1/139. An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome.We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
2/139. 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 = 5keywords = cholecystitis (Clic here for more details about this article) |
3/139. Recanalization of a portal-vein thrombosis and partial resolution of biliary cirrhosis following cholecystectomy for cholelithiasis in an infant.cholelithiasis in infants and children is unusual and is reputedly associated with underlying hemolytic disorders, total parenteral nutrition, ileal disease, and congenital anomalies of the biliary tree. We report a case of cholecystitis with pigmented stones in a 3-month-old infant associated with portal vein thrombosis (PVT) and biliary cirrhosis without the above-mentioned causes. Recanalization of the PV and partial resolution of the cirrhosis was observed following cholecystectomy. To our knowledge, cholelithiasis associated with PVT and cirrhosis in an infant has not been reported in the literature.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
4/139. gallbladder tuberculosis (case report and review of the literature).The incidence of abdominal tuberculosis is increasing and the familiarity with its clinical presentation shortens its diagnostic time and improves its management. gallbladder tuberculosis has unique considerations regarding its pathology, diagnosis and surgical management. The authors report a case of gallbladder tuberculosis in a 40 year-old female who presented with a clinical picture of acute cholecystitis. Abdominal ultrasound showed a dilated gallbladder with a large gall stone located in the neck region. Several lymph nodes were seen in the hilum of the liver compressing the portal vein which were associated with smaller retroperitoneal lymph nodes. The diagnosis of gallbladder tuberculosis was reached only during surgery and was proven by histopathology. The gallbladder was adherent to the surrounding tissues and covered with multiple tuberculous nodules. The patient had a retrograde open cholecystectomy and treated with anti-tuberculous drugs. The literature on this topic is reviewed.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
5/139. Preoperative ultrasound examination interpreted to represent a small contracted gallbladder with stones.Agenesis of the gallbladder is a relatively rare congenital anomaly with an incidence of only 0.01% to 0.04%. Yet it continues to occur. The patient described in this case study was symptomatic and received a clinical diagnosis of cholecystitis after having an ultrasound examination that was read as indicating a small contracted gallbladder with stones. Only after an open surgical procedure and cholangiography was it discovered tht the patient actually had a congenital absence of the gallbladder. Clinicians need to be aware of the potential for congenital absence of the gallbladder when interpreting tests and when findings are questionable, and to ensure no surprises, they should consider ordering other diagnostic tests before doing surgery.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
6/139. Sequential sonographic changes of the gallbladder in hemobilia: case report of a patient with intrahepatic duct stones.The sonographic features of hemobilia in the gallbladder have been reported with variation, including an echogenic mass, hypoechoic mass, and scattered intraluminal echoes. The sequential sonographic changes of hemobilia in the gallbladder were observed in a 59-year-old male patient with bilateral intrahepatic duct stones. The sonograms of hemobilia in the distended gallbladder initially showed a hyperechoic, homogeneous, movable mass-like lesion, 36 hours before the onset of upper gastrointestinal (UGI) bleeding. A hypoechoic mass-like lesion with a hyperechoic ring was found 5 days after the onset of UGI bleeding. A faint hypoechoic mass-like lesion was found 7 days after the onset of UGI bleeding (the day of no further bleeding). Scattered echoic densities were found 9 days after the onset of UGI bleeding, then disappearance of the lesion was noted 12 days after the onset of UGI bleeding. The sonographic patterns of hemobilia in the gallbladder vary depending on the timing of lysis of the blood clot. It should be differentiated from gallbladder cancer, a stone, a polyp, sludge, acute gangrenous cholecystitis, and gallbladder empyema.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
7/139. Pyloric gland metaplasia with perineural invasion of the gallbladder: A lesion that can be confused with adenocarcinoma.BACKGROUND: Metaplastic pyloric glands have been described in a variety of organs including the gallbladder, in which they can extend into the muscular wall and serosa. methods: Clinical, histologic, and immunohistochemical features of four cases of gallbladder florid pyloric gland metaplasia with perineural and intraneural invasion are analyzed. RESULTS: The patients with pyloric gland metaplasia and perineural and intraneural invasion were all females ages 57-72 years. A preoperative diagnosis of chronic cholecystitis and cholelithiasis was made for all four patients, but a histologic diagnosis of adenocarcinoma was made for two patients and entertained in two others. Macroscopically the gallbladders showed changes usually associated with chronic cholecystitis. No intraluminal masses were observed in any of the gallbladders. The characteristic microscopic features included florid pyloric gland metaplasia, proliferation of medium-sized nerve trunks more prominent in the muscular layer and serosa, and perineural and intraneural invasion by the metaplastic glands lined by cytologically bland cuboidal or columnar mucin-containing cells. At last follow-up all patients were alive and symptom free 1-7 years after laparoscopic cholecystectomy. CONCLUSIONS: Pyloric gland metaplasia of the gallbladder should be added to the long and increasing list of benign epithelial proliferations that are associated with perineural and intraneural invasion. This lesion should not be mistaken for adenocarcinoma of the gallbladder, a misinterpretation that may have serious therapeutic implications. The pathogenesis of this phenomenon is unknown.- - - - - - - - - - ranking = 2keywords = cholecystitis (Clic here for more details about this article) |
8/139. Ultrasound of gallbladder wall thickening and its relation to cholecystitis.A prospective ultrasound study of gallbladder wall thickness in patients with suspected gallbladder disease was performed over a 9 month period. gallbladder walls thicker than 3 mm in fasting patients whose gallbladders were wider than 2 cm were considered abnormal. gallstones were documented by ultrasound in 62 patients, a thickened gallbladder wall was demonstrated in 12 of these. Five patients without cholelithiasis had thick-walled gallbladders and were diagnosed as acalculous cholecystitis.- - - - - - - - - - ranking = 5keywords = cholecystitis (Clic here for more details about this article) |
9/139. Retroperitoneal abscess after retained stones during laparoscopic cholecystectomy.Laparoscopic cholecystectomy is associated with a significant risk of gallbladder perforations with bile and stone spillage. The retrieval of dropped stones is sometimes impossible, and intraperitoneally retained stones can be the source of serious complications, such as inflammatory masses or abscesses. The authors describe a patient in whom a large retroperitoneal abscess developed as a result of missed stone fragments during cholecystectomy. Although several cases of intraperitoneal abscess have been reported in the literature, retroperitoneal collection is very uncommon. Crushed and infected stones seem to be the essential prerequisite for abscess formation. Therefore, every attempt should be made to avoid stone spillage and intra-abdominally retained stones. conversion to open surgery has to be considered in the presence of adverse factors, such as primary acute cholecystitis or cholecystitis induced by previous sphincterotomy, or bilirubinate stones believed to be infected. abdominal abscess treatment requires removal of missed stones by surgical incision or new laparoscopic procedure because simple percutaneous drainage is usually unsuccessful.- - - - - - - - - - ranking = 2keywords = cholecystitis (Clic here for more details about this article) |
10/139. Bouveret's syndrome complicated by acute pancreatitis.BACKGROUND/AIM: This study evaluated a case of Bouveret's syndrome due to a cholecystoduodenal fistula and gallstone obstruction of the duodenum, complicated by acute pancreatitis and cholecystitis. methods: The presenting features, special investigations, radiological findings, operative and endoscopic procedures were reviewed. RESULTS: Symptoms persisted after laparotomy and removal of a gallstone in the duodenum. Intra-operative endoscopy identified a second previously undetected stone impacted in the distal duodenum. CONCLUSION: The importance of excluding more than one stone causing Bouveret's syndrome is emphasized.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
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