate nutrient stimulation in CD patients. This situation appears to be reversible with a gluten-free diet in most cases. Despite this gallbladder impairment, CD patients do not seem to be more predisposed to gallbladder complications, such as calculous and acalculous cholecystitis. However, very few clinical studies have actively investigated these clinical aspects, which may not be completely evidenced so far; alternatively, the substantial improvements in the last two decades regarding CD diagnosis, which have reduced the diagnostic delay (and related dietary treatment), may have lessened the potential clinical consequences of CD-related gallbladder dysfunction. Specific clinical studies focused on these aspects are needed for a better understanding of the clinical implications of gallbladder alterations in CD patients.
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Setyawati AN, Tjahjono DK K, Chionardes MA, Arkhaesi N. Acute acalculous cholecystitis in a pediatric dengue hemorrhagic fever patient: A case report, lesson learned from limited resource setting. Ann Med Surg (Lond) 2022; 81:104437. [PMID: 36147073 PMCID: PMC9486663 DOI: 10.1016/j.amsu.2022.104437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Dengue fever (DF) is endemic in numerous regions of Indonesia with primary clinical features such as high fever as well as pullout of intravascular fluid and albumin leakage, which provokes pleural effusion, hypoproteinemia, and blood hemoconcentration. However, the incidence of abdominal pain as a clinical manifestation of DF, which refers to acalculous cholecystitis, is rare. CASE PRESENTATION An 11-year-old female was admitted to the to hospital with fever, headache, and myalgia. Blood examination resulted in low platelet coua nt and positive IgM Dengue antibody test. On the third day, the patient felt sharp abdominal pain. Abdominal ultrasound showed cholecystitis, cholestasis, pleural effusion, ascites, and laboratory finding showed increased C-reactive protein. The management was conservative and discharged at the 7th day. DISCUSSION The acalculous cholecystitis in Dengue Fever/Dengue Hemorrhagic fever (DF/DHF) is challenging in diagnose due to atypical presentations. Several proposed mechanisms are critical illness, including direct invasion of the gallbladder epithelial cells, vasculitis, stasis of biliary flow, obstruction of the biliary tree, ischemia, and sequestration. The actual mechanism of the dengue virus has been proposed that direct viral incursion of the gallbladder may yield edema and exudation. Abdominal ultrasonography is considered to diagnose acute acalculous cholecystitis (AAC) in children. CONCLUSION Understanding pathophysiology of the acalculous cholecystitis in DF/DHF patients and atypical presentation of sharp abdominal pain help physicians for early diagnosis and management both in monitoring and patient care management. Abdominal ultrasonography can help physicians to diagnose AAC.
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Affiliation(s)
- Amallia Nuggetsiana Setyawati
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
- Division of Pediatrics, Williambooth General Hospital, Semarang, Indonesia
- Corresponding author. Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia.
| | - Kusmiyati Tjahjono DK
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Melissa Angela Chionardes
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Nahwa Arkhaesi
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
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20
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Cortellazzo Wiel L, Spezzacatene A, Gortani G, Saccari A, Taddio A, Barbi E. Acute Acalculous Cholecystitis: Think of Hepatitis A Infection and Do Not Underestimate Pain. Pediatr Emerg Care 2022; 38:304-306. [PMID: 35477693 DOI: 10.1097/pec.0000000000002735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
ABSTRACT A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus-related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.
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Affiliation(s)
| | - Anita Spezzacatene
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Giulia Gortani
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessia Saccari
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
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21
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Fosio M, Cherobin G, Stramare R, Fassan M, Giraudo C. Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps. Diagnostics (Basel) 2022; 12:diagnostics12010155. [PMID: 35054322 PMCID: PMC8774625 DOI: 10.3390/diagnostics12010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5–10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.
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Affiliation(s)
- Margherita Fosio
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Giulia Cherobin
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Roberto Stramare
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Matteo Fassan
- Surgical Pathology, Department of Medicine, University of Padova, 35121 Padova, Italy;
- Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
- Correspondence:
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22
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Piccolo G, De Rose EL, Bassi M, Napoli F, Minuto N, Maghnie M, Patti G, d’Annunzio G. Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2022; 13:966344. [PMID: 36093078 PMCID: PMC9449538 DOI: 10.3389/fendo.2022.966344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.
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Affiliation(s)
- Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neuro-oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Elena Lucia De Rose
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Flavia Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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23
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Chen BQ, Chen GD, Xie F, Li X, Mao X, Jia B. Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study. BMC Surg 2021; 21:439. [PMID: 34961498 PMCID: PMC8713395 DOI: 10.1186/s12893-021-01411-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC. MATERIALS AND METHODS The study population comprised 44 patients (median age 76 years; range 31-94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC. RESULTS Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61-1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5-60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21-582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08-2.17; P = 0.018) was independently associated with 60-day mortality after PC. CONCLUSIONS Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes.
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Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
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24
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Jaffey JA. Canine extrahepatic biliary disease: what have we learned? J Small Anim Pract 2021; 63:247-264. [PMID: 34935155 DOI: 10.1111/jsap.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 12/07/2022]
Abstract
Extrahepatic biliary disease in dogs is commonly encountered in clinical practice worldwide. Diseases in this segment of the biliary tract are diverse and can manifest with mild clinical signs or can be life-threatening. In the last decade there have been advances in diagnostic tests, imaging modalities and therapeutic interventions as well as the identification of novel prognostic variables that could improve outcomes in dogs with extrahepatic biliary disease. Therefore, the objective of this review was to summarise clinically relevant updates of extrahepatic biliary disease in dogs.
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Affiliation(s)
- J A Jaffey
- Department of Specialty Medicine, Midwestern University, College of Veterinary Medicine, Glendale, AZ, 85308, USA
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25
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Effects of Serum Metabolites on the Pancreatic Transcriptome in Acute Acalculous Cholecystitis. Gastroenterol Res Pract 2021; 2021:2368571. [PMID: 34925503 PMCID: PMC8674085 DOI: 10.1155/2021/2368571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/15/2021] [Indexed: 01/30/2023] Open
Abstract
Background To provide a basis for the diagnosis and treatment of acalculous biliary pancreatitis, this study investigated the impact of serum metabolites on the pancreatic transcriptome in acute acalculous cholecystitis (AAC). Methods Fourteen rabbits were randomly divided into two groups (a normal control group of 7 rabbits and an AAC group of 7 rabbits), blood was collected from the 14 rabbits, and metabolomic analysis was performed through 1H NMR. Two pancreatic tissue chips of the AAC group and the normal control group were prepared and sequenced. We utilized the limma package of R software, the DAVID database, the STRING database, Cytoscape software, and the CFinder analysis tool to perform differential expression gene analysis, gene function enrichment analysis, protein interaction network (PPI) construction, and network module mining, and we performed gene enrichment analysis in each module. Results Serum metabolism analysis showed that in AAC, the metabolism of sugar, lipids, and protein, that is, the three major nutrients, was affected to varying degrees, and levels of serum trimethylamine N-oxide (TMAO) increased. Bioinformatic methods were utilized to identify a total of 183 differentially expressed genes and 3 key genes. Enrichment analysis showed that differentially expressed genes were significantly enriched in cation transport, the inflammatory response, the NF-κB pathway, and the cancer signaling pathway. Conclusion Metabolomic analysis and functional analysis of 3 key genes demonstrated that abnormal serum metabolites affected the pancreatic transcriptome and induced a sensitive state of inflammation in the pancreas. These metabolites may represent important targets for future research on the pathogenesis, clinical diagnosis, and treatment of noncalculous biliary pancreatitis.
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26
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Lin Q, Shen L, Chen C, Yang Z, Que Y, Liu Y, Yin M, Xu G, Li J. Prognostic Significance of Ultrasound Findings of Acute Acalculous Cholecystitis for Elderly Long-Term Bedridden Patients. Front Med (Lausanne) 2021; 8:743998. [PMID: 34692734 PMCID: PMC8531473 DOI: 10.3389/fmed.2021.743998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/13/2021] [Indexed: 12/07/2022] Open
Abstract
Background: Acute acalculous cholecystitis (AAC) is characterized by the development of cholecystitis in the gallbladder without gallstones or with small gallstones unrelated to inflammatory diseases. This disease is not rare in the elderly bedridden patients with co-morbidities and prone to develop life-threatening gangrene or perforation of gallbladder. Early imaging is essential for detecting and effectively treating AAC. This study aimed to evaluate the use of ultrasound diagnostic criteria for the diagnosis and prognosis of elderly long-term bedridden patients with suspected AAC. Methods: We retrospectively studied 374 elderly bedridden patients with clinical manifestations of AC at the acute stage of the disease. Gallbladder anomalies were found in 92 patients by ultrasound examination, which correlated with the duration time of clinical manifestations, complications, as well as therapeutic prognosis. The major and minor ultrasound criteria of AAC were made according to the Tokyo Guidelines 2018. Ultrasound results were thought to be AAC positive when they met two major criteria or one major and two minor criteria. Results: Forty-three (46.7%) of the 92 patients presented with AAC (+) test results based on the ultrasound criteria, with a higher incidence of complications (27.9%) than AAC (–) patients (0%; P < 0.001). The median length of symptoms (8 vs. 4 days, P < 0.001) and duration of antibiotic therapy (13 vs. 5 days, P < 0.001) were longer in the AAC (+) group. Conclusions: The ultrasound-based AAC (+) group often had a worse prognosis than the AAC (–) group. Therefore, patients from the AAC (+) group should receive a follow-up ultrasound examination to detect disease progression early.
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Affiliation(s)
- Qian Lin
- Department of Medical Ultrasonics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Lei Shen
- Department of Gastroenterology, Faculty of Digestive Medicine, The First Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Cheng Chen
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Zhen Yang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yifan Que
- Department of Geriatric Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yin
- Department of Emergency, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Guogang Xu
- Department of Geriatric Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Junlai Li
- Department of Medical Ultrasonics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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Fu Y, Pang L, Dai W, Wu S, Kong J. Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review. Dig Dis 2021; 40:468-478. [PMID: 34657038 DOI: 10.1159/000520025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations. KEY MESSAGE Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder. SUMMARY Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.
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Affiliation(s)
- Yantao Fu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liwei Pang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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28
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Sojar SH, Harrison D, Fearon D, Herliczek TW, Ziegler JW, Welsh SS. Mural thickening of the gallbladder? Look to the heart of the problem. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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30
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Yakupovich A, Rajeswaran S, Green J, Donaldson JS. Role of Interventional Radiology in Children with Biliary and Gallbladder Diseases. Semin Intervent Radiol 2021; 38:356-363. [PMID: 34393346 DOI: 10.1055/s-0041-1731374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary and gallbladder diseases in infants and children often present unique diagnostic and therapeutic challenges that require a fundamental understanding of notable biliary diseases and anatomical variations. Surgical and endoscopic approaches that are often the gold standard in adult biliary treatment may be technically challenging and are associated with a high morbidity that may warrant a multidisciplinary treatment approach. This article will provide a comprehensive overview of the biliary conditions where interventional radiology can play a vital role in the diagnosis, management, and treatment. Differences in approach or technique between children and adults will be highlighted.
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Affiliation(s)
- Anel Yakupovich
- Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Shankar Rajeswaran
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jared Green
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - James S Donaldson
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
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31
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Bozhinovska A. Coronavirus Disease and Abdominal Pain: Mechanism, Diagnostic, and Treatment. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND: On March 11, 2020, the General Director of the World Health Organization has announced that according to the organization, the level of spread and severity of symptoms of coronavirus disease (COVID-19) is becoming alarming and because of that, it can be characterized as a pandemic. The assessment of the World Health Organization stimulated more urgent and belligerent actions from the governments as the number of case reports and studies on COVID-19 symptoms and treatment increased dramatically.
AIM: In this paper, the aim is to make a review of the studies and case reports/series that indicate that abdominal pain is one of the manifestations of COVID-19.
METHODS: A search was performed on two electronic databases: PubMed Central and Google Scholar, using the key words “COVID-19 and abdominal pain.” Case reports and case series in adults and children were included regardless of the language, region, or the publication date. The methods of synthesis and comparison were also used.
RESULTS: In general, it can be noted that the manifestation of the COVID-19 infection on the digestive tract and the consequences on the same are not fully examined.
CONCLUSION: The conclusion of the analyzed papers is that clinical practitioners in COVID-19 pandemic should carefully distinguish abdominal pain and other GI symptoms from COVID-19 manifestations and should exclude acute surgical condition.
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32
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Poddighe D, Madiyeva A, Talipova D, Umirbekova B. Infantile giant cell hepatitis with autoimmune hemolytic anemia. World J Hepatol 2021; 13:411-420. [PMID: 33959224 PMCID: PMC8080548 DOI: 10.4254/wjh.v13.i4.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/26/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Giant cell hepatitis (GCH) is characterized by large and multinucleated (syncytial) hepatocytes in the context of liver inflammation. Infantile GCH is typically associated with autoimmune hemolytic anemia in the absence of any other systemic or organ-specific autoimmune comorbidity. The etiology is unknown; concomitant viral infections (as potential trigger factors) have been identified in a few patients. The pathogenesis reportedly relies upon immune-mediated/ autoimmune mechanisms. This condition should be considered in any infant developing Coombs-positive anemia; indeed, anemia usually precedes the development of hepatitis. The clinical course is usually aggressive without the appropriate immunosuppressive therapy, which may include steroids, conventional immunosuppressors (e.g., azathioprine and cyclophosphamide as first-line treatments), intravenous immunoglobulin, and biologics (rituximab). Improvements in medical management (including the availability of rituximab) have significantly reduced the mortality of this condition in the last decade.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan
- Department of Pediatrics, National Research Center for Maternal and Child Health, Nur-Sultan 010000, Kazakhstan
| | - Aidana Madiyeva
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan
| | - Diana Talipova
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan
| | - Balzhan Umirbekova
- Department of Pediatrics, National Research Center for Maternal and Child Health, Nur-Sultan 010000, Kazakhstan
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33
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Tarawneh A, Alkhatib AM, AL-Namorah BA. Acute acalculous cholecystitis in a child with hepatitis A infection. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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34
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Acute Acalculous Cholecystitis Due to a Primary Epstein Barr Virus Infection in a Pediatric Patient. Pediatr Rep 2021; 13:86-90. [PMID: 33562159 PMCID: PMC7931023 DOI: 10.3390/pediatric13010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Epstein-Barr virus (EBV) is estimated to infect more than 98% of adults worldwide and is one of the most common human viruses. Acute acalculous cholecystitis (AAC) of the gallbladder is an atypical complication of infectious mononucleosis caused by EBV. Conservative management has been described in the context of AAC caused by EBV. A surgical approach must be considered in the case of acute complications such as perforation or gallbladder gangrene. We present the case of a 10-year-old female patient with AAC due to infectious mononucleosis syndrome caused by primary EBV infection.
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Glucagon-Like Peptide 2 Inhibits Postprandial Gallbladder Emptying in Man: A Randomized, Double-Blinded, Crossover Study. Clin Transl Gastroenterol 2021; 11:e00257. [PMID: 33512799 PMCID: PMC7710225 DOI: 10.14309/ctg.0000000000000257] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION: A recent study in mice points to the gut-derived hormone glucagon-like peptide 2 (GLP-2) as an important regulator of gallbladder motility inducing gallbladder relaxation and refilling. In this study, we evaluated the effect of exogenous GLP-2 on postprandial gallbladder motility in healthy men. METHODS: In a randomized, double-blinded, placebo-controlled, crossover study, we evaluated the effect of 4-hour intravenous infusions of high-dose GLP-2 (10 pmol × kg−1 × min−1), low-dose GLP-2 (1 pmol × kg−1 × min−1), and placebo (saline) on postprandial gallbladder motility. A 300-kcal liquid-mixed meal (added 1.5 g of acetaminophen for indirect measurement of gastric emptying) was served 30 minutes after start of intravenous infusions. Gallbladder volume was assessed by ultrasonography. RESULTS: Fifteen healthy men, age 24.3 (22.4–26.1) years (mean [95% confidence interval]) and body mass index 22.5 (21.7–23.4) kg × m−2, were included. Basal plasma GLP-2 concentration was 14 (11–17) pmol/L. During low-dose and high-dose GLP-2 infusions, steady-state postprandial plasma GLP-2 concentrations amounted to 201 (188–214) and 2,658 (2,443–2,873) pmol/L, respectively, compared with maximum postprandial plasma GLP-2 concentration of 34 (25–44) pmol/L during placebo. Gallbladder emptying (assessed as baseline-subtracted area under the curve for gallbladder volume) was reduced by low-dose GLP-2 (−0.8 [0.7–1.9] L × min, P < 0.0001) and nearly abolished by high-dose GLP-2 (1.3 [−1.7 to 0.01] L × min, P = 0.029) compared to placebo (−2.0 [−2.8 to −1.1] L × min). Compared to placebo, gastric emptying was reduced by high-dose GLP-2 (P = 0.0060 and 0.019), whereas low-dose GLP-2 did not affect gastric emptying (P = 0.13 and 0.85). DISCUSSION: Exogenous GLP-2 exerts a dose-dependent inhibitory effect on postprandial gallbladder emptying in healthy men.
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36
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Groff A, Kavanaugh M, Ramgobin D, McClafferty B, Aggarwal CS, Golamari R, Jain R. Gastrointestinal Manifestations of COVID-19: A Review of What We Know. Ochsner J 2021; 21:177-180. [PMID: 34239378 PMCID: PMC8238098 DOI: 10.31486/toj.20.0086] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Methods: We outline the evidence of the pathophysiology of COVID-19 in the GI tract, the effects of the virus on the gut and liver, the presence of the virus in stool samples, and the potential for fecal-oral transmission of COVID-19. Most of the literature sources used in this paper are case studies from China following the surge of COVID-19 infection. Results: In patients with COVID-19, GI symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain have presented in conjunction with respiratory symptoms such as fever, shortness of breath, and cough. Evidence also shows acute hepatocellular injury, indicated by elevated liver enzymes such as alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. Fecal-oral transmission of COVID-19 is suspected because of the presence of COVID-19 RNA in stool samples of COVID-19-positive patients. Conclusion: Even without the presence of respiratory symptoms, several GI symptoms are associated with COVID-19 infection, as well as possible fecal-oral transmission. Therefore, COVID-19 infection should be considered for patients presenting with primarily GI symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Rohit Jain
- Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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37
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38
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Akello VV, Bitamazire D, Wandabwa J, Ssebuufu R. Subtotal cholecystectomy: An operative option for Salmonellae typhi gangrenous cholecystitis. Clin Case Rep 2020; 8:2231-2233. [PMID: 33235765 PMCID: PMC7669373 DOI: 10.1002/ccr3.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022] Open
Abstract
Typhoid gangrenous cholecystitis is uncommon and can be managed by subtotal cholecystectomy with nonclosure of the cystic duct if that is required for patient safety.
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Affiliation(s)
| | - Denis Bitamazire
- Department of SurgeryHoima Regional Referral HospitalHoimaUganda
| | - Joel Wandabwa
- Department of SurgeryHoima Regional Referral HospitalHoimaUganda
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39
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Zhao Y, Zhang L, Xing F, Zhang R, Huang J. Synchronous Acute Acalculous Cholecystitis and Appendicitis Due to Salmonella Group D: A Rare Case Report From China and Review of the Literature. Front Med (Lausanne) 2020; 7:406. [PMID: 33015080 PMCID: PMC7461861 DOI: 10.3389/fmed.2020.00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/29/2020] [Indexed: 12/07/2022] Open
Abstract
Non-typhoidal Salmonella (NTS) disease is not common as typhoid fever but has become a global public health problem in recent decades. Acute acalculous cholecystitis (AAC) and appendicitis are rare complications of NTS infection, which are usually difficult to be diagnosed with atypical signs. Pathogenesis of NTS-induced AAC and NTS-induced appendicitis is still unclear. Ultrasound is the first choice for diagnosis of these two rare complications, computed tomography can assist in and next-generation sequencing (NGS), as a new technology in clinical medicine, also facilitates diagnosis. We described a case of simultaneous AAC and appendicitis due to NTS in an elderly male and further confirmed the diagnosis using NGS. As far as we know, this is the first Asian case of two complications occurring at the same time. Our aim is to alert physicians to pay attention to this rare condition.
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Affiliation(s)
- Yan Zhao
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China.,Microbiology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Lijun Zhang
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Fanfan Xing
- Microbiology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Ruiping Zhang
- Pathology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Jinxian Huang
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
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40
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Steffens D, Wales K, Toms C, Yeo D, Sandroussi C, Jiwane A. What surgical approach would provide better outcomes in children and adolescents undergoing cholecystectomy? Results of a systematic review and meta-analysis. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is a lack of evidence on the surgical approach for children and adolescents undergoing cholecystectomy. Therefore, the aim of this systematic review is to compare the safety and efficacy of minimally invasive cholecystectomy to open cholecystectomy in children and/or adolescents.
Main body
A search was conducted on MEDLINE, PubMed, Cochrane and Embase from inception to October 2018. We included comparative studies investigating outcomes following robotic-assisted, laparoscopic and/or open cholecystectomy in children and/or adolescents. The outcomes of interest included post-operative complication rate, operation time, length of hospital stay, post-operative pain and conversion to open procedure. The Newcastle-Ottawa Scale was used to assess the risk of bias. Meta-analysis was performed using random-effect models.
Twenty-one studies were included involving 927 children and/or adolescents. All, but one, compared outcomes between laparoscopic versus open cholecystectomy. The great majority of the included studies presented a low risk of bias. Patients undergoing laparoscopic cholecystectomy had less post-operative complications (RR: 0.57; 95%CI 0.35 to 0.94), reduced length of hospital stay (MD − 3.73; 95%CI − 4.88 to − 2.59), but longer operative time (MD 26.61; 95%CI 9.35 to 43.86) when compared to open cholecystectomy. The average conversion from laparoscopic to open cholecystectomy was 7% across studies.
Conclusions
The current evidence suggested that laparoscopic cholecystectomy in children and/or adolescents is safe resulting in lower rates of postoperative complications and length of stay, but longer operative times, when compared to the open approach.
PROSPERO registration
CRD42017067641
Level of evidence
Level III
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41
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AlMutairi AM, AlEid W, Abanomi H. Acute acalculous cholecystitis in child with systemic juvenile idiopathic arthritis, unreported manifestation. Mod Rheumatol Case Rep 2020; 5:40-42. [PMID: 32697135 DOI: 10.1080/24725625.2020.1794532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute acalculous cholecystitis is a gallbladder wall inflammation without gallstones. It was not reported before as a manifestation of systemic juvenile idiopathic arthritis. Here, we describe a 13-month-old boy presented with prolonged intermittent fever, skin rash, arthritis, serositis, and hepatomegaly. After workup, he was diagnosed with systemic juvenile idiopathic arthritis and acute acalculous cholecystitis based on an ultrasound abdomen showing thick gallbladder wall with free fluid. After treatment with three days of intravenous pulse methylprednisolone, he improved dramatically, and repeated ultrasounds showed normal gallbladder. This suggests that Acute acalculous cholecystitis can be a part of systemic juvenile idiopathic arthritis and hypothesised that surgical intervention can be avoided with the use of corticosteroids.
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Affiliation(s)
| | - Weam AlEid
- Department of Pediatric Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hind Abanomi
- Department of Pediatric Rheumatology, King Saud Medical City, Riyadh, Saudi Arabia
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42
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Guri A, Scheier E. Gallbladder wall thickening on bedside ultrasound in a child with Epstein-Barr virus infection. BMJ Case Rep 2020; 13:13/7/e234486. [PMID: 32624485 DOI: 10.1136/bcr-2020-234486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Gallbladder wall thickening (GBWT) is rarely reported in children with acute Epstein-Barr virus (EBV) infection. We present a child with EBV infection who was found on point-of-care ultrasound to have GBWT without signs of cholecystitis that subsequently resolved without intervention. We expect the proliferation of mobile and handheld sonography to increase the number of bedside examinations in febrile children. This, in turn, will increase the incidence of GBWT found in patients with EBV infection and without right upper quadrant pain. Prospective study is needed to define the incidence of GBWT in children with EBV infection.
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Affiliation(s)
- Alex Guri
- Pediatrics, Kaplan Medical Center, Rehovot, Israel
| | - Eric Scheier
- Pediatrics, Kaplan Medical Center, Rehovot, Israel
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43
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Langenohl R, Young S, Couperus K. Acute Acalculous Cholecystitis from Infection with Epstein-Barr Virus in a Previously Healthy Child: A Case Report. Clin Pract Cases Emerg Med 2020; 4:393-396. [PMID: 32926694 PMCID: PMC7434242 DOI: 10.5811/cpcem.2020.4.46301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Acute cholecystitis is the acute inflammation of the gallbladder. In adults it is most frequently caused by a gallstone(s) obstructing outflow from the cystic duct, leading to gallbladder distention and edema with eventual development of biliary stasis and bacterial overgrowth, often requiring operative management. However, in children acalculous cholecystitis is more common and is often the result of an infectious process. Case Report Here we present a case of acute acalculous cholecystitis caused by infection with Epstein-Barr virus in an otherwise healthy three-year-old male. Conclusion Acalculous cholecystitis is an uncommon but potentially significant complication of Epstein-Barr virus infection in the pediatric population. Emergency providers should consider this diagnosis in any child being evaluated for EBV with the complaint of abdominal pain.
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Affiliation(s)
- Robert Langenohl
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Scott Young
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Kyle Couperus
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
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44
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of antibiotics treatment versus placebo, no intervention, or another antibiotic for people with cholecystitis or cholangitis, or both.
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Obasi AA, Igboanugo AA. Gall Bladder Complications Resulting from Typhoid Fever in Children: Challenges of Management and Lessons Learned. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:35-38. [PMID: 35531587 PMCID: PMC9067634 DOI: 10.4103/jwas.jwas_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Surgical complications of typhoid fever present commonly as gut perforation and very rarely as gall bladder gangrene or gall bladder perforation. Gall bladder complications are rare in children and when they occur they are often the result of an infective condition. Occasionally, typhoid fever causes concomitant gall bladder complications and gut perforation. The coexistence of both conditions accentuates morbidity and mortality. We present two cases of typhoid fever with gall bladder perforation and gall bladder gangrene, respectively. Challenges of diagnosis and treatment are highlighted. The need for surgeons in endemic areas to consider these conditions while evaluating children with peritonitis is emphasized. Ultrasound detection of thickened distended gall bladder with pericholecystic fluid in a child with typhoid fever may be a sign of impending gall bladder perforation. To reduce the high morbidity and mortality from surgical complications of typhoid fever, the implementation of proven preventive measures must be encouraged. In addition, public enlightenment of this scourge must be pursued with vigor.
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Affiliation(s)
- Akputa Aja Obasi
- Paediatric Surgery Unit, Department of Surgery, Alex Ekwueme Federal University Teaching, Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Arinze Aetelbert Igboanugo
- Paediatric Surgery Unit, Department of Surgery, Alex Ekwueme Federal University Teaching, Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
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Mycoplasma pneumoniae-related hepatitis in children. Microb Pathog 2019; 139:103863. [PMID: 31712120 DOI: 10.1016/j.micpath.2019.103863] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is a small bacterium characterized by the absence of cell wall. It is a human pathogen causing upper and lower respiratory infections, both in adults and children. However, it is also considered to be implicated in the pathogenesis of several types of extra-respiratory diseases, including some gastrointestinal disorders. The liver involvement in children during or after M. pneumoniae infections is analyzed and discussed in this review. Through a systematic literature search, it is evidenced that M. pneumoniae is not infrequently associated with alteration of liver function, but rarely causes acute and severe hepatitis in children. M. pneumoniae should be considered as an unusual cause of acute hepatitis in children, whenever the most common hepatotropic viruses have been excluded. The pathogenesis of M. pneumoniae-related hepatitis is likely to be immune-mediated: both the innate and adaptive immune responses may play a fundamental role. However, the exact pathological mechanisms have to be elucidated yet. Further clinical studies are needed in order to understand the actual relevance of this microorganism in liver disease and its pathogenesis.
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Kim SH, Park S, Choi J. Acalculous cholecystitis associated with Hantaan virus: A case report. Ann Hepatobiliary Pancreat Surg 2019; 23:278-281. [PMID: 31501818 PMCID: PMC6728245 DOI: 10.14701/ahbps.2019.23.3.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/17/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) still remains one of the most elusive diagnoses and occurs in various conditions. Although AACs caused by viral infections are rare, various viruses have been revealed to cause AAC. Here we present a case in which a man suffered from AAC caused by a Hantaan virus infection. A 35-year-old man was referred to the emergency room for myalgia and fever that began 4 days ago. He suffered oliguria and abdominal pain for 2 days. At the time of his visit to the emergency room, he experienced a fever that spiked up to 38.3℃. An initial blood sample objectified the following pathologic results: white blood cells - 10260/µl; C-reactive protein – 6.76 mg/dl; total bilirubin – 1.7 mg/dl; AST – 90 IU/L; ALT – 233 IU/L. In the computed tomography, bilateral perirenal fluid collections and bilateral flexural effusion were shown and acute hepatopathy and cholecystopathy were also shown. Because there was no definite tenderness around the patient's right upper quadrant from physical examination and his cholecystopathy looked like it was from secondary change according to acute hepatopathy, we decided to perform conservative care without surgical treatment. The following day, in viral antibody test, Hantaan virus antibody was detected. After conservative management, the patient's condition improved and his laboratory findings were stable. The patient was discharged on the 10th day at the hospital stay without any symptoms. The Hantaan virus infection should be suspected as a causative agent of AAC, especially when there is abnormal liver function tests and abdominal pain.
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Affiliation(s)
- Sung Hyun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sejin Park
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Jangkyu Choi
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
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Mazur-Melewska K, Derwich A, Mania A, Kemnitz P, Służewski W, Figlerowicz M. Epstein-Barr virus infection with acute acalculous cholecystitis in previously healthy children. Int J Clin Pract 2019; 73:1-6. [PMID: 31243873 DOI: 10.1111/ijcp.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 06/02/2019] [Accepted: 06/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein-Barr virus (EBV) infection, but it is an atypical clinical presentation. AIM The aim of our study was to analyse AAC occurrence in children with primary symptomatic EBV infection who had been admitted to the hospital. METHODS We retrospectively evaluated the medical documentation of 181 children with EBV infection who were diagnosed based on the presence of viral capsid antigen IgM antibodies. All EBV-positive patients underwent transabdominal ultrasonography of the liver in the supine and right anterior oblique positions. Fifteen children who presented with AAC symptoms, including abdominal pain and a positive Murphy's sign, were analysed as a subsample and re-evaluated after 2-3 months. RESULTS The incidence of AAC in children hospitalised with infectious mononucleosis (IM) was estimated at 8.3%. Analysis of the laboratory results confirmed that the C-reactive protein (CRP) concentration was the only parameter which was higher in children who presented with AAC symptoms. The mean number of leucocytes and monocytes and liver enzyme activities were not significantly higher. The radiological findings of AAC were evident: increased GB wall thickness, non-shadowing echogenic sludge and pericholecystic fluid collection. CONCLUSION AAC during primary EBV infection appears to be a more common pathology than previously suspected. Its relatively mild nature and the lack of laboratory abnormalities mean that ultrasonographic examination is required for diagnosis. This might explain why the prevalence in children is underestimated.
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Affiliation(s)
- Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Aleksandra Derwich
- Student Research Circle at the Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Paweł Kemnitz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Wojciech Służewski
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland
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Young C, Lampe R. Primary Epstein-Barr Virus Infection in an Adolescent Female Complicated by Acute Acalculous Cholecystitis. Cureus 2019; 11:e5044. [PMID: 31501735 PMCID: PMC6721871 DOI: 10.7759/cureus.5044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Epstein-Barr Virus (EBV) is estimated to infect greater than 98% of adults worldwide and is one of the most common human viruses. EBV infection can lead to acute infectious mononucleosis characterized by fever, fatigue, malaise, sore throat, and lymphadenopathy. Elevated liver function tests (LFTs) and hepatosplenomegaly may also be present. This infection usually lasts over a period of weeks or months and is self-limited. Infected individuals, however, may suffer rare complications. Acute acalculous cholecystitis (AAC) is an atypical complication of infectious mononucleosis. The case of a young healthy adolescent female with primary EBV infection complicated by AAC is reported. Providers should be aware that many pediatric and adult cases of AAC due to EBV resolve with conservative treatment. Surgical intervention has not been described as necessary or indicated in the context of AAC caused by EBV and should only be considered in severe cases that are not responding to conservative therapy.
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Affiliation(s)
- Callan Young
- Pediatrics, Texas A&M College of Medicine, Dallas, USA
| | - Richard Lampe
- Pediatrics, Texas Tech University Health Sciences Center, Lubbock, USA
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Velev V, Popov M, Tomov L, Golemanov B. Involvement of the gallbladder in the course of viral hepatitis A in childhood. Trop Doct 2019; 49:271-273. [PMID: 31248318 DOI: 10.1177/0049475519858893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The course of acute hepatitis A (AHA) in childhood is most often benign. There are relatively few reports of gallbladder involvement during such infection and its consequences. We discuss the cases of 75 children (mean age = 4.5 years) with confirmed AHA. Clinical and laboratory evaluation upon admission were classical for AHA. Only two children had normal bilirubin levels and 38.7% had visible involvement of the gallbladder with wall thickening of >3 mm, while six met criteria for acute acalculous cholecystitis. There appears to be no clear relationship between thickening of the gallbladder wall and transaminase levels, but a significant relationship with total and direct bilirubin levels (P < 0.05). Ultrasonographic examination should therefore be carried out in each case of AHA and follow-up should be performed with greater caution, if there are changes in the gallbladder wall.
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Affiliation(s)
- Valeri Velev
- University Hospital for Infectious and Parasitic Diseases "Prof. Iv. Kirov," Medical University of Sofia, Sofia, Bulgaria
| | - Metodi Popov
- University Hospital for Infectious and Parasitic Diseases "Prof. Iv. Kirov," Medical University of Sofia, Sofia, Bulgaria
| | - Latchezar Tomov
- Department of Informatics, New Bulgarian University, Sofia, Bulgaria
| | - Branimir Golemanov
- Department of Gastroenterology, University Hospital "Queen Joanna," Medical University of Sofia, Sofia, Bulgaria
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