1/53. Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis.Gas in the biliary ducts (pneumobilia) was demonstrated in three cases of emphysematous cholecystitis. Pneumobilia is usually secondary to a spontaneous internal biliary fistula or incompetent sphincter of Oddi, and is rarely considered a manifestation of emphysematous cholecystitis. The presence of gas in the biliary ducts in these cases suggests that the cystic duct is patent, allowing gas to escape from the gallbladder lumen. The pathophysiology of emphysematous cholecystitis is discussed and an ischemic etiology considered.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/53. US-guided gallbladder aspiration: a new diagnostic method for biliary fascioliasis.fasciola hepatica is a trematode which is found worldwide. The diagnosis is usually delayed because the disease is relatively rare and the parasite or its eggs must be shown in bile samples for verification. We report three cases in which the diagnosis of fascioliasis was established by simple US-guided aspiration of the gallbladder. This new diagnostic method is less invasive, safe, and easy compared with the conventional endoscopic methods.- - - - - - - - - - ranking = 5keywords = gallbladder (Clic here for more details about this article) |
3/53. Bilo-pancreatic ascaris lumbricoides infestation. Endoscopic discovery and removal.ascaris lumbricoides infestation is relatively rare in industrialized countries, and it occurs mainly in conditions in which hygiene is lacking. We describe here a case of a 39-year-old female from ex-Jugoslavia affected by recurrent hepatic colic. At entry ultrasonography revealed microlithiasis in the gallbladder and widening of the pancreatic head. The subsequent ERCP showed slight filling defects in the choledochus and an inflammation-like stricture of the papilla of Vater, and after endoscopic sphincterotomy we saw an outflow of dense bile and microlitholits. Thus, a standard surgical cholecystectomy was carried out and the patient was dismissed on the 3rd postoperative day without any symptoms. However, the patient was admitted again after four days for a new coliky pain attack. An upper endoscopy showed a 23 cm long mobile parasite in the duodenum: it was caught with the polypectomy loap, extracted and identified as A. Lumbricoides. The patient's symptoms disappeared after the endoscopic removal of the worm and she was dismissed the day after the worm's removal. No recurrence of symptoms was noted during a 1-year follow-up. This case showed that A. Lumbricoides infestation of the biliary tree should be considered when biliary and/or pancreatic symptoms recur, especially in patients coming from undeveloped countries. At the same time we showed that endoscopic removal is a safe and effective treatment for this infestation.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
4/53. coccidioides immitis in the gallbladder and biliary tree.Intraabdominal coccidioidomycosis is a very rare entity and usually responds to medical therapy. Operative intervention is reserved for diagnosis or drainage of localized collections. With biliary coccidioidomycosis, medical treatment appears to be ineffective, and biliary tract drainage is necessary for optimal management. A case of coccidioidomycosis in the gallbladder and biliary tree is described and the literature reviewed.- - - - - - - - - - ranking = 5keywords = gallbladder (Clic here for more details about this article) |
5/53. Advanced gallbladder carcinoma with biliobiliary fistula, resected by hepatopancreatoduodenectomy, in an aged patient.We report a 78-year-old man with a gallbladder carcinoma and biliobiliary fistula, diagnosed by percutaneous transhepatic cholangioscopic biopsy through the fistula. The impacted stones in the common hepatic duct were crushed, and then selective cholangiography under percutaneous transhepatic cholangioscopy (PTCS) revealed a biliobiliary fistula. Cholangioscopic biopsy tissues taken from the gallbladder revealed adenocarcinoma, but biopsies taken from the fistula revealed no evidence of malignancy. Further investigations indicated that the gallbladder carcinoma involved the duodenum and the distal common bile duct. A hepatopancreatoduodenectomy, including both an extended right hepatic lobectomy with resection of the caudate lobe and a pancreatoduodenectomy, was performed. Despite the patient's advanced age, he made an unremarkable postoperative recovery and was able to enjoy an active social life for 8 months after the surgery. We discuss biliobiliary fistula associated with gallbladder carcinomas and the use of hepatopancreatoduodenectomy for advanced biliary cancer in aged patients.- - - - - - - - - - ranking = 8keywords = gallbladder (Clic here for more details about this article) |
6/53. Primary papillary hyperplasia of the gallbladder: a rare cause of biliary colic.Primary papillary hyperplasia of the gallbladder is a rare, poorly defined, clinicopathologic entity in adults. The authors describe a 12-year-old girl with this finding in the neck and body of the gallbladder. She presented with biliary colic, and ultrasonography of the gallbladder showed persistent thickening of the gallbladder wall but no evidence of calculi. Her symptoms resolved completely after cholecystectomy.- - - - - - - - - - ranking = 8keywords = gallbladder (Clic here for more details about this article) |
7/53. Intrabiliary rupture of hydatid cyst of the liver.In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
8/53. Heterotopic gastric mucosa involving the gallbladder and biliary tree.A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion.- - - - - - - - - - ranking = 8keywords = gallbladder (Clic here for more details about this article) |
9/53. Idiopathic cholangiopathy in a biliary cast syndrome necessitating liver transplantation following head trauma.The development of total biliary casts is very unusual, especially in patients who have not undergone liver transplantation. The aetiology of these casts is uncertain but several factors are believed to play a role, including periods of fasting, haemolysis, cholangitis and recent surgery. Resultant bile stasis and/or gallbladder hypocontractility promote sludge and subsequent stone formation. Here we present the case of a previously well 66-year-old woman who developed a total biliary cast several weeks after being involved in a road traffic accident during which she sustained head injuries but no obvious liver insult. This cast was removed at laparotomy but the patient had resultant diffuse biliary tree abnormalities and persistent cholestasis and subsequently required a liver transplant. The possible aetiologies of biliary cast formation and subsequently cholangiopathy necessitating transplantation in this patient are described.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
10/53. Motility and dysmotility of the biliary tract.Muscle fibers in the biliary tree, and therefore the potential for dysmotility, are located in the gallbladder and the sphincter of Oddi. Dysmotility at either site is a potential cause of biliary pain in the absence of stones, although significant controversy persists. Diminished gallbladder emptying measured by biliary scintigraphy is an indication for cholecystectomy, although studies are contradictory regarding clinical benefit. It is likely that careful selection of patients for cholescintigraphic testing, many of whom have had missed stones or sludge, will identify patients who benefit from cholecystectomy. However, given the increased incidence of gallbladder stasis in functional gastrointestinal disorders, wide use of this study in patients with abdominal symptoms leads to a frequent failure to respond to cholecystectomy. sphincter of oddi dysfunction (SOD) has been best studied in patients with biliary type pain who have had prior cholecystectomy. Much less understood is the association of SOD with idiopathic recurrent acute pancreatitis and chronic pancreatitis. The least-studied clinical association for SOD is in patients with biliary pain and intact gallbladders. Elevated basal sphincter of Oddi pressure is predictive of clinical response to sphincterotomy in patients with postcholecystectomy pain in two randomized sham-controlled studies. However, patients with suspected SOD have the highest complication rate from endoscopic retrograde cholangiogram and sphincterotomy, and, therefore, careful patient selection is mandatory.- - - - - - - - - - ranking = 4keywords = gallbladder (Clic here for more details about this article) |
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