1
|
Xu Z, Stanton CN, Ahsan BU. Ectopic Liver Tissue Associated With the Gallbladder: Two Unique Patients and a Literature Review. Int J Surg Pathol 2024; 32:791-795. [PMID: 37488488 DOI: 10.1177/10668969231188910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Ectopic/accessory liver tissue is a rare developmental anomaly thought to be due to abnormal development of the liver during embryogenesis. Most patients with ectopic liver tissue are asymptomatic, and the condition is usually discovered incidentally during intraabdominal surgery or autopsy. In rare symptomatic cases, patients' presentations can range from mild liver function test abnormalities to severe abdominal pain or discomfort secondary to torsion and ischemia. Here, we report 2 patients with ectopic liver tissue identified incidentally during cholecystectomy: one with histologic manifestations of sickle cell congestion and the other with steatohepatitis. A possible relationship between ectopic liver tissue and gallbladder and biliary diseases, such as cholecystitis, has been proposed. To the best of our knowledge, ectopic liver tissue with sickle cell congestion has not been reported previously.
Collapse
Affiliation(s)
- Zhengfan Xu
- Department of Pathology and Laboratory Services, Henry Ford Hospital, Detroit, USA
| | - Cletus N Stanton
- Department of Surgery, Henry Ford Hospital and Henry Ford Macomb, Detroit, USA
| | - Beena U Ahsan
- Department of Pathology and Laboratory Services, Henry Ford Hospital, Detroit, USA
| |
Collapse
|
2
|
Xu KJ, Brock JC, Goussous N, Sill AM, Cunningham SC. Functional gallbladder disorder: Interim analysis of a prospective cohort study. Am J Surg 2024; 229:129-132. [PMID: 38110322 DOI: 10.1016/j.amjsurg.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Functional gallbladder disorder (FGBD) remains a controversial indication for cholecystectomy. METHODS A prospective cohort study enrolled patients strictly meeting Rome criteria for FGBD, and cholecystectomy was performed. They were assessed pre- and 3 and 6 months postoperatively with surveys of abdominal pain and quality of life (RAPID and SF-12 surveys, respectively). Interim analysis was performed. RESULTS Although neither ejection fraction nor pain reproduction predicted success after cholecystectomy, the vast majority of enrolled patients had a successful outcome after undergoing cholecystectomy for FGBD: of a planned 100 patients, 46 were enrolled. Of 31 evaluable patients, 26 (83.9 %) reported RAPID improvement and 28 (93.3 %) SF12 improvement at 3- or 6-month follow-up. CONCLUSION FGBD, strictly diagnosed, should perhaps no longer be a controversial indication for cholecystectomy, since its success rate for biliary pain in this study was similar to that for symptomatic cholelithiasis. Larger-scale studies or randomized trials may confirm these findings.
Collapse
Affiliation(s)
- Kevin J Xu
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, 21229, USA
| | - Josie C Brock
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, 21229, USA
| | - Naeem Goussous
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, 21229, USA
| | - Anne M Sill
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, 21229, USA
| | - Steven C Cunningham
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, MD, 21229, USA.
| |
Collapse
|
3
|
Zheng Y, Xu L, Song X, Ding F, Li X. A rare case of gallbladder cystic echinococcosis disease in western China. Parasitol Int 2023; 97:102792. [PMID: 37544640 DOI: 10.1016/j.parint.2023.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
Hydatid disease, also known as echinococcosis, is an endemic zoonotic parasitic disease caused by larvae of the Echinococcus tapeworm.Humans as accidental intermediate hosts in the parasite life cycle, echinococcus usually parasitizes the liver, solitary cystic echinococcosis in the gallbladder is very rare. Here we report a rare case of cystic echinococcosis in the gallbladder without liver involvement. A female patient was admitted to the hospital primarily for "right upper abdominal pain with radiating pain in the back of the shoulder for 20 days", initially suspected to be gallbladder stones, and underwent laparoscopic cholecystectomy after completing the relevant investigations, and was diagnosed with primary cystic echinococcosis of the gallbladder based on the pathologic findings in the postoperative period. The patient recovered well after surgery and remained well without complications during the 6-month follow-up period. This case illustrates that echinococcus granulosus can also parasitize in the gallbladder only, although it is quite uncommon. In addition, it is difficult to distinguish it from gallbladder stones by conventional imaging. The diagnosis of some cases of gallbladder cystic echinococcosis is completed during surgery and confirmed by postoperative pathological results.
Collapse
Affiliation(s)
- Yan Zheng
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Lingcong Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Xiaojing Song
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Fanghui Ding
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China
| | - Xun Li
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu, China; Department of General Surgery, First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China.
| |
Collapse
|
4
|
D'Amata G, Del Papa M, Palmieri I, Manzi F, Musmeci L, Florio G, Buonocore V, Demoro M, Antonellis F. Cholecystogastric fistula. A case report and literature review. Ann Ital Chir 2021; 10:S2239253X21036483. [PMID: 34982734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cholecystogastric fistulas is a rare complication of gallstone. Even if well described in the literature, this condition still poses a debate on diagnosis and surgical treatment. We present a case of a 35 year's old female which unexpectedly presented a cholecystogastric fistula during a laparoscopic cholecystectomy, treated successfully with fistula transection and repair and cholecystectomy through an open access. The open access remains the preferable option in this cases but laparoscopic techniques are being used worldwide with increasing success. The preoperative diagnosis remains difficult for the unspecific symptoms. KEY WORDS: Biliodigestive Fistula, Gallstone Ileus, Gastric Fistula, Biliary Fistula, Cholecystitis.
Collapse
|
5
|
Lindeman B, Brasel K, Minter RM, Buyske J, Grambau M, Sarosi G. A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States. Acad Med 2021; 96:S9-S13. [PMID: 34183596 DOI: 10.1097/acm.0000000000004107] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident education within general surgery in 2016. As the complement of EPAs drafted for a specialty serve to define the core tasks of a professional within that discipline, initial efforts to define the entire scope of general surgery were fraught with difficulty as no commonly accepted definition of a general surgeon currently exists. Opting to prioritize a pilot of the EPA conceptual framework within surgical training rather than defining the entirety of the specialty, ABS leaders identified 5 EPAs that represent a core of general surgery with which to begin. This article details the process of choosing the initial set of EPAs and provides a roadmap for other disciplines interested in testing the feasibility of this assessment framework while garnering buy-in among the community of educators. Future steps, including implementation of the existing 5 EPAs beyond the initial pilot sites and drafting and implementation of the additional complement of EPAs, are also described.
Collapse
Affiliation(s)
- Brenessa Lindeman
- B. Lindeman is assistant professor, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Brasel
- K. Brasel is professor, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Rebecca M Minter
- R.M. Minter is professor, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jo Buyske
- J. Buyske is president and chief executive officer, American Board of Surgery, Philadelphia, Pennsylvania
| | - Marni Grambau
- M. Grambau is director of examination development, American Board of Surgery, Philadelphia, Pennsylvania
| | - George Sarosi
- G. Sarosi is professor, Department of Surgery, University of Florida, Gainesville, Florida
| |
Collapse
|
6
|
Tao J, Zhang Y, Chen H, Wang S, Sun Q, Zhang W, Liu Q, Mai X, Yu D. Triphasic dynamic contrast-enhanced computed tomography predictive model of benign and malignant risk of gallbladder occupying lesions. Medicine (Baltimore) 2020; 99:e19539. [PMID: 32221073 PMCID: PMC7220315 DOI: 10.1097/md.0000000000019539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Gallbladder occupying lesions are common diseases of biliary system. Among them, gallbladder cancer is difficult to diagnose due to the indistinguishable early symptoms, thus posing a great risk to the population. This study aims to establish a computed tomography (CT) prediction model for distinguishing benign and malignant lesions of gallbladder occupying lesions.The study included 211 patients with benign or malignant gallbladder occupying lesions who have taken resection in the Nanjing Drum Tower Hospital from January 2009 to December 2017. Clinical data collected includes age and sex; CT data includes tumor location, tumor maximum diameter, tumor form, venous phase portal venous CT value, abdominal aortic CT value, plain phase CT value, arterial phase CT value, venous phase CT value, delayed phase CT value, ΔCT1, ΔCT2, ΔCT3, ΔCT4, ΔCT5, ΔCT6, and ΔCT7. Calculation of odds ratio between benign and malignant gallbladder occupying lesions using single factor screening variables and multivariate logistic regression was done to establish a model and calculate the areas under receiver operating characteristic curves of the model.Multivariate logistic regression analysis showed that age, tumor maximum diameter, tumor form, venous phase portal venous CT value, ΔCT2, ΔCT4, and ΔCT6 are the main characteristic index for differential diagnosis of benign and malignant risk of gallbladder occupying lesions.Patients' age, tumor maximum diameter, tumor form, venous phase portal venous CT value, ΔCT2, ΔCT4, and ΔCT6 are independent risk factors for judging the benign and malignant of gallbladder occupying lesions. The model established exhibited a potential diagnostic value for distinguishing the malignant properties of gallbladder occupying lesions.
Collapse
Affiliation(s)
| | | | | | | | - Qi Sun
- Department of Pathology, the Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | | | | | | | | |
Collapse
|
7
|
Sommer B, Eggstein S. Gas Gangrene of the Gallbladder. Dtsch Arztebl Int 2020; 117:38. [PMID: 32031512 PMCID: PMC7026577 DOI: 10.3238/arztebl.2020.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Benjamin Sommer
- *HELIOS Klinik Titisee-Neustadt, Allgemein- und Viszeralchirurgie,
| | - Stefan Eggstein
- *HELIOS Klinik Titisee-Neustadt, Allgemein- und Viszeralchirurgie,
| |
Collapse
|
8
|
Abdullazade S, Akarca FG, Esendağlı G, Turhan N, Erden E, Savaş B, Markoç F, Tunçel D, Özgüven Yılmaz B, Saka B, Hallaç Keser S, Şengiz Erhan S, Gücin Z, Sağol Ö, Aysal Ağalar A, Çelik S, Özer H, Erbarut Seven İ, Ataizi Çelikel Ç, Ekinci Ö, Eğilmez HR, Balcı S, Akyol G. The Contribution of Additional Sampling in Cholecystectomy Materials: A Multicenter Prospective Study. Turk Patoloji Derg 2020; 36:188-194. [PMID: 32364613 PMCID: PMC10510599 DOI: 10.5146/tjpath.2020.01483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cholecystectomy materials are frequently encountered in routine practice. The aim of this study was to determine the true frequency of gallbladder lesions, the diagnostic consistency, and standardization of reports after macroscopic sampling and microscopic evaluation based on previously defined criteria. MATERIAL AND METHOD 14 institutions participated in the study within the Hepato-Pancreato-Biliary Pathology Study Group. Routinely examined cholecystectomies within the last year were included in the study in these institutions. Additional sampling was performed according to the indications and criteria. The number of blocks and samples taken in the first macroscopic examination and the number of blocks and samples taken in the additional sampling were determined and the rate of diagnostic contribution of the additional examination was determined. RESULTS A total of 5,244 cholecystectomy materials from 14 institutions were included in the study. Additional sampling was found to be necessary in 576 cases (10.98%) from all institutions. In the first macroscopic sampling, the mean of the numbers of samples was approximately 4 and the number of blocks was 2. The mean of the numbers of additional samples and blocks was approximately 8 and 4, respectively. The diagnosis was changed in 144 of the 576 new sampled cases while the remaining 432 stayed unaltered. CONCLUSION In this study, it was observed that new sampling after the first microscopic examination of cholecystectomy materials contributed to the diagnosis. It was also shown that the necessity of having standard criteria for macroscopic and microscopic examination plays an important role in making the correct diagnosis.
Collapse
Affiliation(s)
- Samir Abdullazade
- Department of Pathology, İzmir Tepecik Education and Research Hospital, İzmir, Turkey
| | - Fahire Göknur Akarca
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Güldal Esendağlı
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Nesrin Turhan
- Department of Pathology, Turkey Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Esra Erden
- Department of Medical Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Berna Savaş
- Department of Medical Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Fatma Markoç
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Deniz Tunçel
- Şişli Etfal Education and Research Hospital, İstanbul, Turkey
| | | | - Burcu Saka
- Department of Medical Pathology, Medipol University, Faculty of Medicine, İstanbul, Turkey
| | - Sevinç Hallaç Keser
- Department of Pathology, Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | | | - Zühal Gücin
- Department of Medical Pathology, Bezmialem Vakıf University, Faculty of Medicine, İstanbul, Turkey
| | - Özgül Sağol
- Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | | | - Sevinç Çelik
- Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Hatice Özer
- Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| | | | | | - Özgür Ekinci
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | | | | | - Gülen Akyol
- Department of Medical Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
9
|
Matsuda S, Nishikata M, Takai K, Motoyoshi T, Yamashita Y, Kirishima T, Yoshinami N, Shintani H. An Unusual Case of Acute Cholecystitis with Amyloidosis: A Case Report and Literature Review. Intern Med 2019; 58:803-807. [PMID: 30449804 PMCID: PMC6465008 DOI: 10.2169/internalmedicine.1805-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We present an extremely rare case of amyloid A (AA) deposition in the gallbladder and review the literature on similar cases. The patient was a 76-year-old man who had been diagnosed with mild bronchiectasis three years previously, who was admitted to the hospital with right upper quadrant pain and fever. Computed tomography revealed swelling and wall thickening of the gallbladder with a small gallstone. The patient was diagnosed with acute cholecystitis and cholelithiasis and underwent open cholecystectomy. A postoperative histological examination revealed extensive AA deposition in the gallbladder wall. Thus, the definitive diagnosis was acute cholecystitis with AA amyloidosis.
Collapse
Affiliation(s)
- Shogo Matsuda
- Department of Gastroenterology, Keiju Medical Center, Japan
| | | | - Koji Takai
- Department of Gastroenterology, Kyoto City Hospital, Japan
| | | | | | | | | | | |
Collapse
|
10
|
Lan X, Xiang Y, Liu F, Li B, Wei Y, Zhang H. Massive hemoperitoneum and upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation: A case report and literature review. Medicine (Baltimore) 2019; 98:e14729. [PMID: 30882639 PMCID: PMC6426586 DOI: 10.1097/md.0000000000014729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Available literature states that the common reasons for non-traumatic spontaneous liver rupture are hepatocellular carcinoma, macronodular cirrhosis, hemangioma, and other tumors; gallbladder perforation is not cited as a cause. PATIENT CONCERNS The patient presented with sudden-onset right upper quadrant pain with tarry stool for 3 days after eating with dysphoria and increasing thirst; gradually, hemorrhagic shock developed. He had no history of trauma, no background of chronic hepatitis, and no cirrhosis. DIAGNOSIS Hemorrhage secondary to spontaneous rupture of intrahepatic cholangiocarcinoma. INTERVENTIONS Left hemihepatectomy, cholecystectomy, and common bile duct exploration were performed. OUTCOMES The patient was diagnosed with massive hemoperitoneum accompanying upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation. The postoperative course was uneventful and the patient was discharged after 10 days of hospitalization. LESSONS If patients present with non-traumatic spontaneous liver rapture accompanying cholelithiasis and gallbladder hematoma, gallbladder perforation should be considered as a differential diagnosis. Misdiagnosis can lead to incorrect treatment.
Collapse
Affiliation(s)
- Xiang Lan
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chendu, Sichuan
| | - Yuanyuan Xiang
- Department of Digestive Disease Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fei Liu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chendu, Sichuan
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chendu, Sichuan
| | - Yonggang Wei
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chendu, Sichuan
| | - Hua Zhang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chendu, Sichuan
| |
Collapse
|
11
|
Vezakis A, Pantiora E, Giannoulopoulos D, Fontara S, Kontis E, Polydorou A, Fragulidis G. A Duplicated Gallbladder in a Patient Presenting with Acute Cholangitis. A Case Study and a Literature Review. Ann Hepatol 2019; 18:240-245. [PMID: 31113599 DOI: 10.5604/01.3001.0012.7932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/28/2017] [Indexed: 02/04/2023]
Abstract
Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 63-year-old woman who presented with cholangitis and underwent a successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Using ERCP, MRCP and 3D reconstructions the two cystic ducts with one common bile duct were identified. A review of the literature in referral of this variant, its anatomical classifications and significance to clinical and surgical practice is included. In conclusion, gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder when evaluating radiologic studies. In case of surgery, preoperative diagnosis is essential to prevent possible biliary injuries or reoperation if accessory gallbladder has been overlooked during initial surgery. Laparoscopic cholecystectomy remains feasible for intervention can be safely done and awareness is necessary to avoid complications or multiple procedures.
Collapse
Affiliation(s)
- Antonios Vezakis
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Eirini Pantiora
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Dimitrios Giannoulopoulos
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Sofia Fontara
- 1st Dept. of Radiology, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Elissaios Kontis
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Andreas Polydorou
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Georgios Fragulidis
- 2nd Dept. of Surgery, "Aretaieio" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece.
| |
Collapse
|
12
|
Abstract
Heterotopic pancreas is defined as aberrantly located pancreatic tissue without anatomical, vascular, or neural connection to the pancreas. Usual sites include the stomach, duodenum, jejunum, and spleen; in rare cases, heterotopic pancreas can be found in the lungs, gallbladder, Meckel’s diverticulum, and the mediastinum. In most cases, it is an insignificant, incidental finding. Pre-operative diagnosis is not possible, and histopathological examination is mandatory for establishing a definite diagnosis. Less than 40 cases of heterotopic pancreas in the gallbladder have been reported worldwide. Recently, a laparoscopic cholecystectomy specimen from a 43-year-old male showed a small nodule in the gallbladder neck. Microscopy revealed heterotopic pancreas composed of exocrine and endocrine glandular tissue with ducts. We report this case to highlight this rare, incidental finding. This condition should not cause pathologists to over diagnose such occurrences as malignancies; neither should they be neglected because they have potential complications.
Collapse
Affiliation(s)
- Shashi P Sharma
- Department of Basic Medical Sciences, College of medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia. E-mail.
| | | | | | | |
Collapse
|
13
|
Abstract
RATIONALE Gallbladder duplication is a rare congenital disorder, which could cause an increasing risk of complications during surgery. The coexistence of cholangiocarcinoma with double gallbladder is extremely rare, which might lead to an even higher possibility of misdiagnosis and postsurgery complications. PATIENT CONCERNS A 58-year-old female was presented with abdominal pain and jaundice. Abdominal ultrasonography showed duplication of gallbladder, one of which with a thickened wall and a rough surface. This was also confirmed by an abdominal computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) scan. During the surgery, we found a tumor inside one bile duct. The postsurgery pathology showed adenosquamous carcinoma. DIAGNOSES Gallbladder duplication, cholangiocarcinoma. INTERVENTIONS The tumor was removed by surgery. OUTCOMES The patient died of tumor relapse six months after surgery. LESSONS This is the first reported case with coexistence of gallbladder duplication and cholangiocarcinoma, which was diagnosed by abdominal ultrasound, CT and MRCP, as well as further confirmed in surgery and pathology. This case emphasized the importance of a thorough examination of gallbladder before surgery, especially in those cases with suspected double gallbladder, since each gallbladder could have the possibility of an independent cholangiocarcinoma.
Collapse
|
14
|
Abstract
The authors report a rare case of primary pleomorphic carcinoma of the gallbladder in a 70-year-old woman. A polypoid tumor protruded into the lumen from the fundus of the gallbladder. Characteristic histologic findings Included a general lack of architectural cohesiveness, marked pleomorphism, presence of mononucleated and multinucleated giant cells, extensive necrosis, leukocyte-tumor cell phagocytosis or cannibalism. Immunoreactivity for cytokeratin, carclnoembryonic antigen and epithelial membrane antigen as well as histochemical positivity for mucins demonstrated the epithelial nature of the tumor. The neoplasm behaved aggressively; the patient died of metastases 9 months after the operation.
Collapse
Affiliation(s)
- R A Caruso
- Dipartimento di Patologia Umana, Università di Messina, Policlinico, G. Martino, Italy
| | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Heterotopic gastric tissue can be found in the entire gastrointestinal tract. It is usually located in the upper intestine. Rarely, it can be found in the gallbladder. This study describes several clinically, imaging features as well as histopathology findings of heterotopic gastric tissue in gallbladder (HGM). METHODS The radiologic database of 1 tertiary university hospital was retrospectively screened for HGM. Additionally, a systemic review of the Medline database was conducted to identify previously published cases reports. In all cases clinical, imaging as well as histopathology features were retrieved from the papers. RESULTS In our databases, 1 patient with HGM was identified. Additionally, the systemic review yielded 32 suitable papers with 34 patients. Clinically, most of the patients suffered from abdominal discomfort. Most of the lesions were located in the lower gallbladder, especially (n = 14, 40%) in the gallbladder neck. On sonography, in 20.7% a broad-based mass was described. In 10.3% a sessile polyp was identified. In 5 cases, the mass was characterized as hyperechoic (55.5%), as isoechoic in 3 (33.3%) cases, and hypoechoic in 1 (11.1%). On computed tomography (CT), the lesions were most frequently hyperdense and all of them showed a slightly enhancement after application of contrast medium. On histopathology, most cases revealed heterotopic gastric mucosa of body-fundic type (60%) with chief and parietal cells, followed by pyloric type glands (20%). Every patient was treated with cholecystectomy and all had an uneventful recovery. CONCLUSION HGM is a rare disorder with several differential diagnoses. Typically features were described to identify HGM in clinical routine and rule out malignant diseases like gallbladder carcinoma.
Collapse
Affiliation(s)
| | | | - Katrin Schierle
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology
| |
Collapse
|
16
|
Limaiem F, Sassi A, Talbi G, Bouraoui S, Mzabi S. Routine histopathological study of cholecystectomy specimens. Useful? A retrospective study of 1960 cases. Acta Gastroenterol Belg 2017; 80:365-370. [PMID: 29560664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS Traditionally, a gallbladder removed for presumed benign disease is sent for histopathological examination, but this practice has been the subject of controversy. AIM The aim of this study was to assess the usefulness of routine histopathological examination of cholecystectomy specimens and its impact on the management of patients. PATIENTS AND METHODS The histopathological reports of 1960 patients who underwent cholecystectomy from January 2011 to November 2016 were retrospectively reviewed. Results : There were 519 men and 1441 women (sex-ratio M/F = 0,36) aged between 8 and 96 years (mean = 51,23 years). All patients underwent cholecystectomy (either open or laparoscopic). Histological examination of the surgical specimens showed chronic cholecystitis (n = 1319) (67,29%), acute cholecystitis (n = 117) (5,96%), cholestrolosis (n = 255) (13%), follicular cholecystitis (n = 230) (11,73%), xanthogranulomatous cholecystitis (n = 6) (0,30%), cholesterol polyps (n = 5) (0,255), tubular adenoma (n = 3) (0,15%), mucocele (n = 2) (0,10%), pancreatic heterotopia (n = 2 ) (0,10%), hyperplastic Luschka ducts (n = 2) (0,10%), adenomyoma (n = 2) (0,10%), porcelain calcification (n = 2) (0,10%) and biliary-type adenocarcinoma (n = 9) (0,46%). In 9 cases (0,46%), the gallbladder was histologically normal. CONCLUSION Our study shows that the incidence of pre-malignant and malignant lesions of the gallbladder is very low. We therefore recommend selective histopathological examination of cholecystectomy specimens with abnormal macroscopic findings.
Collapse
Affiliation(s)
- Faten Limaiem
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia
| | - Asma Sassi
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia
| | - Ghofran Talbi
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia
| | - Saâdia Bouraoui
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia
| | - Sabeh Mzabi
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia
| |
Collapse
|
17
|
Chang KL, Estores DS. Upper Gastrointestinal Conditions: Gallbladder Conditions. FP Essent 2017; 458:33-38. [PMID: 28682049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Asymptomatic patients with gallstones typically do not require treatment. Surgical intervention is indicated in most symptomatic patients with gallstones. For patients with uncomplicated cholecystitis, laparoscopic cholecystectomy performed within 24 hours of admission is associated with significantly decreased morbidity, hospital length of stay, and cost. Most gallbladder polyps are found incidentally during ultrasonography. Patients with gallbladder polyps are at increased risk of malignant transformation if they are older than 50 years; the gallbladder wall is thickened; or the polyp is adenomatous, solitary, larger than 10 mm, sessile in appearance, or has a rapid increase in size. It is crucial but sometimes difficult to differentiate between benign and malignant polyps using transabdominal ultrasonography. Cholecystectomy is recommended for all patients with a polyp larger than 1 cm.
Collapse
Affiliation(s)
- Ku-Lang Chang
- University of Florida Department of Community of Health and Family Medicine, 1600 SW Archer Road Suite N107, Gainesville, FL 32610-3001
| | - David S Estores
- University of Florida Department of Medicine Division of Gastroenterology Hepatology and Nutrition, PO Box 100214, Gainesville, FL 32610-0214
| |
Collapse
|
18
|
Carrascosa MF, Daroca-Pérez R, Silva-Carmona M. Gallbladder Vasculitis: An Unexpected and Puzzling Finding. Clin Gastroenterol Hepatol 2017; 15:A27-A28. [PMID: 27913242 DOI: 10.1016/j.cgh.2016.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023]
|
19
|
Hrivnák R, Čan V, Rovný I, Andrašina T. [Gallbladder volvulus]. Rozhl Chir 2017; 96:309-312. [PMID: 28948803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Volvulus of the gallbladder is one of very rare diseases ranked among acute abdomen conditions. Only case reports are described in the literature. The disease presents with acute biliary ailments, often reminiscent of acute cholecystitis. It is more common in frail elderly women and its preoperative diagnosis is very difficult, and therefore this finding is encountered intraoperatively in most cases. CASE REPORT In our case report we present the case of a female patient where the volvulus of the gallbladder was found as a surprising discovery during surgery. CONCLUSION Gallbladder volvulus is a rare disease that presents as acute abdomen. It is most often diagnosed intraoperatively. Cholecystectomy is the most appropriate therapeutic method.Key words: gallbladder volvulus - acute abdomen - floating gallbladder.
Collapse
|
20
|
Donati M, Brancato G, Scilletta R, Deiana E, Basile G. A Surgical "Chimera": The Gallbladder Volvulus in the Spigelian Hernia Sac. Am Surg 2017; 83:e11-e12. [PMID: 28234109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Marcello Donati
- Department of Surgery and Medical-Surgical Specialties, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, University of Catania, Italy
| | | | | | | | | |
Collapse
|
21
|
Vimalachandran P, Paknikar J. Recurrent right upper quadrant abdominal pain. J Fam Pract 2016; 65:723-724. [PMID: 27846330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A minimally tender mass was detected during palpation of the abdomen, but a Murphy's test was negative. An abdominal x-ray revealed the cause of the patient's pain.
Collapse
|
22
|
Yi DY, Chang EJ, Kim JY, Lee EH, Yang HR. Age, Predisposing Diseases, and Ultrasonographic Findings in Determining Clinical Outcome of Acute Acalculous Inflammatory Gallbladder Diseases in Children. J Korean Med Sci 2016; 31:1617-23. [PMID: 27550491 PMCID: PMC4999405 DOI: 10.3346/jkms.2016.31.10.1617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/24/2016] [Indexed: 12/23/2022] Open
Abstract
We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.
Collapse
Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eun Jae Chang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
23
|
Håkansson K, Leander P, Ekberg O, Håkansson HO. MR imaging of upper abdomen following cholecystectomy: Normal and abnormal findings. Acta Radiol 2016; 42:181-6. [PMID: 11259947 DOI: 10.1080/028418501127346486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse sequences in abdominal MR imaging. Material and Methods: In a prospective study of 119 patients, 64 were examined with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1–5 days (mean 1.6 days) after cholecystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1–12 days after the cholecystectomy. Results: Oedema in the gallbladder fossa was the only finding in 39 patients (61%), all with uneventful recovery. Small fluid collections in an area consistent with the gallbladder fossa were seen in 9/64 (14%) patients, of which 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twenty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical complications. Seven patients had fluid in the rest of the abdomen of which 5 had surgical complications; 4 due to bile duct leakage and 1 acute pancreatitis. One patient had a postoperative bleeding not seen on MR images. Conclusion: MR is very sensitive in detecting fluid collections. Early MR findings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.
Collapse
Affiliation(s)
- K Håkansson
- Department of Radiology, Kalmar Hospital, Kalmar, Sweden
| | | | | | | |
Collapse
|
24
|
Han IW, Kwon OC, Oh MG, Choi YS, Lee SE. Effects of Rowachol on prevention of postcholecystectomy pain after laparoscopic cholecystectomy: prospective multicenter randomized controlled trial. HPB (Oxford) 2016; 18:664-70. [PMID: 27485060 PMCID: PMC4972378 DOI: 10.1016/j.hpb.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postcholecystectomy pain (PCP) is characterized by abdominal pain after cholecystectomy. However, prevention of PCP is not well known yet. The purpose of this study was to determine whether Rowachol might be useful in preventing PCP. METHODS Between May 2013 and January 2014, a total of 138 patients with gallbladder disease who were scheduled to undergo laparoscopic cholecystectomy were randomly assigned to orally receive 100 mg Rowachol or placebo three times daily for 3 months after surgery. Abdominal pain was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. RESULTS Incidence of PCP in the placebo group (n = 9, 14.3%) was higher than that in the Rowachol group (n = 3, 4.7%) with statistically marginal significance (P = 0.08). Risk factor analysis implicated PCP with increased difficulty in performing LC, more frequent pathology with acute cholecystitis, and absence of postoperative Rowachol treatment. Multivariate analysis revealed that greater difficulty of laparoscopic cholecystectomy (HR = 5.78, 95% CI 1.36-24.40, P < 0.05), and absence of postoperative Rowachol treatment (HR = 2.54, 95% CI 1.10-10.39, P < 0.05) were independent risk factors for development of PCP. CONCLUSION Rowachol might be beneficial for prevention of PCP after laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- In Woong Han
- Department of Surgery, Dongguk University College of Medicine, South Korea
| | - O Choel Kwon
- Department of Surgery, Dongguk University College of Medicine, South Korea
| | - Min Gu Oh
- Department of Surgery, Dongguk University College of Medicine, South Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, South Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, South Korea.
| |
Collapse
|
25
|
Abstract
Fascioliasis is a zoonotic disease that is acquired by ingestion of the metacercaria form on uncooked aquatic plants, and humans act as an accidental host. Diagnosis is confirmed by the demonstration of the parasites or evidence of them in faeces and serology. In the absence of these data, delays or misdiagnosis may occur since it may mimic many diseases. In this study, we present three cases, among them two were similar to the above-mentioned statement. The first case, to the best of our knowledge, is the first case with adult-type living fluke in the gall bladder, diagnosed by laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- E Bulbuloglu
- Department of General Surgery, Faculty of Medicine, School of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Gallbladder (GB) bleeding is very rare and it is caused by cystic artery aneurysm and rupture, or GB wall rupture. For GB rupture, the typical findings are positive Murphy's sign and jaundice. GB bleeding mostly presented as hemobilia. This is the first case presented with severe GI bleeding because of GB rupture-related GB bleeding. After comparing computed tomography, one gallstone spillage was noticed. In addition to gallstones, uremic coagulopathy also worsens the bleeding condition. This is also the first case that patients with GB spillage-related rupture and bleeding were successfully treated by nonsurgical management. Clinicians should bear in mind the rare causes of GI bleeding. Embolization of the bleeding artery should be attempted as soon as possible.
Collapse
Affiliation(s)
- Jun-Li Tsai
- Division of Family Medicine, Cheng Ching General Hospital
| | - Shang-Feng Tsai
- Department of Internal Medicine, Division of Nephrology, Taichung Veterans General Hospital
- Department of Life Science, Tunghai University
- School of Medicine, China Medical University, Taichung
- Department of Medicine, National Yang Ming University, Taipei, Taiwan
- ∗Correspondence: Shang-Feng Tsai, Department of Internal Medicine, Division of Nephrology, Taichung Veterans General Hospital, Taiwan, 160, Section 3, Chung-Kang Road, Taichung 407, Taiwan (e-mail: )
| |
Collapse
|
27
|
Harmon L, Abernathy S, Regner J, Isbell T. An Uncommon Presentation of Gastric Outlet Obstruction: Bouveret's Syndrome. Am Surg 2016; 82:E49-E51. [PMID: 26874125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Laura Harmon
- Department of Surgery, Baylor Scott and White Memorial Hospital, Temple, Texas, USA
| | | | | | | |
Collapse
|
28
|
Sulu B, Allahverdi TD, Altun H, Koksal N. The Comparison of Four-Port, Two-Port Without Suspension Suture and Single Port Laparoscopic Cholecystectomy Results. ADV CLIN EXP MED 2016; 25:101-9. [PMID: 26935504 DOI: 10.17219/acem/26237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Single-port surgery has recently become popular, however, many surgeons have to use additional ports during the surgery due to difficulties. OBJECTIVES We performed two-port MCAP (with an additional port using a multi-channel device through the umbilicus) without a suspension suture in a group of patients. We compared the results of this technique to the LC and SILC techniques. MATERIAL AND METHODS A total of 90 patients with gallbladder disease were included in the study. LC (n = 30) and SILC (n = 30) were performed in two groups. The other group underwent cholecystectomy (MCAP) by using an additional 5 mm port through the subxiphoid region with a multi-channel port through the transumblical. A transabdominal suspension suture was not used for the patients in this group. The surgery duration, estimated blood loss, length of hospitalization, visual analogue scale (VAS) score in the postoperative 1st and 7th day, need for analgesia in the postoperative period and complications, and the conversion rate were compared between the three methods. RESULTS A total of 62 females (68.9%) and 28 males (31.1%) participated in the study. MCAP duration was significantly shorter than LC and SILC (38.1 ± 16.6, 49.4 ± 15.8, 77.8 ± 26.7 min respectively) (p < 0.05). The conversion rate was similar in all three groups. Hernia developed in the port area in two patients after SILC (6.7%). No significant difference was found between the groups for the other data we compared. CONCLUSIONS MCAP seems to be an easier technique with a shorter operation time compared to the other two techniques. However, there is a need for other studies to evaluate the cosmetic results.
Collapse
Affiliation(s)
- Barlas Sulu
- Department of General Surgery, Faculty of Medicine, Kafkas University, Turkey
| | - Tulay D Allahverdi
- Department of General Surgery, Faculty of Medicine, Kafkas University, Turkey
| | - Hasan Altun
- Department of General Surgery, Faculty of Medicine, Kafkas University, Turkey
| | - Neset Koksal
- Department of General Surgery, Faculty of Medicine, Kafkas University, Turkey
| |
Collapse
|
29
|
Černá M, Opatrný V, Nosek J, Geiger J, Třeška V, Boudová L, Buriánek V. [Coincidence of colonic lymphoma and gallstone ileus - case report]. Rozhl Chir 2016; 95:377-382. [PMID: 27653308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Primary colonic lymphoma is a very rare malignant disease of the gastrointestinal tract, accounting for 14% of all malignant diseases in this location. It is classified in the group of extranodal lymphomas; its long-term asymptomatic progression makes it different from common colorectal carcinomas making its diagnosis very difficult, more often accidental. Gallstone ileus is quite an uncommon complication of cholecystolithiasis diagnosed with difficulty. Up to 50% of cases are diagnosed during surgery. The obturated location depends on the size of the stone, location of the conjunction between the biliary and gastrointestinal tracts, and also on any preexisting stenosis due to another unknown pathology. CASE REPORT We present a case of an 86-year-old man treated for acute diverticulitis with typical clinical symptoms. Following further examination (colonoscopy, computed tomography) revealed a tumour-like infiltration in the sigmoid colon wall and a voluminous polyp was suspected according to the colonoscopy. Computed tomography described an obstruction by a biliary stone tumbling through the cholecystocolonic fistula. Subsequent biopsy supported the suspected malignant etiology. The patient underwent resection of the sigmoid colon sec. Hartmann; an infiltration was found in the subhepatic space, which corresponded to the described fistulisation between the biliary tract and the colon. A large 40 mm gallstone was found in the resected sigmoid colon over the stenosis and the bowel wall showed diffuse thickening with several polyps; final histopathological assessment confirmed malignant lymphoma of the plasmocytoma type. No serious complications occurred in the postoperative period; after healing, the patient was transferred to hematooncology care. CONCLUSION The article describes the presence of two rare diseases - colonic lymphoma and gallstone ileus. Clearly, without the biliary stone obstruction in the preexisting tumorous stenosis in the sigmoid colon, the malignant hematooncology disease would not have been diagnosed. KEY WORDS primary colonic lymphoma - gallstone ileus - complication of the cholecystolithiasis - extranodal lymphoma - acute diverticulitis.
Collapse
|
30
|
DeBoard ZM, Ferrigno L, Thoman D. Gallbladder Volvulus: A Single Institution's Experience over Two Years. Am Surg 2015; 81:E347-E348. [PMID: 26672559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Zach M DeBoard
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA
| | | | | |
Collapse
|
31
|
Chen GL, Akmal Y, DiFronzo AL, Vuong B, O'Connor V. Porcelain Gallbladder: No Longer an Indication for Prophylactic Cholecystectomy. Am Surg 2015; 81:936-940. [PMID: 26463284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Porcelain gallbladder (PG) was historically associated with gallbladder cancer (GBC), (range 12-62%, largest series n = 26). Presently, cholecystectomy is still performed in many patients with PG. The objective of this study was to determine the incidence of GBC in patients with radiographic diagnosis of PG. We conducted a retrospective chart review of the Kaiser Permanente southern California electronic medical record database and identified patients with radiographic diagnosis of PG between 2008 and 2013. Extracted were patient demographics, imaging modality, symptoms, surgical and observational outcomes, and pathology results. Out of 192 PG patients, 102 underwent cholecystectomy, and 90 were observed. None of the patients in the surgery group had GBC on pathology review, and none of the observed patients developed GBC during follow-up (mean 3.5 years). In the surgery group, 82 per cent of the patients were asymptomatic with a perioperative complication rate of 10.7 per cent. Among symptomatic patients, the complication rate was 16.7 per cent. Rate of conversion to open surgery was 5 per cent. Complications led to eight endoscopic or percutaneous interventions and five additional operations. PG is not associated with increased risk of GBC but is associated with high risk of postoperative complications. Cholecystectomy should not be recommended in asymptomatic patients with PG.
Collapse
Affiliation(s)
- Gao L Chen
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | | | | |
Collapse
|
32
|
Hamdy RF, Stein RE, Larru B, Bellah RD, Grossman AB, Hodinka RL, Feemster KA. Gallbladder Wall Thickening in an Adolescent With Acute Mononucleosis: A Case Report and Brief Review of the Literature. J Pediatric Infect Dis Soc 2015; 4:267-71. [PMID: 26407432 DOI: 10.1093/jpids/piu023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/25/2014] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | | | - Richard L Hodinka
- Clinical Virology Laboratory, The Children's Hospital of Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | |
Collapse
|
33
|
Abstract
Cholecystectomy is associated with an increased risk of colorectal cancer, but little is known about the relationship between gallbladder disease and colorectal adenoma. Gallbladder polyps and colorectal neoplasia (CRN) share several risk factors such as obesity, diabetes and metabolic syndrome, which might account for their association. In this study, we investigated whether asymptomatic patients with gallbladder disease are at increased risk of CRN and identified the factors to their association. The study population consisted of 4,626 consecutive, asymptomatic individuals drawn from a prospective health check-up cohort who underwent both ultrasonography and colonoscopy screening. The prevalence of CRNs in patients with gallbladder polyps or gallstones was significantly higher than that in the control group (32.1% vs. 26.8%; P = 0.032, 35.8% vs. 26.9%; P = 0.020). A multivariate regression analysis showed that gallbladder polyps were an independent risk factor for CRN [adjusted odds ratio (OR): 1.29; 95% confidence interval (CI); 1.03-1.62] whereas gallstones were not (adjusted OR: 1.14; 95% CI: 0.79-1.63). The adjusted OR for the risk of CRN was 1.12 for gallbladder polyps < 5 mm (95% CI, 0.85-1.46) and 1.79 for gallbladder polyps ≥ 5 mm (95% CI, 1.15-2.77). The prevalence of CRN increased with increasing polyp size (P trend = 0.022). Our results suggest that colorectal neoplasia is significantly related to gallbladder polyps, especially those ≥ 5 mm.
Collapse
Affiliation(s)
- Sung Noh Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yoon Lee
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
34
|
|
35
|
Abstract
BACKGROUND Although a laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis, its safety and efficacy in the morbidly/super obese patients is unknown. The aim of this study was to investigate the safety and efficacy of an elective LC in the morbid/super obese patients. METHODS A retrospective review of the hospital electronic database and medical records was conducted searching for all elective LC from 2010 to 2013. The data collected included patient demographics and body mass index (BMI), length of hospital stay (LOS), duration of surgery (DOS), intra- and post-operative complications, bile duct injuries, performance of an intra-operative cholangiogram, the incidence of open conversion and the seniority of the operator. RESULTS A total of 799 patients (76% female) with a mean age of 46 years and BMI of 31 were included in this study. There were significant differences in the median DOS between the three BMI groups; BMI < 26 [64 min; interquartile range (IQR) 54-83]; BMI 26-40 (72 min, IQR 58-91) and BMI > 40 (82 min, IQR 63-104), P < 0.001. There were no statistically significant differences in the LOS, peri-operative complication rates, open conversions or bile duct injuries among the BMI groups. CONCLUSIONS This study showed that LC can be performed safely in the morbid/super obese patients.
Collapse
Affiliation(s)
- Leong Tiong
- Department of Surgery, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Jaewook Oh
- Department of Surgery, Lyell McEwin Hospital, Adelaide, SA, Australia
| |
Collapse
|
36
|
Díaz-Tobarra M, Garcés-Albir M, Moro-Valdezate D, Ortega-Serrano J. Hemocholecyst: A rare cause of acute abdomen. Rev Esp Enferm Dig 2015; 107:394-395. [PMID: 26031878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
37
|
Xu B, Xu B, Zheng WY, Ge HY, Wang LW, Song ZS, He B. Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis. World J Gastroenterol 2015; 21:5393-5406. [PMID: 25954114 PMCID: PMC4419081 DOI: 10.3748/wjg.v21.i17.5393] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/29/2014] [Accepted: 01/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease.
METHODS: We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models. Statistical heterogeneity was evaluated with the χ2 test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found.
RESULTS: There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 1 (SMD: -0.957, 95%CI: -1.488 to -0.426, P < 0.001), needed less postoperative analgesic medication (SMD: -0.574, 95%CI: -0.807 to -0.341, P < 0.001) and stayed for a shorter time in hospital (MD: -1.004 d, 95%CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95%CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group.
CONCLUSION: TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.
Collapse
|
38
|
Lloyd A, Steinberg SM. Gallbladder torsion in a 91-year-old female: an unusual cause of right upper quadrant pain. Am Surg 2015; 81:E201-E203. [PMID: 25975309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
39
|
Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbecks Arch Surg 2015; 400:455-62. [PMID: 25910600 DOI: 10.1007/s00423-015-1302-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/13/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs. METHODS MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points. RESULTS Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy. CONCLUSIONS Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.
Collapse
Affiliation(s)
- Benoy I Babu
- Leicester HPB Unit, University Hospitals of Leicester, Gwendolen Road, LE5 4PW, Leicester, UK,
| | | | | |
Collapse
|
40
|
Mori R, Matsuyama R, Ohta Y, Homma Y, Kubota K, Endo I. [The differential diagnosis between gallbladder cancer and other benign lesions]. Nihon Rinsho 2015; 73 Suppl 3:567-571. [PMID: 25857088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
41
|
Chrestiana D, Sucandy I. Current management of gallbladder polyp: should cholecystectomy be recommended for polyps smaller than 10 mm? Am Surg 2015; 81:101-103. [PMID: 25569074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Dewi Chrestiana
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
42
|
Fabbi M, Volta A, Quintavalla F, Zubin E, Manfredi S, Martini FM, Mantovani L, Tribaudino M, Gnudi G. Cholecystocutaneous fistula containing multiple gallstones in a dog. Can Vet J 2014; 55:1163-1166. [PMID: 25477544 PMCID: PMC4231803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 7-year-old dog was presented with a history of an open lesion on the right thoracic wall, discharging honey-like fluid and small stones. Ultrasonography and computed tomographic fistulography identified a cholecystocutaneous fistula; cholecystectomy was curative. Veterinarians should consider this disease in patients with long-term discharging lesions on the right thoracic or abdominal wall.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Giacomo Gnudi
- Address all correspondence to Prof. Giacomo Gnudi; e-mail:
| |
Collapse
|
43
|
Matsui Y, Ryota H, Sakaguchi T, Nakatani K, Matsushima H, Yamaki S, Hirooka S, Yamamoto T, Kwon AH. Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy. Am Surg 2014; 80:1245-1249. [PMID: 25513924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC.
Collapse
Affiliation(s)
- Yoichi Matsui
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Hernández-Rodríguez J, Tan CD, Rodríguez ER, Hoffman GS. Single-organ gallbladder vasculitis: characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 61 patients. Medicine (Baltimore) 2014; 93:405-413. [PMID: 25500710 PMCID: PMC4602437 DOI: 10.1097/md.0000000000000205] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Systemic vasculitis (SV) involving abdominal structures usually has a poor prognosis. Gallbladder vasculitis (GV) has been reported as part of SV (GB-SV) and focal single-organ vasculitis (GB-SOV). We analyzed clinical and histologic characteristics of patients with GV to identify features that differentiate GB-SOV from the systemic forms of GV. To identify affected patients with GV we used pathology databases from our institution and an English-language PubMed search. Clinical manifestations, laboratory and histologic features, treatment administered, and outcomes were recorded. Patients were divided in 2 groups, GB-SOV and GB-SV. As in previous studies of single-organ vasculitis, GB-SOV was only considered to be a sustainable diagnosis if disease beyond the gallbladder was not apparent after a follow-up period of at least 6 months. Sixty-one well-characterized patients with GV were included (6 from our institution). There was no significant sex bias (32 female patients, 29 male). Median age was 52 years (range, 18-94 yr). GB-SOV was found in 20 (33%) and GB-SV in 41 (67%) patients. No differences were observed in age, sex frequency, or duration of gallbladder symptoms between groups. Past episodes of recurrent right-upper quadrant or abdominal pain and lithiasic cholecystitis were more frequent in GB-SOV patients, whereas acalculous cholecystitis occurred more often in GB-SV. In GB-SV, gallbladder-related symptoms occurred more often concomitantly with or after the systemic features, but they sometimes appeared before SV was fully developed (13.5%). Constitutional and musculoskeletal symptoms were reported only in GB-SV patients. Compared to GB-SOV, GB-SV patients presented more often with fever (62.5% vs 20%; p = 0.003) and exhibited higher erythrocyte sedimentation rate levels (80 ± 28 vs 37 ± 25 mm/h, respectively; p = 0.006). All GB-SV patients required glucocorticoids and 50% of them also received cytotoxic agents. Mortality in GB-SV was higher than in GB-SOV (35.5% vs 10%; p = 0.05). Nongranulomatous inflammation with fibrinoid necrosis of medium-sized vessels occurred equally in both groups (>90%). Forms of SV affecting the gallbladder included polyarteritis nodosa (n = 10), hepatitis B virus-associated vasculitis (n = 8), cryoglobulinemic (essential or hepatitis C virus-associated) vasculitis (n = 6), vasculitis associated with autoimmune diseases (n = 6), microscopic polyangiitis (n = 4), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (n = 4), IgA vasculitis (Henoch-Schönlein) (n = 2), and giant cell arteritis (n = 1).GV is uncommon. Its histology most often consists of a nongranulomatous necrotizing vasculitis affecting medium-sized vessels. GB-SOV is usually discovered after routine cholecystectomy performed because of the presence of local symptoms, gallstone-associated cholecystitis, and contrary to GB-SV, GB-SOV is usually not associated with systemic symptoms. Acute phase reactants and surrogate markers of autoimmunity are usually normal or negative in GB-SOV. GB-SOV does not require systemic antiinflammatory or immunosuppressive therapy; surgery is adequate to achieve cure. GB-SV always warrants immunosuppressant therapy and is associated with high mortality. The finding of GV may precede the generalized manifestations of SV. Therefore, once GV is discovered, studies to determine disease extent and a vigilant follow-up are mandatory.
Collapse
Affiliation(s)
- José Hernández-Rodríguez
- From the Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain (JHR); Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (GSH); and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, Ohio, United States
| | | | | | | |
Collapse
|
45
|
Pu TW, Fu CY, Lu HE, Cheng WT. Complete body-neck torsion of the gallbladder: A case report. World J Gastroenterol 2014; 20:14068-14072. [PMID: 25320548 PMCID: PMC4194594 DOI: 10.3748/wjg.v20.i38.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/07/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Gallbladder torsion is a rare, acute abdominal disease. It was first reported by Wendell in 1898. Since then, only 500 cases have been reported. Gallbladder torsion occurs in all age groups, although it usually appears in the latter stages of life. The occurrence ratio between women and men is 3:1. Most cases are diagnosed during surgery. The main treatment is surgical detorsion and cholecystectomy. Despite progress in radiologic imaging diagnosis, it is not easy to obtain a precise preoperative diagnosis of gallbladder torsion. In previous reports, only 9.8% of all gallbladder torsion cases were diagnosed preoperatively. We present a case of acute body-neck gallbladder torsion in an elderly man, and we review the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. The radiologic findings in the present case were helpful in obtaining a preoperative diagnosis of gallbladder torsion. The diagnosis was confirmed by T2-weighted magnetic resonance images, which showed an intra-gallbladder segment located between the body and neck of the gallbladder, with a notable crease within this segment.
Collapse
|
46
|
Ge C, Sun T, Meng J, Wang K, Huang P. [Research of conjugated bile acids in gallbladder bile of patients with polypoid lesions of gallbladder]. Zhonghua Wai Ke Za Zhi 2014; 52:109-112. [PMID: 24809518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the difference in conjugated bile acids in the gallbladder bile between gallbladder cholesterol polyps and adenomatous polyps patients, and screen the differential diagnosis-markers for polypoid lesions of gallbladder (PLG). METHODS From January to June 2013, the 20 cholesterol polyps patients, 10 adenomatous polyps patients and 10 patients without gallbladder diseases were enrolled. High performance liquid chromatography assay with ultraviolet detection was used to test 8 conjugated bile acids in gallbladder bile. RESULTS The 8 conjugated bile acids were completely analyzed in 10 minutes, and the assay was liner in the range 8-500 µg/ml. The correlation coeffients for linear regression was from 0.9996-0.9999 and the detection limits ranged from 3.90-7.81 µg/ml. The level of taurocholic acid (TCA) in adenomatous polyps group ((75 ± 51) µg/ml) was significantly lower than that in the cholesterol polyps ((228 ± 206) µg/ml, q = 3.120, P = 0.014) and control groups ((104 ± 40) µg/ml, q = 2.950, P = 0.027). The level of taurochenodeoxycholic acid (TCDCA) in cholesterol polyps group ((604 ± 444) µg/ml) was significantly higher than that in the adenomatous polyps ((310 ± 182) µg/ml, q = 2.560, P = 0.048) and control groups ((308 ± 21) µg/ml, q = 2.970, P = 0.023). CONCLUSIONS The levels of TCA and TCDCA in the gallbladder biles in cholesterol polyps patients were higher than those in adenomatous polyps patients, which may be the differential diagnosis-markers for PLG.
Collapse
Affiliation(s)
- Chunlin Ge
- Department of Pancreatic Surgery, the First Hospital of China Medical University, Shenyang 110001, China.
| | | | | | | | | |
Collapse
|
47
|
Patel RV, Kumar H, More B, Rajimwale A. Trilogy of foregut atresia without genetic abnormality: exception to the Martinez-Frias syndrome. BMJ Case Rep 2014; 2014:bcr-2013-200477. [PMID: 24464842 PMCID: PMC3902341 DOI: 10.1136/bcr-2013-200477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We present a case of oesophageal atresia with distal tracheo-oesophageal fistula and duodenal atresia, which later on was detected to have cystic variant of biliary atresia. He underwent primacy repair of oesophageal atresia with ligation of distal tracheo-oesophageal fistula and duodenoduodenostomy. He later developed features of obstructive jaundice, and on investigation was diagnosed to have cystic variant of biliary atresia which was initially confused with iatrogenic biliary obstruction. Exploration and operative cholangiogram with biopsy confirmed cystic variant of biliary atresia and underwent successful Kasai procedure. Our case effectively demonstrates a rare triology of foregut atresia without an apparent genetic association. It highlights stepwise systematic management of foregut atresias in this patient and demonstration of cystic variant of biliary atresia. Even though these are rarely seen, still the clinician should be aware of such a possibility and should adopt a multimodality approach to diagnose and an aggressive approach to manage the condition.
Collapse
Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Hemant Kumar
- Department of Paediatric Surgery, LRI, Leicester, UK
| | - Bharat More
- Department of Paediatric Surgery, LRI, Leicester, UK
| | | |
Collapse
|
48
|
Udekwu PO, Sullivan WG. Contemporary experience with cholecystectomy: establishing 'benchmarks' two decades after the introduction of laparoscopic cholecystectomy. Am Surg 2013; 79:1253-1257. [PMID: 24351351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
With quality and public reporting of increasing importance, benchmarks are anticipated to grow in relevance. We studied cholecystectomy in a practice in an urban tertiary care hospital. A total of 1083 cholecystectomies were performed in 2008 and 2009. Laparoscopic cholecystectomy was performed in 97.8 per cent of patients with a 2.2 per cent conversion rate. A planned open procedure was performed in only 2.2 per cent of patients. Approximately half of procedures were urgent and performed during an acute hospitalization. Most patients (74%) were female and most patients were overweight or obese (64.8%). Ages into the tenth decade of life were represented. Comorbidities included hypertension, 28.7 per cent; coronary disease, 15.6 per cent; diabetes mellitus, 13.4 per cent; gastroesophageal reflux disease, 10.7 per cent; and asthma, 5.5 per cent. Of female patients, 98 (12.2%) were postpartum and five (0.6%) were pregnant. Of 137 patients without gallstones, 59.1 per cent had biliary dyskinesia and 27 per cent had acalculous cholecystitis. Preoperative magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were performed in most patients with suspected choledocholithiasis. Intraoperative cholangiograms were performed in 6.9 per cent of patients, 3.3 per cent for abnormal liver function studies. Postoperative ERCP was used in most patients with positive intraoperative cholangiograms. All-cause mortality was 0.8 per cent and attributable mortality was 0.2 per cent. Complications occurred in 7.5 per cent of patients, including retained common bile duct stones in 1.1 per cent, bile duct leak in 0.3 per cent, and common bile duct injury in 0.1 per cent.
Collapse
|
49
|
Tana C, Mezzetti A, Schiavone C. Gallbladder infection by trematodes. Intern Emerg Med 2013; 8:761-3. [PMID: 23843077 DOI: 10.1007/s11739-013-0974-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Claudio Tana
- Department of Medicine and Science of Aging, "G. d'Annunzio" University, Via dei Vestini 29, 66100, Chieti, Italy
| | | | | |
Collapse
|
50
|
Abstract
Ascariasis of the gallbladder is a very rare presentation. We report a case of a 15-year-old boy who presented with complaints of pain in the abdomen, vomiting, pruritus, and fever on-and-off for 10 days. On radiological examination, an ultrasonography of the abdomen showed a dilated gallbladder with multiple linear echogenic, tubular, parallel lines inside the lumen of the gallbladder, common bile duct and intrahepatic biliary radicles. The zigzag and coiling movement of a worm was noted in the lumen of the gallbladder on real time B-mode ultrasonography. The patient was successfully treated with an anthelminthic drug. On follow up no evidence of the worm was noted in the gallbladder or common bile duct lumen.
Collapse
Affiliation(s)
- Sachin Khanduri
- Professor, Department of Radio Diagnosis, Era's Lucknow Medical College, Lucknow, India
| | | | | | | |
Collapse
|