1/7. Laparoscopic cholecystectomy in a patient on continuous ambulatory peritoneal dialysis.The patient was a 72-year-old man who was receiving continuous ambulatory peritoneal dialysis (CAPD) with a diagnosis of chronic renal failure. Although his response to dialysis therapy was favorable, right hypochondralgia and fever occurred, and gallstones were detected by abdominal ultrasonography and computed tomography. Drip-infusion cholangiography (DIC) revealed neither dilation nor calculus in the common bile duct. The patient was diagnosed as having acute cholecystitis and cholecystolithiasis and, in consideration of his general condition, laparoscopic cholecystectomy was carried out. pneumoperitoneum was performed through a CAPD tube, and a 10 mm-trocar was carefully introduced through a supraumbilical incision so as not to injure the CAPD tube. Since intraoperative cholangiography showed a condition similar to preoperative DIC, only cholecystectomy was undertaken. The postoperative course was uneventful, with neither postoperative hemorrhage nor leakage of dialysate from the wound.- - - - - - - - - - ranking = 1keywords = cholecystolithiasis (Clic here for more details about this article) |
2/7. Structural changes of the exocrine pancreas in a patient with cholecystolithiasis.The exocrine pancreas has been studied histologically, morphometrically, and ultrastructurally in a patient with cholecystolithiasis in comparison with three control patients free from gastrointestinal or pancreatic diseases. In the gallstone-bearing patient, acinar cells undergo a significant increase in the average cell area and average zymogenic area (i.e., the portion of acinar cell cytoplasm occupied by zymogen granules). In addition, these cells showed cytological signs of enhanced synthesis of secretory proteins and increased formation and release of zymogen granules. The findings concerning centroacinar/ductular cells are consistent with a significant increase in their number and average cell area that is associated with ultrastructural signs of enhanced functional activity.- - - - - - - - - - ranking = 5keywords = cholecystolithiasis (Clic here for more details about this article) |
3/7. intensive care treatment of severe mixed metabolic acidosis.We report a case of severe metabolic acidosis associated with acute renal failure and septicaemia following treatment with maximal therapeutic doses of metformin and diclofenac. On the second day of intensive care the patient deteriorated with respiratory insufficiency and abdominal pain during continuous renal replacement therapy. A laparoscopy revealed a perforated cholecystitis with abscess formation. The patient regained renal function and recovered. Intake of diclofenac 5 days before this episode could have been the main cause of renal insufficiency and metabolic acidosis in this patient and could also have delayed surgical treatment by masking early clinical signs of perforated cholecystitis. The renal failure may also have caused metformin and lactate to accumulate, contributing to the mixed pattern of metabolic acidosis. This case report describes a mixed organic and non-organic metabolic acidosis associated with acute renal failure, presumably resulting from a combination of drugs and diseases often found in the elderly - metformin for diabetes mellitus and a non-steroidal anti-inflammatory drug for cholecystolithiasis. Acid-base balance and electrolyte changes were rapidly normalized by continuous renal replacement therapy.- - - - - - - - - - ranking = 1keywords = cholecystolithiasis (Clic here for more details about this article) |
4/7. Right hepatic duct opening into the cystic duct: the role of pre- and intraoperative cholangiography.Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare. A 69-year-old woman developed severe intermittent right upper quadrant pain and high fever. A diagnosis of acute calculus cholecystitis was made by radiographic examinations. Magnetic resonance cholangiopancreatography demonstrated dilatation of the right hepatic duct, but could not identify the junction of the right hepatic duct and the cystic duct. Endoscopic retrograde cholangiopancreatography established that the right hepatic duct joined the cystic duct and that cholecystolithiasis was present. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy. Pre- and intraoperative cholangiography contribute to the avoidance of iatrogenic bile duct injury. When the right hepatic duct drains into the cystic duct, the gallbladder should be removed distal to the junction of the hepatic and cystic ducts.- - - - - - - - - - ranking = 1keywords = cholecystolithiasis (Clic here for more details about this article) |
5/7. hemobilia: a rare complication of cholecystitis and cholecystolithiasis. Case report.hemobilia, although not uncommon, is usually inconsequential and most of the times not even diagnosed. It is known that hemobilia is a rare complication of cholecystitis and cholecystolithiasis. We report the case of a patient who presented with a life-threatening upper gastro-intestinal bleeding due to erosion of the cystic artery by cholecystolithiasis and cholecystitis.- - - - - - - - - - ranking = 6keywords = cholecystolithiasis (Clic here for more details about this article) |
6/7. cholecystolithiasis and infection of the biliary tract with salmonella Virchow--a very rare case in early childhood.In early childhood gallstones are rare. However, in the last years the number of patients has increased. A possible cause for calculous and acalculous cholecystitis are infections with salmonella species. The following report describes a case of perforated cholecystitis and cholecystolithiasis accompanied by microbiological finding of salmonella Virchow in the gallbladder in a three-and-a-half-year-old boy. A combination of symptomatic cholecystolithiasis and salmonella Virchow has not yet been described in the literature. The belated diagnosis resulted in a sealed perforation of the gallbladder with local biliary peritonitis. After cholecystectomy and antimicrobial therapy, the patient could be discharged without any complaints. Diseases of the biliary tract are part of the differential diagnosis of unclear abdominal pain in early childhood.- - - - - - - - - - ranking = 2keywords = cholecystolithiasis (Clic here for more details about this article) |
7/7. Endoscopic sphincterotomy and laparoscopic cholecystectomy in an infant with cholecysto-choledocholithiasis.Laparoscopic cholecystectomy (LC) and endoscopic sphincterotomy (EST) are widely accepted procedures for cholecysto-choledocholithiasis in adults. However, their use in infants has not been reported. An 8-month-old girl presented with high fever and obstructive jaundice. Ultrasound scan showed acute cholecystitis with stones in the bile duct. After 2-week-long antibiotic therapy the acute cholecystitis and hepatic impairment resolved. An endoscopic retrograde cholangiopancreatography (ERCP) confirmed choledocholithiasis and cholecystolithiasis. risk factors for the development of biliary calculi were not detected. One month after the restoration of her liver function, she underwent EST using a side-viewing endoscope with a small sphincterotome. A common bile duct stone was extracted using a basket catheter. LC was then carried out. The time interval between the EST and LC was 34 days. No complications have been noted for 6 months.- - - - - - - - - - ranking = 1keywords = cholecystolithiasis (Clic here for more details about this article) |