1/14. What happens to the lost gallstone during laparoscopic cholecystectomy?Iatrogenic gallbladder perforation with resultant spillage of bile and gallstones is common during laparoscopic cholecystectomy. Although it's assumed to be harmless, several complications may occur as a result of spillage. We present a 57-year-old woman with localized abdominal pain in the upper abdomen, jaundice, and itching because of retained stones in both common bile duct (CBD) and the abdominal cavity, who had undergone laparscopic cholecystectomy three years previously. After reoperation, stones in the CBD were removed after CBD exploration and a T-tube was inserted. A mass (8 x 5 cm) located in the gastrocolic omentum, which was not reported on imaging studies, was found coincidentally and was totally excised. Investigation of the mass resulted in the discovery of eight gallstones located in the abcess-like central cavity, which was surrounded by fibrous tissue. The patient had an uneventful recovery. Despite the unaffected long-term sequelae, any patients with gallbladder perforations and spillage should not be considered for extension of antibiotic prophylaxis to avoid early complications. Whenever gallstones are lost in the abdominal cavity, every effort should be made to find and remove them to prevent late complications.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/14. Heterotopic gastric mucosa involving the gallbladder and biliary tree.A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion.- - - - - - - - - - ranking = 4keywords = gallbladder (Clic here for more details about this article) |
3/14. Poorly differentiated adenocarcinoma with signet-ring cells of the Vater's ampulla, without jaundice but with disseminated carcinomatosis.A 49-year-old man was hospitalized because of a 2-month history of purpura in his extremities and for back pain. Laboratory findings showed alkaline phosphatase to be greatly elevated, and platelet counts and coagulation factor showed that the patient had disseminated intravascular coagulation (DIC). Compression fractures of the thoracic vertebrae were found on radiological examination. The histological findings from bone marrow showed metastasis of adenocarcinoma with signet-ring cells, although the primary site was unknown. To reduce tumor cells in number and improve DIC, 11 cycles of 5-fluorouracil and leucovorin therapy were done, and the patient survived for 12 months. autopsy showed a 0.8 cm diameter, poorly differentiated adenocarcinoma with the signet-ring cell type in the lamina propria of the Vater's ampulla. Many metastatic foci and micro tumor emboli were found in the lung and in bone marrow. The sections of the stomach, the gallbladder, urinary bladder, prostate, and thyroid gland showed no malignant cells. These findings suggest that the origin of the cancer may have been located in the Vater's ampulla. This is a rare case of an ampullary tumor of poorly differentiated adenocarcinoma with the signet-ring cell type, without jaundice but with multiple metastasis. 5-fluorouracil and leucovorin were effective for increasing survival time and improving quality of life.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
4/14. jaundice due to extrabiliary gallstones.OBJECTIVE: cholecystectomy is one of the most common general surgical procedures performed today. The laparoscopic approach is beneficial to patients in terms of length of stay, postoperative pain, return to work, and cosmesis. Some drawbacks are associated with the minimal access form of cholecystectomy, including an increased incidence of common bile duct injuries. In addition, when the gallbladder is inadvertently perforated during laparoscopic cholecystectomy, retrieval of dropped gallstones may be difficult. We present a case in which gallstones spilled during cholecystectomy, causing near circumferential, extraluminal common hepatic duct compression, and clinical jaundice 1 year later. methods: The patient experienced jaundice and pruritus 12 months after laparoscopic cholecystectomy. A computed tomographic scan was interpreted as cholelithiasis, but otherwise was normal (despite a previous cholecystectomy). Endoscopic retrograde cholangiopancreatography was performed and a stent placed across a stenotic common hepatic duct. RESULTS: The results of brush biopsies were negative. The stent rapidly occluded and surgical intervention was undertaken. At exploratory laparotomy, an abscess cavity containing multiple gallstones was encountered. This abscess had encircled the common hepatic duct, causing compression and fibrosis. The stones were extracted and a hepaticojejunostomy was tailored. The patient's bilirubin level slowly decreased and she recovered without complication. CONCLUSIONS: gallstones lost within the peritoneal cavity usually have no adverse sequela. Recently, however, numerous reports have surfaced describing untoward events. This case is certainly one to be included on the list. A surgeon should make every attempt to retrieve spilled gallstones due to the potential later complications described herein.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
5/14. Painful jaundice revealing Kawasaki disease in a young man.liver involvement is usually a minor manifestation of Kawasaki disease and includes hepatobiliary dysfunction or gallbladder hydrops. We describe here an unusual case of jaundice revealing an adult onset Kawasaki disease. An 18-year-old man presented with abdominal pain and jaundice associated with cholestasis as the initial manifestation of Kawasaki disease. Abdominal evaluation (ultrasonography and CT-scan) did not find abnormality. Other signs typical of the Kawasaki disease occurred a few days later and permitted diagnosis. With aspirin and intravenous immunoglobulins, outcome was favorable without any cardiovascular complication. Our case suggests that Kawasaki disease should be added to the etiological list of painful febrile icterus in young patients.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
6/14. Dual hereditary jaundice: simultaneous occurrence of mutations causing Gilbert's and Dubin-Johnson syndrome.BACKGROUND & AIMS: Dubin-Johnson syndrome is recessively inherited, conjugated hyperbilirubinemia induced by mutations in the ABCC2/MRP2 gene encoding the canalicular transporter for conjugated bilirubin. Gilbert's syndrome is recessively inherited, unconjugated hyperbilirubinemia caused by decreased conjugation rate of bilirubin associated mostly with homozygous A(TA) 7 TAA variant of the TATAA-box in the UGT1A1 gene promoter. Our aim was to establish the molecular diagnosis in a 3-year-old male with atypical, intermittent, predominantly unconjugated, hyperbilirubinemia. methods: 99m Tc-HIDA cholescintigraphy was used for imaging the biliary tree. Expression of ABCC2/MRP2 protein in hepatocytes was investigated immunohistochemically. UGT1A1 and ABCC2/MRP2 genes were sequenced from genomic dna, and the mutations were verified by fragment analysis, sequencing the cloned exons, and restriction fragment length polymorphism. RESULTS: Cholescintigraphy revealed delayed visualization of the gallbladder. A brown granular lipopigment differing from melanin-like pigment reported in Dubin-Johnson syndrome was present in hepatocytes, but, otherwise, liver histology was normal. ABCC2/MRP2 protein was not detected on the canalicular membrane of hepatocytes, and 2 novel mutations were found in the ABCC2/MRP2 gene: a heterozygous in-frame insertion-deletion mutation 1256insCT/delAAACAGTGAACCTGATG in exon 10 inherited from the father and a heterozygous deletion 4292delCA in exon 30 inherited from the mother. In addition, the patient was homozygous for -3279T>G and A(TA) 7 TAA mutations in the UGT1A1 gene promoter. CONCLUSIONS: Our patient represents a case of digenic mixed hyperbilirubinemia-a distinct type of constitutive jaundice resulting from coinherited defects in ABCC2/MRP2 and UGT1A1 genes.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
7/14. gallbladder sludge and acute pancreatitis induced by acute hepatitis a.In this case report, a young woman with gallbladder sludge and acute pancreatitis due to acute hepatitis a (HAV) is presented. She was admitted to our hospital with abnormal hepatic enzymes. Five days prior to her admission, an initial abdominal ultrasound was performed at another hospital and revealed no abnormality, while her serum aspartate aminotransferase (AST) level was at the upper limit of normal (ULN) x 8. A second ultrasound was performed at our hospital and revealed a gallbladder wall thickness (9.3 mm), gallbladder sludge in the gallbladder lumen, pancreatic edema, ascites, and hepatomegaly while AST was at the ULN x 50. magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed imaging features of an acute stage of pancreatitis and gallbladder wall thickness with coexisting sludge in the gallbladder lumen. HAV infection was diagnosed by the detection of immunoglobulin m against HAV in the serum. The patient underwent two repeated abdominal ultrasound examinations on the 5th (AST was at the ULN x 3) and the 20th days (AST was at the normal) after her discharge, and both revealed normal findings. In our case, we observed reversible changes in the hepatobiliary and pancreatic system which was related to the severity of hepatic necro-inflammation. HAV-associated pancreatitis may be due to the formation of biliary sludge during the acute phase of the viral illness, but this association needs further investigation.- - - - - - - - - - ranking = 3keywords = gallbladder (Clic here for more details about this article) |
8/14. cystadenoma of the gallbladder.A case of obstructive jaundice due to extrinsic common bile duct (CBD) pressure from a gallbladder mass is presented. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a dilated CBD and a massively dilated gallbladder. Computed tomography scan of the abdomen revealed a multiseptated cystic structure originating from the gallbladder fossa. Histologic sections of the surgical specimen demonstrated a multilocular cyst lined with biliary-type epithelium. Fibromuscular proliferation of the cyst walls also was noted. A literature search did not reveal documentation of a similar gallbladder lesion. We believe this lesion represents the first reported case of gallbladder cystadenoma.- - - - - - - - - - ranking = 4.5keywords = gallbladder (Clic here for more details about this article) |
9/14. A case of primary sclerosing cholangitis.A case of primary sclerosing cholangitis (PSC) is reported. A 16 year-old female developed right hypochondralgia and nausea without jaundice. Examination on admission showed elevation of SGOT, SGPT, Al-P, gamma-GTP and LAP activities, but T-Bil, AFP and CEA were within normal limits. Peripheral eosinocytes increased by 10%, and tests for HBsAg, antiHBs, antimitochondrial antibody and anti-smooth muscle antibody were all negative. ERCP revealed a narrowing of the proximal portion of the common the hepatic duct, and beading of the intrahepatic bile ducts. liver scintigram and CT revealed no tumors in the liver, biliary tract or pancreas. laparoscopy showed a smooth liver without swelling and a slightly swollen gallbladder. Histologically, the liver biopsy specimen showed ductal proliferation of small interlobular bile ducts and periductal fibrosis. No bile plugs, granuloma or distinct cholangitis were observed. No abnormal findings, including evidence of inflammatory bowel disease, were detected by barium enema. At present, one year after discharge, although her symptoms and liver function test abnormalities continue, she has been attending high school. Although 58 cases of PSC have been reported in japan, juvenile cases occurring before the third decade number only 3 including ours.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
10/14. Ultrasound and false normal oral cholecystogram.Although oral cholecystography is a highly accurate investigation for the diagnosis of gallbladder disease, false normal examinations do occur. In other patients, the presence of jaundice, nausea, or vomiting may preclude oral cholecystography. When there is clinical suspicion of gallbladder disease with a normal or equivocal oral cholecystogram, ultrasound examination is a highly accurate alternative imaging procedure. We describe in this article three patients with apparently normal oral cholecystography who were found to have obvious gallstones on ultrasound examination and at surgery. The relative accuracy of these diagnostic procedures is reviewed and their place in the diagnosis of biliary tract disease is discussed.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
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