1/3. gallbladder vasculitis associated with type-1 cryoglobulinemia.A patient with type I cryoglobulinemia and monoclonal gammopathy of uncertain significance was found to have acute gallbladder vasculitis. The most prominent manifestation was upper abdominal pain in the setting of normal liver tests. An abdominal ultrasound demonstrated a thickened gallbladder wall, along with gallstones. HIDA scanning showed a nonfunctioning gallbladder with an edematous and thickened wall. There was characteristic leukocytoclastic vasculitis affecting the gallbladder. The patient recovered uneventfully subsequent to cholecystectomy. gallbladder vasculitis should be considered in patients with unexplained upper abdominal pain and systemic vasculitis.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/3. Gallstone ileus as a complication of cholecystolithiasis.biliary fistula and gallston ileus are rarely found. The diagnosis is difficult. Gallstone ileus requires urgent and appropriate surgical therapy. Enterolitotomy remains the gold standard of operative treatment for gallstone ileus, but additional procedures of one-stage cholecystectomy and repair of fistula are necessary. Some researchers advise first to resolve the gallstone ileus and then to perform the elective operation for gallstone disease in more ideal circumstances. Our case had clinical evidence of ileus, which was confirmed by radiological exam. Ultrasonographic examination performed before operation did not confirm the presence of gallbladder; it did not detect a large stone located in the intestine. The patient, a 75-year-old woman, was operated on. During the procedure it was shown that the second part of the duodenum was involved in a scar and displaced to the hepatic hilus. There was no gallbladder; it was probably destroyed by a long-lasting vesicoduodenal fistula. cholangiography also did not detect the gallbladder. Biliary passage through the common bile duct was sufficient. The hole in the duodenum wall was sutured, and Kehr drain was inserted into the common bile duct. The gallstone was removed by incision of the intestine down to the obstruction. The postoperative period was complicated by a small suppuration of the laparotomy wound. Vesicoduodenal fistula present for a long time can lead to atrophy of the gallbladder. The one-stage procedure seems to be appropriate if biliary fistula and gallstone ileus are found.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
3/3. rocky mountain spotted fever. Gastrointestinal and pancreatic lesions and rickettsial infection.Recent clinical studies have shown a high incidence of nausea, vomiting, diarrhea, and abdominal pain in rocky mountain spotted fever (RMSF), and case reports have documented rickettsial infection and vascular injury in the small intestine, appendix, and gallbladder. To determine the incidence and distribution of rickettsia rickettsii and rickettsial lesions that might be the basis for these clinical manifestations of RMSF, tissues that were available from the stomach, small intestine, colon, and pancreas in fatal cases of RMSF were examined. Lesions were identified in pancreatic tissue in 91% of cases and in tissue obtained from the stomach, small intestine, and colon in all cases. Most tissues were judged to be only moderately injured. Organisms of R rickettsii were demonstrated by immunofluorescence in 14 (50%) of 28 cases and, when identified, correlated topographically with the location of vascular injury. These observations support the concept of rickettsial vascular injury of the gastrointestinal (GI) tract and pancreas leading to GI signs and symptoms in RMSF.- - - - - - - - - - ranking = 0.25keywords = gallbladder (Clic here for more details about this article) |