11/28. Acute cholecystitis with a hemocholecyst as an unusual presentation of gallbladder cancer: report of a case. Several atypical presentations of gallbladder carcinoma have been reported, but one of the rarest is intraluminal hemorrhage. We report a case of carcinoma of the gallbladder disclosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst. The diagnostic approaches and characteristics of a hemocholecyst associated with carcinoma of the gallbladder are discussed. ( info) |
| BACKGROUND: Significant gastrointestinal complications following cardiac surgery requiring cardiopulmonary bypass (CPB) are relatively infrequent but are associated with high morbidity and mortality rates. Acute acalculous cholecystitis (AAC) may be a devastating complication if the diagnosis is missed or management delayed. AIM: We present two cases of AAC that followed coronary artery bypass graft (CABG) surgery. RESULTS: In one case a cholecystectomy was performed whereas percutaneous drainage was utilised in the second case. The application of these two different individualised treatment options lead to successful outcomes in both cases. CONCLUSION: awareness with vigilance enables early diagnosis and treatment. The clinical state of the patient at the time of diagnosis ultimately determines the management strategy in the post cardiac surgery patient. ( info) |
13/28. Laparoscopic procedures in adults with ventriculoperitoneal shunts. Until recently, the presence of a ventriculoperitoneal shunt (VPS) was considered an absolute contraindication to laparoscopy. In some cases, intraabdominal insufflation causes a rapid, sustained increase in intracranial pressure (ICP). Such intracranial hypertension may result in hindbrain herniation. To prevent this, the use of lower abdominal pressures, intraoperative ICP monitoring, intraoperative ventricular drainage, and distal shunt catheter clamping/externalization has been reported in some studies. However, other studies show that laparoscopy is safe even without VPS catheter clamping and with only routine anesthetic monitoring. Moreover, the risk of retrograde failure of the valve system has been shown to be minimal even with intraabdominal pressures as high as 80 mm Hg. We report how we managed a hydrocephalic adult with a VPS shunt undergoing laparoscopic cholecystectomy in the hope that our experience contributes to the successful management of such patients in the future. ( info) |
14/28. Rim sign in Tc-99m sulfur colloid hepatic scintigraphy. A case of pericholecystic hyperperfusion on Tc-99m sulfur colloid (SC) flow images with a pericholecystic rim of increased activity (PCHA) on delayed planar and single-photon emission computed tomography images of the liver was seen in a patient with a history of multiple renal transplants admitted with cramping right lower quadrant abdominal pain. laparotomy performed 5 days after the scan revealed an acutely perforated gangrenous gallbladder and occluded cystic duct. The secondary findings of gallbladder hyperperfusion and PCHA or "rim sign" have been frequently reported with Tc-99m IDA hepatobiliary imaging. These secondary findings in conjunction with a nonvisualized gallbladder on an IDA scan suggest a complicated or advanced stage of acute cholecystitis and usually require urgent surgical intervention. The rim sign on Tc-99m SC scintigraphy also likely indicates the same grave diagnosis. ( info) |
15/28. Acute cholecystitis at initial presentation of polyarteritis nodosa. polyarteritis nodosa (PAN) is a systemic vasculitis of unknown etiology. Although gastrointestinal involvement may be seen in half of the cases of PAN, vasculitis of the gallbladder at the disease onset is a rare presentation. We report a case of a 48-year-old man who was admitted due to acute cholecystitis. He had complained of myalgia, fever and weight loss for about one month prior to admission. At physical examination, mild hypertension and calf pain were noted. He underwent a cholecystectomy; histopathological evaluation disclosed necrotizing vasculitis suggestive of PAN. We emphasize that cholecystitis may be part of the initial presentation of systemic vasculitis. ( info) |
16/28. Fitz-Hugh-Curtis-syndrome mimicking acute cholecystitis: value of new ultrasound findings in the differential diagnosis. Fitz-Hugh-Curtis is a rare syndrome characterised by perihepatitis following pelvic inflammatory disease. We report the case of a patient with a right ovarian teratoma, abnormal liver tests and pain in the right abdomen and shoulder, initially attributed to an acalculous cholecystitis. Before gynaecological surgery, a repeat ultrasound scan found several small avascular peritoneal masses at the upper dome of the liver, not reported in the initial examination. This prompted laparoscopic exploration of the subdiaphragmatic space, and the final diagnosis of Fitz-Hugh-Curtis-syndrome was made. Such ultrasound finding appears to be a new diagnostic feature of this syndrome. ( info) |
| We report a 7-year-old girl who presented with features of acute acalculous cholecystitis. She was found to be positive for plasmodium falciparum. To the best of our knowledge, this is the first report of acalculous cholecystitis caused by P. falciparum in a child. ( info) |
18/28. Gall bladder perforation: report of 3 cases. We report 3 cases of gall bladder perforation treated in this centre between January 1996 and June 2001. These were compared with Neimier's original classification of types of gall bladder perforation and areas of difficulty in management emphasised. The literature was also reviewed. ( info) |
| Torsion of the gallbladder is an unusual cause of gangrenous cholecystitis. Even with the advent of recent radiological imaging modalities, the preoperative diagnosis of this entity remains elusive. Herein, we present a case of gallbladder torsion in a 76-year-old lady who successfully underwent laparoscopic derotation and cholecystectomy. ( info) |
| actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required. ( info) |