1/230. Acute acalculous cholecystitis in young patients without predisposing factors.We report the atypical presentation of acute acalculous cholecystitis in four young, otherwise healthy patients. These cases emphasize the fact that the traditional concept of this disease as being associated with trauma, major surgery, or other pathology may no longer be true, and an important number of cases may appear de novo in patients without any predisposing factors.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
2/230. Duplicate gallbladder cholecystitis after open cholecystectomy.A 42-year-old man presented with acute right upper quadrant abdominal pain 2 years after open cholecystectomy. Evaluation revealed cholecystitis in a second gallbladder and a second cholecystectomy was performed. Acute right upper quadrant abdominal pain after cholecystectomy presents a wide differential diagnosis, including the often idiopathic and difficult to manage postcholecystectomy syndrome. Emergency physicians should be aware of the most common causes of pain in these patients. Previously unrecognized congenital abnormalities of the biliary system should be considered when the diagnosis is not clear, as highlighted by this case report.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
3/230. Peripheral clear cell cholangiocarcinoma: a rare histologic variant.We present the case of a 50-year-old diabetic male who underwent open cholecystectomy for acute gangrenous cholecystitis. At the time of exploration, a 1.5-cm mass was found peripherally in the right lobe of his liver, and an incisional biopsy was performed. Microscopic examination revealed a distinct overgrowth of clear cells in an acinar pattern, with tumor cells emerging directly from bile ducts. The tumor cells were periodic acid-Schiff reactive and diastase resistant, indicating the presence of mucin. No bile canaliculi were demonstrated by immunostaining with carcinoembryonic antigen. CT scans of the chest and abdomen were otherwise normal. Based on these microscopic, immunohistochemical, and clinical data, a diagnosis of clear cell cholangiocarcinoma was established. The patient later underwent reexploration and generous hepatic wedge resection. He did well postoperatively and is free of disease after 12 months.- - - - - - - - - - ranking = 0.2keywords = cholecystitis (Clic here for more details about this article) |
4/230. Percutaneous drainage of emphysematous cholecystitis associated with pneumoperitoneum.emphysematous cholecystitis, a relatively rare variant of acute cholecystitis, is associated with high morbidity and mortality rates. In the presence of a concomitant pneumoperitoneum, these rates may be considered even higher, approaching those of perforation of the gallbladder. The first choice of treatment in cases presenting with pneumoperitoneum is emergency laparotomy. We performed a staged procedure as a second best alternative. In a 65 year-old female patient, initial percutaneous cholecystostomy with a strict intravenous antibiotics regimen, and subsequent cholecystectomy 6 months, later was carried out with successful outcome. A review of the literature revealed 13 other cases of this combination. Treatment modalities and outcome of these patients are discussed.- - - - - - - - - - ranking = 1.2keywords = cholecystitis (Clic here for more details about this article) |
5/230. hyperbaric oxygenation as adjuvant therapy to surgery of emphysematous cholecystitis.Three cases of emphysematous cholecystitis are presented. The role of hyperbaric oxygenation as excellent adjuvant therapy to urgent surgical as well as intensive conservative treatment is emphasized.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
6/230. Successful nonoperative management of neonatal acute calculous cholecystitis.Acute cholecystitis in the neonate is rare and usually treated by cholecystectomy. A 1-day-old full-term girl had clinical and sonographic features of acute calculous cholecystitis. This was successfully managed nonoperatively with intravenous fluids and antibiotics, leading to complete resolution of the condition. The infant currently is thriving and asymptomatic with a sonographically normal biliary tree. Spontaneous resolution of cholelithiasis may occur in neonates, even in the presence of acute cholecystitis.- - - - - - - - - - ranking = 1.4keywords = cholecystitis (Clic here for more details about this article) |
7/230. Acute cholecystitis secondary to hemobilia.Invasive diagnostic and therapeutic techniques such as percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), transjugular intrahepatic portosystemic shunting, and laparoscopic cholecystectomy have led to a rise in hemobilia. Most complications from hemobilia are attributable to acute blood loss; other complications are secondary to thrombus formation in the biliary tree. We present a case report of acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. The role of ERCP in the diagnosis and treatment of this exceedingly rare event is discussed.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
8/230. Acute acalculous cholecystitis in leptospirosis.The authors present three patients with acalculous cholecystitis seen at a tertiary care center in Bangkok. The first patient was explored surgically because peritonitis was suspected. The two other patients were treated conservatively with antibiotics and supportive care, and they recovered fully. The diagnosis of leptospirosis was confirmed by increasing antibody titers in three patients and by blood culture in one patient. leptospira were not detected in the surgical specimen. leptospirosis is a systemic disease that can present with a multitude of symptoms and signs including right upper quadrant pain mimicking cholecystitis. A high level of awareness and appropriate laboratory studies should allow early diagnosis and may prevent unnecessary surgical intervention.- - - - - - - - - - ranking = 1.2keywords = cholecystitis (Clic here for more details about this article) |
9/230. Acute acalculous cholecystitis in a patient on total parenteral nutrition: case report and review of the Japanese literature.Acute acalculous cholecystitis (AAC) is a rare and dangerous complication of various medical and surgical conditions. We report on a male patient with bile panperitonitis caused by gangrenous AAC, which developed while he was on total parenteral nutrition (TPN) for ileus related to obstructive colon cancer. We also review the relevant Japanese literature on AAC associated with TPN. Our patient suddenly developed right hypochondrial pain after 3 days of TPN while waiting for colon cancer surgery. We diagnosed acute AAC by ultrasonography, and salvaged the patient by cholecystectomy plus left colectomy. early diagnosis by ultrasound is important for this critical condition. knowledge of the risk of acute gangrenous cholecystitis during TPN may allow the physician to provide an appropriate diagnosis and treatment.- - - - - - - - - - ranking = 1.2keywords = cholecystitis (Clic here for more details about this article) |
10/230. Right hepatic lobectomy for recurrent cholangitis after bile duct and hepatic artery injury during laparoscopic cholecystectomy: report of a case.A patient is reported who required a right hepatic lobectomy for recurrent cholangitis due to injury of the major bile ducts and the right hepatic artery during laparoscopic cholecystectomy. A 39 year-old woman with acute cholecystitis underwent laparoscopic cholecystectomy. A laparotomy was performed due to a bile duct injury at the hepatic bifurcation. After surgery, she suffered from recurrent cholangitis due to inadequate biliary reconstruction. A right hepatic lobectomy and reconstruction of the left hepatic duct was required because of right hepatic lobe atrophy and recurrent cholangitis. After the 2nd operation, she was active and exhibited no evidence of recurrence at 22 months.- - - - - - - - - - ranking = 0.2keywords = cholecystitis (Clic here for more details about this article) |
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