Cases reported "Cholecystitis"

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1/153. Perforation of the gallbladder: analysis of 19 cases.

    Perforation of the gallbladder occurred in 19 (3.8%) of 496 patients with acute cholecystitis treated at one hospital in an 8-year period. The average age of the 19 patients was 69 years and the female:male ratio was 3:2. Most had a history suggestive of gallbladder disease and most had coexisting cardiac, pulmonary, renal, nutritional or metabolic disease. The duration of the present illness was short, perforation occurring within 72 hours of the onset of symptoms in half the patients; the diagnosis was not suspected preoperatively in any. In the elderly patient with acute cholecystitis who has a long history of gallbladder disease, cholecystectomy should be performed early, before gangrene and perforation of the gallbladder can occur.
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2/153. Postoperative acalculous cholecystitis due to Torulopsis glabrata.

    Acute acalculous cholecystitis due to Torulopis glabrata, an opportunistic yeast, developed postoperatively in a 70-year-old man who had an extremely complicated course after resection of an abdominal aortic aneurysm. The infection first appeared as an acute surgical abdomen, three days after resumption of solid food intake subsequent to a prolonged ileus and after 31 days of parenteral hyperalimentation. The condition was successfully treated by cholecystostomy; at the time of writing, six months after cholecystostomy, there are no gastrointestinal symptoms.
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3/153. Peripheral clear cell cholangiocarcinoma: a rare histologic variant.

    We present the case of a 50-year-old diabetic male who underwent open cholecystectomy for acute gangrenous cholecystitis. At the time of exploration, a 1.5-cm mass was found peripherally in the right lobe of his liver, and an incisional biopsy was performed. Microscopic examination revealed a distinct overgrowth of clear cells in an acinar pattern, with tumor cells emerging directly from bile ducts. The tumor cells were periodic acid-Schiff reactive and diastase resistant, indicating the presence of mucin. No bile canaliculi were demonstrated by immunostaining with carcinoembryonic antigen. CT scans of the chest and abdomen were otherwise normal. Based on these microscopic, immunohistochemical, and clinical data, a diagnosis of clear cell cholangiocarcinoma was established. The patient later underwent reexploration and generous hepatic wedge resection. He did well postoperatively and is free of disease after 12 months.
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4/153. Successful nonoperative management of neonatal acute calculous cholecystitis.

    Acute cholecystitis in the neonate is rare and usually treated by cholecystectomy. A 1-day-old full-term girl had clinical and sonographic features of acute calculous cholecystitis. This was successfully managed nonoperatively with intravenous fluids and antibiotics, leading to complete resolution of the condition. The infant currently is thriving and asymptomatic with a sonographically normal biliary tree. Spontaneous resolution of cholelithiasis may occur in neonates, even in the presence of acute cholecystitis.
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ranking = 5
keywords = operative
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5/153. Acute acalculous cholecystitis complicated by penetration into the liver after coronary artery bypass grafting.

    BACKGROUND: Perforation or penetration due to acute acalculous cholecystitis is a rare complication after open-heart surgery. The mortality rate of this disease is high. methods: A 71-year-old woman complained of a sudden onset of right upper abdominal pain with development of peritoneal signs at 21 days after coronary artery bypass grafting. Abdominal ultrasonography and laboratory examination performed at 1 day earlier had revealed no abnormalities. Neither anticoagulants nor antiplatelet agents were administered following the bypass operation. An exploratory laparotomy was performed to locate a presumed embolization to the superior mesenteric artery. RESULTS: laparotomy revealed acute acalculous cholecystitis complicated by penetration into the liver, causing a subserosal hematoma. The hematoma had ruptured into the abdominal cavity. A cholecystectomy was performed. The gallbladder wall which was in contact with the liver was necrotic. Most of the gallbladder mucosa was necrotic. Microscopical examination revealed atherosclerosis of the cystic artery which was partially obstructed by thrombus. CONCLUSIONS: Given the atherosclerotic condition of the cystic artery, hypotension during the bypass in combination with postoperative total parenteral nutrition and hypovolemia may have induced the cystic artery thrombosis. Surgeons who manage patients with cardiovascular disease should be aware of this potentially lethal development.
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6/153. Ultrasonographic evaluation of pericholecystic abscesses.

    Pericholecystic abscess formation is a serious complication of cholecystitis that develops after gallbladder perforation and is usually associated with acute inflammatory signs and symptoms. Ultrasonographic findings in three surgically proven cases of pericholecystic abscess are reported. The findings ranged from a well defined band of low-level echoes around the gallbladder to multiple, poorly defined hypoechoic masses surrounding an irregular, indistinct gallbladder outline. The former situation correlated with a well encapsulated pericholecystic inflammatory process, while the latter was associated with extensive abscess formation resulting from gallbladder rupture. cholelithiasis was identified in two of the three cases. Ultrasound for preoperative detection of pericholecystic abscess is discussed.
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keywords = operative
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7/153. Preoperative ultrasound examination interpreted to represent a small contracted gallbladder with stones.

    Agenesis of the gallbladder is a relatively rare congenital anomaly with an incidence of only 0.01% to 0.04%. Yet it continues to occur. The patient described in this case study was symptomatic and received a clinical diagnosis of cholecystitis after having an ultrasound examination that was read as indicating a small contracted gallbladder with stones. Only after an open surgical procedure and cholangiography was it discovered tht the patient actually had a congenital absence of the gallbladder. Clinicians need to be aware of the potential for congenital absence of the gallbladder when interpreting tests and when findings are questionable, and to ensure no surprises, they should consider ordering other diagnostic tests before doing surgery.
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ranking = 4
keywords = operative
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8/153. intestinal obstruction from midgut volvulus after laparoscopic cholecystectomy. A report of an unusual complication.

    Congenital midgut malrotation, a rare anatomic anomaly that can lead to duodenal or small bowel obstruction, rarely is recognized beyond the first year of life. We report a case of unrecognized congenital midgut malrotation that resulted in midgut volvulus, causing intestinal obstruction and requiring emergent reoperation after laparoscopic cholecystectomy. This unusual complication, first reported in 1994, involved a 56-year-old man and resulted in cecal infarction recognized and treated on the second postoperative day. This second case describes a less acute postoperative course, with multiple bouts of partial bowel obstruction leading to two readmissions and finally resulting in a reexploration and definitive treatment on the 19th postoperative day.
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ranking = 3
keywords = operative
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9/153. Pyloric gland metaplasia with perineural invasion of the gallbladder: A lesion that can be confused with adenocarcinoma.

    BACKGROUND: Metaplastic pyloric glands have been described in a variety of organs including the gallbladder, in which they can extend into the muscular wall and serosa. methods: Clinical, histologic, and immunohistochemical features of four cases of gallbladder florid pyloric gland metaplasia with perineural and intraneural invasion are analyzed. RESULTS: The patients with pyloric gland metaplasia and perineural and intraneural invasion were all females ages 57-72 years. A preoperative diagnosis of chronic cholecystitis and cholelithiasis was made for all four patients, but a histologic diagnosis of adenocarcinoma was made for two patients and entertained in two others. Macroscopically the gallbladders showed changes usually associated with chronic cholecystitis. No intraluminal masses were observed in any of the gallbladders. The characteristic microscopic features included florid pyloric gland metaplasia, proliferation of medium-sized nerve trunks more prominent in the muscular layer and serosa, and perineural and intraneural invasion by the metaplastic glands lined by cytologically bland cuboidal or columnar mucin-containing cells. At last follow-up all patients were alive and symptom free 1-7 years after laparoscopic cholecystectomy. CONCLUSIONS: Pyloric gland metaplasia of the gallbladder should be added to the long and increasing list of benign epithelial proliferations that are associated with perineural and intraneural invasion. This lesion should not be mistaken for adenocarcinoma of the gallbladder, a misinterpretation that may have serious therapeutic implications. The pathogenesis of this phenomenon is unknown.
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ranking = 1
keywords = operative
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10/153. Synchronically performed laparoscopic cholecystectomy and hernioplasty.

    Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.
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ranking = 3
keywords = operative
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