Cases reported "Cholecystitis, Acute"

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1/9. 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.
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2/9. Gastroduodenal artery pseudo-aneurysm after cholecystectomy.

    We report the case of a 69-year-old man presenting with rupture of a pseudo-aneurysm of the gastroduodenal artery into the duodenum eight days after open cholecystectomy for acute cholecystitis. The surgical approach to a ruptured visceral artery pseudo-aneurysm is technically difficult and hazardous. The operative mortality rate reaches 16 to 50%, mainly dependent on the anatomic location of the visceral artery pseudo-aneurysm. This report describes a case in which bleeding from a pseudo-aneurysm of the gastroduodenal artery was successfully treated by embolisation using metal coils.
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3/9. Double gallbladder-a laparoscopic management.

    A rare case of gallbladder duplication, an unusual biliary anomaly is reported in a young female patient presenting with acute cholecystitis. After a confirmed diagnosis of double gallbladder was made by sonography, endoscopic retrograde cholangio-pancreaticography (ERCP), and magnetic retrograde cholangio-pancreaticography(MRCP), both gallbladders were removed laparoscopically. On histology both gallbladders showed cholesterolosis. Detailed preoperative investigations are required for an accurate preoperative diagnosis before considering laparoscopic cholecystectomy to avoid inadvertent damage to biliary ductal system and overlooking of second gallbladder during surgery.
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4/9. Acute cholecystitis as a complication following percutaneous ethanol injection of a hepatocellular carcinoma.

    Percutaneous ethanol injection is a useful option in the treatment of hepatocellular carcinoma which are not amenable to resection or transplantation. We describe a case of cholecystitis and tumour infiltration of the gallbladder after percutaneous ethanol injection, a complication not previously described in literature. The patient was a 70-year-old woman with a history of asymptomatic HCV hepatopathy and a 6 cm hepatocellular carcinoma nodule in segment V which had been treated two months before by percutaneous ethanol injection in another center. She attended our center due to febrile syndrome. Imaging studies suggested cholecystitis with an abscess on the wall of the gallbladder, purulent material obtained by means of a CT-guided puncture. Surgery revealed purulent and neoplasic material inside the gallbladder, with tumor invasion of the posterior wall; a partial cholecystectomy was therefore performed and a drainage inserted. The patient showed no post-operative complications and was discharged after seven days. CONCLUSION: we believe that the percutaneous ethanol injection of hepatocellular carcinomas located close to the gallbladder may occasionally lead to complications in the form of cholecystitis with neoplasic infiltration of the gallbladder. A case of cholecystitis secondary to radiofrequency treatment of a similarly-located tumor has previously been described and, therefore, the use of percutaneous local destructive treatments for tumors close to the gallbladder would seem unadvisable.
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5/9. Ruptured pancreaticoduodenal artery aneurysm with acute gangrenous cholecystitis: a case report and review of the literature.

    We have experienced a very rare case of ruptured pancreaticoduodenal artery aneurysm with acute gangrenous cholecystitis. A 67-year-old male complaining of epigastralgia was admitted to our hospital. Ultrasound sonography demonstrated acute cholecystitis and cholecystolithiasis. Computed tomography scan showed the findings of acute cholecystitis and retroperitoneal mass. Emergency laparotomy revealed an acute gangrenous cholecystitis and a retroperitoneal hematoma around the second portion of the duodenum. cholecystectomy was performed, however, the bleeding vessel was not identified. The patient bled again from the abdomen on the 6th postoperative day. A postoperative angiography indicated an inferior pancreaticoduodenal artery aneurysm. A resection of the aneurysm was performed following the angiography. Pancreaticoduodenal artery aneurysms are uncommon and ruptured pancreaticoduodenal artery aneurysms result in fatal hemorrhage and high mortality. We reviewed the previously reported cases and discussed the suitable and expeditious diagnosis and management of the pancreaticoduodenal artery aneurysms.
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6/9. Cytologic diagnosis of suppurative cholecystitis due to candida albicans and actinomyces. A report of 2 cases.

    BACKGROUND: Cholecystitis is a common inflammatory disease of the gallbladder. actinomycosis and candidiasis of the gallbladder are uncommon causes of acute cholecystitis. There has been no previous report on the cytologic diagnosis of actinomycosis and candidiasis from aspirated gallbladder bile intraoperatively. CASES: Purulent bile was intraoperatively aspirated from the gallbladder of 71-year-old Indian and a 30-year-old Australian woman. The specimens were sent for cytologic examination. The first case revealed sulphur granules characteristic of actinomyces spp. The second case showed budding spores and pseudohyphae of Candida spp. Pure colonies of candida albicans grew from the bile culture. CONCLUSION: actinomycosis and candidiasis rarely cause acute suppurative cholecystitis. Initial diagnosis can be made by cytologic examination of the aspirated purulent bile intraoperatively.
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7/9. Laparoscopic procedures in adults with ventriculoperitoneal shunts.

    Until recently, the presence of a ventriculoperitoneal shunt (VPS) was considered an absolute contraindication to laparoscopy. In some cases, intraabdominal insufflation causes a rapid, sustained increase in intracranial pressure (ICP). Such intracranial hypertension may result in hindbrain herniation. To prevent this, the use of lower abdominal pressures, intraoperative ICP monitoring, intraoperative ventricular drainage, and distal shunt catheter clamping/externalization has been reported in some studies. However, other studies show that laparoscopy is safe even without VPS catheter clamping and with only routine anesthetic monitoring. Moreover, the risk of retrograde failure of the valve system has been shown to be minimal even with intraabdominal pressures as high as 80 mm Hg. We report how we managed a hydrocephalic adult with a VPS shunt undergoing laparoscopic cholecystectomy in the hope that our experience contributes to the successful management of such patients in the future.
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8/9. Laparoscopic derotation and cholecystectomy for torsion gallbladder.

    Torsion of the gallbladder is an unusual cause of gangrenous cholecystitis. Even with the advent of recent radiological imaging modalities, the preoperative diagnosis of this entity remains elusive. Herein, we present a case of gallbladder torsion in a 76-year-old lady who successfully underwent laparoscopic derotation and cholecystectomy.
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9/9. actinomycosis of the gallbladder: case report and review of the literature.

    actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.
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