1/369. 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 = gallbladder (Clic here for more details about this article) |
2/369. Double gallbladder originating from left hepatic duct: a case report and review of literature.BACKGROUND: Double gallbladder is a rare anomaly of the biliary tract. Double gallbladder arising from the left hepatic duct was previously reported only once in the literature. CASE REPORT: A case of symptomatic cholelithiasis in a double gallbladder, diagnosed on preoperative ultrasound, computed tomography (CT) and endoscopic retrograde cholangiopancreatogram (ERCP) is reported. At laparoscopic cholangiography via the accessory gallbladder no accessory cystic duct was visualized. After conversion to open cholecystectomy, the duplicated gallbladder was found to arise directly from the left hepatic duct; it was resected and the duct repaired. CONCLUSIONS: We emphasize that a careful intraoperative cholangiographic evaluation of the accessory gallbladder is mandatory in order to prevent inadvertent injury to bile ducts, since a large variety of ductal abnormality may exist.- - - - - - - - - - ranking = 1.25keywords = gallbladder (Clic here for more details about this article) |
3/369. Parietal seeding of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.- - - - - - - - - - ranking = 0.875keywords = gallbladder (Clic here for more details about this article) |
4/369. Unexpected gallbladder cancer after laparoscopic cholecystectomy: an emerging problem? Reflections on four cases.gallbladder cancer (GC) has been reported in 0.3-1.5% of cholecystectomies. Since the introduction of laparoscopic surgery, cholecystectomies have increased and occult GC may therefore be more frequent. Herein we analyze our own experience to determine whether there was an increase in GC. We also evaluate the risk factors for this outcome. Four patients with GC undiagnosed before surgery (four of 602 cases, or 0.66%) were submitted to laparoscopic cholecystectomy. The percentage in patients who underwent open surgery was 0.28% (two of 714 cases). Without reoperation, three patients died in the laparoscopic group and one is alive at 12 months. Trocar site metastasis was not observed. Although the percentage of GC (0.28% versus 0.66%) increased, the percentage is still in the referred average. Undiagnosed GC is on the increase. Examination of the gallbladder and a frozen section, if necessary, are recommended. Calcified gallbladders, age >70 years, a long history of stones, and a thickened gallbladder all represent significant risk factors.- - - - - - - - - - ranking = 0.875keywords = gallbladder (Clic here for more details about this article) |
5/369. Laparolithic cholecystectomy: laboratory data and first clinical case.A method of laparoscopic cholecystectomy is described. After control of the cystic duct and artery, gallstones are emulsified with a laparoscopic lithotriptor and the debris aspirated from the gallbladder. The free wall of the gallbladder is excised and the remaining gallbladder mucosa ablated with holmium:yttrium-aluminum-garnet (Ho:YAG) laser. This technique eliminates the need for dissection of the gallbladder from the liver, thereby reducing the possibility of hemorrhage from the gallbladder fossa. At the same time stones and bile are aspirated so that the excised portion of gallbladder can be easily removed through an access port without spillage of contaminated bilious debris into the abdominal cavity or puncture wound that could cause infection. Acute and chronic animal studies confirm the feasibility of this technique. A clinical case is described.- - - - - - - - - - ranking = 0.75keywords = gallbladder (Clic here for more details about this article) |
6/369. Percutaneous endoscopic laser lithotripsy of a cystic duct stone: a case report.A case report of an elderly patient with severe heart disease and chronic obstructive pulmonary disease who required laser lithotripsy for a retained cystic duct stone is presented. This high-risk patient underwent a laparoscopic cholecystostomy and gallstone removal as treatment for symptomatic gallstone disease. On cholecystography the patient was found to have a small stone fragment in the cystic duct. Under intravenous sedation this stone fragment was fragmented and removed using an 8.5F flexible ureteroscope and a coumarin pulsed-dye laser lithotriptor. The stone was fragmented and washed into the common bile duct. Follow-up cholecystogram prior to removal of the cholecystostomy tube demonstrated no stones in the gallbladder, cystic duct, or common bile duct. The management of percutaneous removal of retained stones is reviewed.- - - - - - - - - - ranking = 0.125keywords = gallbladder (Clic here for more details about this article) |
7/369. Undiagnosed Mirizzi's syndrome: a word of caution for laparoscopic surgeons--a report of three cases and review of the literature.The mirizzi syndrome is often undiagnosed before surgery and can carry a high risk of iatrogenic damage to the common bile duct when encountered during open or, especially, laparoscopic surgery. Endoscopic management has recently been reported, but this treatment can be performed only when there is a high index of suspicion based on clinical criteria that the condition is present and therefore suggests the indication for endoscopic retrograde cholangiopancreatography (ERCP). This is not always the case. Consequently, in a considerable percentage of patients, the syndrome is discovered only after the bile ducts have been damaged during surgery. Three cases of Mirizzi's syndrome were observed in our experience of 896 laparoscopic cholecystectomies (0.3%). All patients were without typical symptoms, and the syndrome was unsuspected in spite of preoperative intravenous cholangiography. All patients required conversion to an open procedure, with two injuries of the common bile duct (a complete transection and a tear) being promptly repaired. We conclude that when this syndrome is suspected or found during surgery, the surgeon should follow these guidelines: (1) perform intraoperative cholangiography when possible, even through the gallbladder wall; and (2) dissect the gallbladder from above and, if necessary, open it to extract the stone. dissection of Calot's triangle should never be attempted. Great expertise is required to complete the operation laparoscopically. The reported cases in the literature refer to a high percentage of conversion, underlining the technical difficulties and making this syndrome, when undiagnosed and unsuspected, a real challenge for laparoscopic surgeons.- - - - - - - - - - ranking = 0.25keywords = gallbladder (Clic here for more details about this article) |
8/369. Combined endoscopic and surgical management of mirizzi syndrome.mirizzi syndrome is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with or without a cholecystocholedochal fistula. This syndrome is a rare complication of cholelithiasis that accounts for 0.1% of all patients with gallstone disease. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with a preoperative diagnosis of type I mirizzi syndrome that was confirmed and drained by endoscopic retrograde cholangiography (ERC), followed by subtotal cholecystectomy. A review of the literature covering its clinical presentation, diagnosis, and surgical treatment is also presented.- - - - - - - - - - ranking = 0.125keywords = gallbladder (Clic here for more details about this article) |
9/369. Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy.The case is described of a 74-year-old woman who presented with an abdominal abscess 1.5 years after laparascopic cholecystectomy. CT and ultrasound showed the presence of gallstones within the abscess. Spillage of gallstones from perforation of the gallbladder is a well recognized complication of laparascopic cholecystectomy, although subsequent abscess formation is unusual especially after a long delay as in this case.- - - - - - - - - - ranking = 0.125keywords = gallbladder (Clic here for more details about this article) |
10/369. Port-site metastasis after laparoscopic cholecystectomy for benign disease.We describe the case history of a patient presenting with a port-site metastasis from an occult pancreatic malignancy after laparoscopy for benign gallbladder disease. While port-site recurrence is well recognized after laparoscopy for malignant disease, its presentation after laparoscopy for benign disease is rare, this being only the third such case to be reported in the literature. It emphasizes that all pathology localizing to port sites after surgery should be investigated, as it may represent the earliest sign of a hitherto occult intra-abdominal malignancy.- - - - - - - - - - ranking = 0.125keywords = gallbladder (Clic here for more details about this article) |
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