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Acute Cholecystitis (acute + cholecystitis)
Selected AbstractsENDOSONOGRAPHY-GUIDED GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS FOLLOWING COVERED METAL STENT DEPLOYMENTDIGESTIVE ENDOSCOPY, Issue 1 2009Osamu Takasawa Endosonography-guided biliary drainage (ESBD) is gaining acceptance as an effective treatment for obstructive jaundice. Only a few reports on the application of this technique to the gallbladder (endosonography-guided gallbladder drainage [ESGBD]) have been published in the literature. In order to relieve acute cholecystitis which developed in a patient with unresectable malignant biliary obstruction after deployment of a covered metal stent (CMS), we applied this technique. ESGBD was carried out by using an electronic curved linear array echoendoscope. After visualization of the gallbladder and determination of the puncture route, a needle knife papillotome was advanced with electrocautery to pierce the gastric and gallbladder walls. Under the guidance of a guidewire inserted through the needle sheath into the gallbladder, a 7.2 Fr, 30 cm-long, single pigtail plastic tube was placed to bridge the gallbladder and the stomach. No complications relevant to the procedure were encountered. ESGBD was quite effective in ameliorating the patient's acute cholecystitis and the drainage tube was removed after 10 days without sequelae. Acute cholecystitis following CMS deployment is considered to be a good indication for ESGBD. [source] INTRADUCTAL ULTRASONOGRAPHY OF THE GALLBLADDER IN APPLICATION OF THE ENDOSCOPIC NASO-GALLBLADDER DRAINAGEDIGESTIVE ENDOSCOPY, Issue 1 2007Daisuke Masuda Background:, Although endoscopic naso-gallbladder drainage (ENGBD) for gallbladder disease is useful, the procedure is difficult and investigations involving many cases are lacking. Furthermore, reports on transpapillary intraductal ultrasonography (IDUS) of the gallbladder using a miniature probe are rare. Methods:, A total of 150 patients (119 suspected of having gallbladder carcinoma, 24 with acute cholecystitis (AC), and seven with Mirizzi's syndrome (MS)) were the subject. (i) ENGBD: We attempted to put ENGBD tube into the GB. (ii) IDUS of the gallbladder: Using the previous ENGBD tube, we attempted to insert the miniature probe into the gallbladder and perform transpapillary IDUS of the gallbladder. In five patients, we attempted three-dimensional intraductal ultrasonography (3D-IDUS). Results:, (i) ENGBD: Overall success rate was 74.7% (112/150); the rate for the patients suspected of having gallbladder carcinoma was 75.6% (90/119), and was 71.0% (22/31) for the AC and MS patients. Inflammation and jaundice improved in 20/22 successful patients with AC and MS. Success rate was higher when cystic duct branching was from the lower and middle parts of the common bile duct than from the upper part, and was higher when branching was upwards than downwards. (ii) IDUS of the gallbladder: Success rate for miniature probe insertion into the gallbladder was 96.4% (54/56). Lesions could be visualized in 50/54 patients (92.6%). Of these, detailed evaluation of the locus could be performed in 41. In five patients attempted 3D-IDUS, the relationship between the lesion and its location was readily grasped. Conclusion:, IDUS of the gallbladder is superior for diagnosing minute images. Improvement on the device will further increase its usefulness. [source] Systematic review of cholecystostomy as a treatment option in acute cholecystitisHPB, Issue 3 2009Anders Winbladh Abstract Objectives:, Percutaneous cholecystostomy (PC) is an established low-mortality treatment option for elderly and critically ill patients with acute cholecystitis. The primary aim of this review is to find out if there is any evidence in the literature to recommend PC rather than cholecystectomy for acute cholecystitis in the elderly population. Methods:, In April 2007, a systematic electronic database search was performed on the subject of PC and cholecystectomy in the elderly population. After exclusions, 53 studies remained, comprising 1918 patients. Three papers described randomized controlled trials (RCTs), but none compared the outcomes of PC and cholecystectomy. A total of 19 papers on mortality after cholecystectomy in patients aged >65 years were identified. Results:, Successful intervention was seen in 85.6% of patients with acute cholecystitis. A total of 40% of patients treated with PC were later cholecystectomized, with a mortality rate of 1.96%. Procedure mortality was 0.36%, but 30-day mortality rates were 15.4 % in patients treated with PC and 4.5% in those treated with acute cholecystectomy (P < 0.001). Conclusions:, There are no controlled studies evaluating the outcome of PC vs. cholecystectomy and the papers reviewed are of evidence grade C. It is not possible to make definitive recommendations regarding treatment by PC or cholecystectomy in elderly or critically ill patients with acute cholecystitis. Low mortality rates after cholecystectomy in elderly patients with acute cholecystitis have been reported in recent years and therefore we believe it is time to launch an RCT to address this issue. [source] Microbiological assessment of bile during cholecystectomy: is all bile infected?HPB, Issue 3 2007G.J. MORRIS-STIFF Abstract Aims. To determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course. Patients and methods. Patients undergoing cholecystectomy under the care of a single consultant surgeon during a continuous 5-year period were identified from a prospectively maintained departmental database. Symptoms, clinical signs, findings of investigations, details of treatment and postoperative care were noted. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age > 70 years) were documented. Patients were divided according to the presence (B +) or absence (B,) of bacteria on culture of their bile. Results. In all, 128/180 (70%) of cholecystectomies had full data available for analysis. Bacteria were identified in the bile of 20 (15.6%) patients (B+ group). The B+ group was significantly older at 63.78±9.7 versus 61.62±13.9 (p<0.05) and contained significantly fewer females than the B, group (p<0.05). All 20 patients (100%) in the B+ group had , 1 risk factor, while these factors were present in only 29/108 (30.3%) of patients in the B, group (p<0.05). The overall incidence of infective complications was 20% in the B+ group compared with 0.9% in the B, group (p<0.05) and the bile-related infections were higher in the B+ group (p<0.05). Conclusions. The study demonstrated that while patients with complicated gallstone disease frequently exhibit bactibilia, patients with uncomplicated cholelithiasis have aseptic bile. The findings would suggest that prophylactic antibiotics should be limited to patients with risk factors for bactibilia. [source] Difficult laparoscopic cholecystectomy in acute cholecystitis: use of ,finger port', a new approachHPB, Issue 3 2003R Sinha Background Adhesions in acute cholecystitis tax even the more experienced operator during laparoscopic cholecystectomy. Blunt and sharp dissection, electrocautery, laser, hydrodissection, and ultrasonic dissection may all have their limitations. Thus there is a need for an alternative and more effective method. Method Laparoscopic cholecystectomy was carried out in 281 patients with acute cholecystitis. Separation of the gallbladder from the adherent structures was carried out in 13 patients, using the forefinger of the left hand introduced through the right hypochondrial port. In two patients a second finger was introduced through the epigastric port. Results The mean time required for the dissection was 7.9 minutes. Finger dissection failed in three patients because of dense adhesions on a high subcostal position of the gallbladder. Discussion Finger dissection is easy, fast, and limits injury because of the direct vision and tactile sensation, which are missing in other methods of laparoscopic dissection. [source] Evaluation of preoperative sonography in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomyJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2004Kyung Soo Cho MD Abstract Purpose The aim of this study was to evaluate the role of preoperative sonography in predicting technical difficulties during laparoscopic cholecystectomy in patients with acute cholecystitis. Methods Sonographic assessment of 14 parameters was performed in 55 patients during a 9-month period: volume of gallbladder (GB), thickness of GB wall, pattern of GB wall thickening, size of largest gallstone, gallstone mobility, adhesion of GB to its bed, fat plane between GB and hepatoduodenal ligament, free fluid in GB fossa, common bile duct (CBD) dilatation, CBD stone(s), color and power Doppler signals in GB wall, and increased color and power Doppler signals in adjacent liver. Each of the 5 operative steps of laparoscopic cholecystectomy was scored as being difficult (1) or not (0). The scores for each step were added to obtain the overall difficulty score (0,5). We evaluated prospectively whether there were significant associations among the preoperative sonographic findings and the overall difficulty score, scores for each of the 5 operative steps, and operation time. Results The overall difficulty score was significantly associated with a GB volume of 50 cm3 or more, GB wall thickness of 3 mm or more, and presence of color Doppler signals in the GB wall. Increased GB volume also made dissection of adhesions from the GB and dissection of Calot's triangle more difficult. Extraction of the GB from the abdomen was more difficult with a thickened GB wall or adhesion of the GB to its bed. The presence of a CBD stone, dilatation of the CBD (, 8 mm), color Doppler signals in the GB wall, and increased power Doppler signals in the adjacent liver were significantly associated with increased operation time. Conclusions Based on our experience, preoperative determination of GB volume, GB wall thickness, and presence of color Doppler signals in the GB wall in patients with acute cholecystitis helps predict technical difficulties during laparoscopic cholecystectomy. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:115,122, 2004 [source] Role of sonography in the diagnosis of gallbladder perforationJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2002Bimal P. Sood MD Abstract Purpose Gallbladder perforation is a dreaded complication of acute cholecystitis that is associated with a high mortality rate. Early detection of gallbladder perforation reduces the associated mortality and morbidity rates. The purpose of this study was to highlight the role of sonography in the diagnosis of gallbladder perforation and to compare the diagnostic accuracy of sonography with that of CT. Methods We retrospectively evaluated the sonographic and CT findings in surgically proven cases of gallbladder perforation. Results In 18 of 23 cases, both sonography and CT had been performed; in the other 5 cases, only sonography had been performed. Sonography helped to diagnose the defect in the gallbladder wall and gallbladder perforation in 16 (70%) of 23 patients. In the 18 cases in which both sonography and CT had been performed, sonography showed the wall defect in 11 cases (61%), whereas CT was diagnostic in 14 cases (78%). The difference between sonography and CT in the ability to visualize a defect in the gallbladder wall was not statistically significant. Conclusions Sonography is useful for diagnosing gallbladder perforation and detecting the defect in the gallbladder wall. We believe that sonography should be the first-line imaging modality for evaluating the patients in these cases. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:270,274, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10071 [source] Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2009Shou-Wu Lee Abstract Background and Aim:, Prompt treatments for acute calculous cholecystitis can reduce both mortality and morbidity. The aim of this retrospective study was to assess the impact of the Tokyo guidelines on management of patients with acute cholecystitis. Methods:, The records of patients admitted due to acute calculous cholecystitis were collected between January 2007 and June 2008. Exclusion criteria included acalculous, hepatobiliary malignancy, younger than 18 years old and mortality unrelated to cholecystitis. These 235 patients were classified into three groups; grade I, grade II and grade III, according to the severity grading in the Tokyo guidelines for acute cholecystitis. They were further classified into two subgroups; those compatible with and incompatible with managements suggested in the Tokyo guidelines, for comparison. Results:, Lower levels of platelets, lower blood pressure, higher levels of C-reactive protein, blood urine nitrogen, prothrombin time, bilirubin, alkaline phosphatase, and more incidences of positive microorganisms cultured in bile or blood, were found in patients as the severity of disease progressed. Shorter mean length of hospital stay was compatible with the Tokyo guidelines, but no significant differences in outcomes, including incidences of survival, post-surgery complications and mortality, were found between the two subgroups. Conclusion:, No significant benefit of the application of the Tokyo guidelines in the management of patients was found between the two subgroups except for reduced mean length of hospital stay. The application of the Tokyo guidelines for improving the outcomes of patients with acute cholecystitis needs further investigation and evaluation. [source] False negative biliary scintigraphy in gangrenous cholecystitisJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2002Robyn L Grant SUMMARY Gangrenous cholecystitis is a serious complication of acute cholecystitis and is associated with increased morbidity and mortality rates. We report a case in which the diagnosis was suggested by ultrasound, but cholecystectomy delayed due to atypical clinical presentation and a false negative radionuclide biliary scan. [source] Does an acute care surgical model improve the management and outcome of acute cholecystitis?ANZ JOURNAL OF SURGERY, Issue 6 2010Christopher W. Lehane Abstract The aim of this study was to compare the management and outcome of acute cholecystitis in an acute care surgery (ACS) model to that of the traditional home-call attending surgeon. The ACS model is one in which a consultant led team manage all emergency surgical presentations. The consultant is involved with every decision made including theatre allocation. Records of all patients who underwent an emergency cholecystectomy in the 2 years before and after introduction of an ACS model were reviewed. A total of 202 patients were recruited into this study. The groups were matched for sex, age and insurance status. There was a decrease in the median time to theatre (1 versus 2 days) and total length of stay (4 versus 6 days) in the ACS group. There was no significant difference in the conversion rate between the groups. However, there was a decreased complication rate in the ACS group (8.7 versus 17.2%). There were no differences in the histological findings. Consultant presence in theatre was higher in the ACS group (73.9 versus 56.3%), and they were more often assisting (30.4 versus 4.6%). Results suggest that an ACS model is beneficial to patient care with shorter hospital stay and a decreased complication rate. This may reflects a greater input to patient assessment and management by the on-site consultant. In addition, the ACS model provides greater consultant supervision to the trainee. [source] Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitisANZ JOURNAL OF SURGERY, Issue 4 2010Kenneth S. H. Chok Abstract Aim:, To assess the efficacy and safety of percutaneous transhepatic cholecystostomy (PTC) in treatment for acute cholecystitis in high surgical risk patients. Patients and methods:, A retrospective review was carried out from January 1999 to June 2007 on 23 patients, 11 males and 12 females, who underwent PTC for the management of acute cholecystitis at the Department of Surgery, Queen Mary Hospital, Hong Kong, China. The mean age of the patients was 83. They all had either clinical or radiological evidence of acute cholecystitis and had significant pre-morbid diseases. The median follow-up period on them was 35 months. Results:, All the PTCs performed were technically successful. One patient died from procedure-related haemoperitoneum, while 87% (n= 20) of all the patients had clinical resolution of sepsis by 20 h after PTC. Eight patients underwent elective cholecystectomy afterwards (62.5% with the laparoscopic approach). Eight patients had dislodgement of the PTC catheter and one of them developed recurrent acute cholecystitis 3 months after PTC. That patient was treated conservatively. Four patients died from their pre-morbid conditions during the follow-up period. Conclusion:, PTC was a safe and effective alternative for treating acute cholecystitis in this group of patients. Thirteen of them without elective cholecystectomy performed did not have recurrent acute cholecystitis after a single session of PTC. It may be considered as a definitive treatment for this group of patients. [source] LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS WITH SYMPTOMATIC GALLSTONE DISEASEANZ JOURNAL OF SURGERY, Issue 5 2008Emmanuel Leandros Background: The aim of this study was to evaluate the outcome in patients with liver cirrhosis who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Methods: Retrospective analysis of prospectively collected data of 34 patients operated between March 1998 and April 2006. Results: There were 19 male and 15 female patients with a median age of 62 years. Cirrhosis aetiology was viral hepatitis in 25 patients, alcohol in 6, primary biliary cirrhosis in 2 and in 1 patient the cause was not identified. Twenty-three were classified as Child,Pugh,Turcotte stage A and 11 as Child,Pugh,Turcotte stage B. The median Model For End-Stage Liver Disease score was 12. Median operating time was 96 min. In three patients there was conversion to open cholecystectomy. Postoperatively, one patient died and six more patients had complications. Median postoperative stay was 3 days. Patients with acute cholecystitis did not have increased morbidity, but had significantly longer hospital stay. Conclusion: Laparoscopic cholecystectomy can be carried out with acceptable morbidity in selected patients with well-compensated Child A and B stages liver cirrhosis. Patients with evidence of significant portal hypertension and severe coagulopathy should avoid surgery. [source] PREDICTING IATROGENIC GALL BLADDER PERFORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY: A MULTIVARIATE LOGISTIC REGRESSION ANALYSIS OF RISK FACTORSANZ JOURNAL OF SURGERY, Issue 3 2006Kamran Mohiuddin Background: Seventeen independent risk factors were examined using multivariate logistic regression analysis to develop a profile of patients most likely at risk from iatrogenic gall bladder perforation (IGBP) during laparoscopic cholecystectomy. Methods: Since 1989, a prospectively maintained database on 856 (women, 659; men, 197) consecutive laparoscopic cholecystectomies by a single surgeon (R. J. F.) was analysed. The mean age was 48 years (range, 17,94 years). The mean operating time was 88 min (range, 25,375 min) and the mean postoperative stay was 1 day (range, 1,24 days). There were 311 (women, 214; men, 97) IGBP. Seventeen independent variables, which included sex, race, history of biliary colic, dyspepsia, history of acute cholecystitis, acute pancreatitis and jaundice, previous abdominal surgery, previous upper abdominal surgery, medical illness, use of intraoperative laser or electrodiathermy, performance of intraoperative cholangiogram, positive intraoperative cholangiogram, intraoperative common bile duct exploration, presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively and success of the operation, were analysed using multivariate logistic regression for predicting IGBP. Results: Multivariate logistic regression analysis against all 17 predictors was significant (,2 = 94.5, d.f. = 17, P = 0.0001), and the variables male sex, history of acute cholecystitis, use of laser and presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively were individually significant (P < 0.05) by the Wald ,2 -test. Conclusion: Laparoscopic cholecystectomy, using laser, in a male patient with a history of acute cholecystitis or during an acute attack of cholecystitis is associated with a significantly higher incidence of IGBP. [source] Limy bile syndrome: review of seven casesANZ JOURNAL OF SURGERY, Issue 9 2005Konstantinos D. Ballas Background: Milk of calcium bile or limy bile is a rare disorder in which the gall bladder is filled with a thick, paste-like, radiopaque material. Methods: Seven patients with limy bile syndrome were treated in our department from 1980 to 2003. There were five women and two men, and their age ranged from 30 to 64 years. A retrospective analysis of clinical symptoms, diagnostic work-up, treatment approach and operative findings was performed. Results: All patients presented with intermittent right upper abdominal quadrant pain. Three of the seven patients (42.85%) presented with complications like acute cholecystitis (two of seven patients) and obstructive jaundice (one of seven patients). Diagnosis was based on clinical findings, plain abdominal X-rays, ultrasonography and computed tomography scanning. Surgery was the treatment of choice and cholecystectomy alone or in combination with common bile duct exploration and drainage (if needed) was performed. Conclusion: The clinical aspect of the disease is similar to that of biliary lithiasis and the diagnosis is easily made by the characteristic spontaneous opacification of the gall bladder on plain abdominal X-rays. Complications such as acute cholecystitis, pancreatitis or obstructive jaundice can also be present. Although some cases of conservative pharmaceutical treatment as well as cases of spontaneous disappearance of limy bile have been reported, surgical treatment remains the treatment of choice. [source] Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stonesANZ JOURNAL OF SURGERY, Issue 8 2002Kaja Ludwig Background: The purpose of the present study was to examine the current approach and different strategies adopted for laparoscopic cholecystectomy in Germany. Methods: A retrospective survey was conducted at 859 (n = 1200; 67.6%) hospitals in Germany. Data from 123 090 patients who had undergone cholecystectomy were analysed. Results: 71.9% of the operations were finished laparoscopically (n= 88 537) whereas 22.5% were carried out using the open technique. Conversion to open surgery was required in 7.1% of the laparoscopically started operations. When common bile duct stones were diagnosed preoperatively, 74.4% of the participants favoured the primary endoscopic extraction, following laparoscopic cholecystectomy. In cases of intraoperative diagnoses, laparoscopic cholecystectomy was finished and postoperative primary endoscopic extraction was carried out in more than half of the hospitals (58.4%). Sixteen per cent converted to an open operation with simultaneous exploration of the common duct. Laparoscopic desobstruction of the common bile duct was extremely rare (4.4%). Compared with open cholecystectomy, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for laparoscopic cholecystectomy. In contrast, common bile duct injuries were more frequent in the laparoscopic cholecystectomy group (0.32 vs 0.12%). The median duration of hospitalization was 6.1 days (range: 2.8,12) in the laparoscopic cholecystectomy group compared with 10.4 days (range: 3,28) in the open cholecystectomy group. Conclusions: Laparoscopic cholecystectomy is the standard procedure for the treatment of uncomplicated gallstone disease. There are reasonable differences between the hospitals in type of cholecystectomy for acute cholecystitis, management of common duct stones and intraoperative diagnostics in laparoscopic cholecystectomy, even after adjustment for differences in patient comorbidities. [source] Authors' reply: Cost,utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis (Br J Surg 2010; 97: 210,219)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2010E. Wilson No abstract is available for this article. [source] Current practice in the management of acute cholecystitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2000I. C. Cameron Aims: Several recent papers have advocated emergency cholecystectomy for patients with acute cholecystitis, stating that it is safe, cost effective and leads to less time off work. This study was designed to assess current practice in the management of acute cholecystitis in the UK. Methods: A postal questionnaire was sent to 357 consultant surgeons who were thought to be involved in a general surgical on-call rota, to ascertain their current management of patients with acute cholecystitis. Replies were received from 250 consultants (70 per cent) of whom 242 (68 per cent) were involved in a general surgical take. Sixteen of these consultants, however, handed their patients with acute cholecystitis on to a different team the following day for further management. Results: Twenty-seven consultants (12 per cent) routinely treat their patients by emergency cholecystectomy whenever possible, with 24 stating that they would do this within 72 h. Limiting factors to this practice were stated to be availability of surgical staff (15), theatre space (nine) and radiological investigations (four). The remaining consultants (n = 199) routinely manage their patients conservatively initially and providing they settle, either (1) book directly for cholecystectomy (n = 94, 47 per cent), (2) reassess as an outpatient (n = 65, 33 per cent), (3) either of above (n = 21; 11 per cent) or (4) refer on to a colleague (n = 19, 10 per cent). The commonest indications for acute cholecystectomy stated by consultants whose initial treatment policy is conservative are spreading peritonitis due to bile leak (93 per cent), empyema (89 per cent), unexpected space on a theatre list (28 per cent) and failure of an acute episode to settle (21 per cent). The laparoscopic method is the commonest for both elective and emergency cholecystectomy, but the percentage of consultants using an open method rises dramatically from 9 per cent in the elective situation to 48 per cent for emergency cholecystectomy. Conclusions: Despite evidence to support the increased use of emergency cholecystectomy, this practice is routinely carried out by only 12 per cent of consultants. However, of the consultants who treat their patients conservatively, 28 per cent are prepared to undertake emergency cholecystectomy if an unexpected space appears on the theatre list. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||