1/29. Massive postoperative hemorrhage from hepatic artery erosion.A 66-year-old male patient who had undergone repeated operations for peptic ulcer disease involving the right upper abdominal quadrant, developed cholecystitis with calculous obstruction of the common bile duct. The gallbladder was removed. Later, an operation was performed for removal of a residual stone from the common duct. At this time an anomalous arterial structure was noted about the duct. Hemorrhage occurred ten days postoperatively, and the anomalous hepatic artery was found to be eroded. The bleeding was controlled. During the succeeding two weeks there were four episodes of bleeding (involving erosion of the hepatic artery and adjacent tissues), three of which were controlled. The fourth episode ended in the death of the patient from exsanguination secondary to bleeding from stress ulcers in the gastric remnant. At no time did the laboratory data unequivocally indicate an abnormality of blood coagulation. Erosion of the anomalous cystic artery apparently precipitated the fatal chain of events.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
2/29. 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 = cholecystitis (Clic here for more details about this article) |
3/29. ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child.ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
4/29. Acute acalculous cholecystitis associated with aortic dissection: report of a case.Acute acalculous cholecystitis is uncommon, but not rare. Classically, this disease is observed in the intensive care unit associated with major trauma, burns, or surgery. Moreover, comorbidity such as infection, hypertension, and diabetes mellitus is often found. Although the exact pathogenesis is still not fully understood, it may be multifactorial and ischemia seems to play a central role. We herein report an unusual case of acute alithiasic cholecystitis predisposing to a de Bakey type III aortic dissection. A 57-year-old man was referred to our hospital for investigation of persistent right upper abdominal pain with tenderness and fever, associated with a newly diagnosed aortic dissection treated conservatively. The diagnosis of acalculous cholecystitis, which is often difficult to establish, was particularly delayed. An open cholecystectomy was performed, revealing a preperforating gangrenous gallbladder without any stones. The patient was discharged from hospital 9 days postoperatively without any early or late complications. No operative treatment for the aortic dissection was needed.- - - - - - - - - - ranking = 7keywords = cholecystitis (Clic here for more details about this article) |
5/29. Laparoscopic versus conventional cholecystectomy. Use of biliary scintigraphy.Laparoscopic cholecystectomy has become a popular alternative to traditional open cholecystectomy for uncomplicated, acute cholecystitis. At some centers, laparoscopic cholecystectomy is already the more frequently performed procedure. The presence or suspicion of common bile duct (CBD) stones or obstruction may necessitate conventional surgery or additional procedures. This report describes a patient with acute cholecystitis for whom the surgical management changed based on biliary scintigraphy. The demonstration of an unsuspected CBD obstruction by biliary imaging allowed the surgeon to change the initial plan for laparoscopic cholecystectomy to conventional open surgery. Stones in the common bile duct were removed.- - - - - - - - - - ranking = 2keywords = cholecystitis (Clic here for more details about this article) |
6/29. Gallstone disease and its complications.Gallstone disease is one of the most common disorders of the gastrointestinal tract, and more cholecystectomies are performed each year in the united states than any other elective abdominal operation. As such, clinicians need a fundamental knowledge of gallstone disease and the common complications that are associated with this disease. overall, the prevalence of gallstones in the united states is approximately 10% to 15%, of which, approximately 80% are without symptoms. Symptoms will occur in approximately 20% of those with gallstones, and this subgroup is at the highest risk for developing serious complications from their gallstone disease. These complications can range from simple recurrent biliary colic to severe, life-threatening ascending cholangitis and/or pancreatitis. This review will outline the basis for gallstone formation, the underlying mechanisms that result in gallstone-induced symptoms and a rational approach to individuals who present with symptoms consistent with gallstone disease. Current diagnostic and treatment modalities will be discussed, with a particular emphasis on acute cholecystitis and acute biliary pancreatitis.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
7/29. common bile duct stone caused by a fish bone: report of a case.Investigations to determine the cause of jaundice in an 83-year-old man led to the diagnosis of incomplete obstruction of the common bile duct due to stone formation around an ingested fish bone. Abdominal ultrasound and computed tomography performed preoperatively revealed evidence of chronic cholecystitis with a gallstone and calcification in the common bile duct. Endoscopic retrograde choangiopancreatography showed stone formation in the common bile duct. After normalizing the serum bilirubin level by endoscopic retrograde bile duct drainage, we performed cholecystectomy and choledocholithotomy, which revealed stone formation around an ingested bone in the common bile duct. To the best of our knowledge based on a computer-assisted search, this is only the third report of the formation of a choledocal stone around an ingested fish bone. We reviewed the literature on choledocholithiasis caused by a foreign body, in an attempt to classify this entity according to the pathways through which a foreign body can migrate into the common bile duct.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
8/29. Gallstone ileus: rare and still controversial.BACKGROUND: Gallstone ileus is a rare disease and accounts for about 1-3% of mechanic ileus of the small bowel, but for 25% of all small bowel obstructions in patients older than 65 years. Concomitant cardiorespiratory diseases or diabetes are frequent in older patients and responsible for the high mortality rate. The aim of the present study was to evaluate and discuss different surgical approaches and to analyze the clinical outcome. methods: Four patients with a mean age of 72 years were treated for gallstone ileus at our hospital in the last 10 years. patients history, operative strategy and their outcome is elucidated and a review of the recent literature is given. RESULTS: In all patients the operative strategy was a one-stage procedure including enterolithotomy, cholecystectomy and closure of the fistula. The 30-day mortality rate was 25%. CONCLUSION: One-stage procedure prevents from cholangitis, cholecystitis and recurrent ileus caused by further gallstones but bears the risk of enteric or biliary leakage after fistula closure. It should therefore be reserved for patients presenting in good general condition with a low degree of cholecystitis.- - - - - - - - - - ranking = 2keywords = cholecystitis (Clic here for more details about this article) |
9/29. 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 = cholecystitis (Clic here for more details about this article) |
10/29. Cholescintigraphic demonstration of transient and functional common bile duct obstruction in a patient with acute pancreatitis.Cholescintigraphy has proven useful in diagnosis of acute and chronic cholecystitis and evaluation of common bile duct obstruction. common bile duct obstruction may be due to mechanical obstruction such as impact stone in the common duct or functional obstruction due to sepsis with intra-hepatic cholestasis or acute viral hepatitis. We present a cholescintigram of a patient with acute pancreatitis showing complete common bile duct obstruction.- - - - - - - - - - ranking = 1keywords = cholecystitis (Clic here for more details about this article) |
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