Cases reported "Gallbladder Diseases"

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1/10. MRI of perforated gall bladder.

    Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost-effective.
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2/10. Iatrogenic haemobilia: ultrasound appearance of intragallbladder haemorrhage. A report of two cases.

    Ultrasound appearance of intragallbladder haemorrhage in two patients with haemobilia is presented. gallbladder lumina were occupied by non-shadowing, firm masses of mixed echogenicity representing blood clots. In both cases iatrogenic trauma following percutaneous transcholecystic cholangiography and blind hepatic biopsy caused bleeding in the biliary tree.
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3/10. Novel approach to iatrogenic bile peritonitis.

    bile peritonitis after injury to the biliary tree is a serious complication that requires exploratory laparotomy. Our patient had an obstructing ampullary carcinoma, and generalized bile peritonitis developed from attempted percutaneous transhepatic cholangiography. The patient's condition was managed by peritoneal lavage and endoscopic transampullary stenting, with immediate relief of pain and toxicity. Exploratory laparotomy was avoided, and an eventual pylorus-sparing Whipple resection was the definitive treatment. We believe this to be the first report of successful nonoperative treatment of a patient with bile peritonitis with obstructive jaundice.
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4/10. Cholecystocolic fistula: an unusual presentation and diagnosis by endoscopic retrograde cholangiopancreatography.

    This report describes a patient with a cholecystocolic fistula whose presentation was unusual because it lacked the signs and symptoms that suggest biliary disease (abdominal pain, food intolerance, and belching) and because the fistula was not visualized on barium enema but was apparent on endoscopic retrograde cholangiopancreatography after incidental pneumobilia discovered on ultrasound directed our attention to the biliary tree. A previous Billroth II with vagotomy may have predisposed to the development of the fistula.
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5/10. Kawasaki disease complicated by gallbladder hydrops mimicking acute abdomen: a report of three cases.

    Three cases of gallbladder hydrops associated with Kawasaki disease are presented. The initial manifestations were high fever, jaundice and distended abdomen with guarding. The first two cases received laparotomy under the impression of suppurative cholecystitis with peritonitis. A markedly distended acalculous, nongangrenous gallbladder was noted. A cholecystostomy for drainage was performed. diagnosis of Kawasaki disease was made only when the clinical manifestations became full-blown postoperatively. Both patients led an uneventful postoperative course. The third case had apparent features of Kawasaki disease at admission though the abdominal symptoms were rather prominent. With supportive care, the patient stabilized by the sixth hospital day without complication and did not require surgical intervention. We suggest that the preferred treatment of abdominal symptoms in Kawasaki disease is medical, and surgical intervention is deserved only for the complications of the hydrops. Simple cholecystostomy seems to be safe and sufficient for such occasion. ultrasonography is helpful for the correct diagnosis of gallbladder hydrops and can exclude dilatation of the intrahepatic biliary trees and cholelithiasis.
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6/10. Intrahepatic cholestasis associated with an enlarged gall-bladder.

    A 60-year-old man with a history of ingesting herbal medication and a 59-year-old woman with malignant lymphoma presented with painless jaundice and palpably enlarged gall-bladders. Abdominal ultrasonography confirmed that the gall-bladders were enlarged, but showed normal-sized biliary trees with no stones. The final diagnoses for these patients were drug-induced hepatitis with intrahepatic cholestasis and lymphomatous infiltration of the liver, respectively. A palpable gall bladder in cholestatic jaundice may not always be caused by extrahepatic biliary obstruction, and ultrasonography is very useful in ruling this out.
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7/10. mirizzi syndrome associated with liver atrophy. Diagnostic and management considerations.

    It is not often appreciated that the mirizzi syndrome represents a spectrum of pathological lesions of the proximal extrahepatic biliary tree consequent on chronic gallbladder disease. A patient with this syndrome and associated liver atrophy is presented, emphasising the view that the syndrome has neither uniform appearance nor typical features and that a high index of suspicion and comprehensive investigations are required for diagnosis and optimal therapy.
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8/10. Percutaneous catheterization of the gallbladder with ultrasonic guidance.

    We have described a case in which the gallbladder was catheterized by the Seldinger technic, using ultrasonic guidance. The biliary tree was flushed until clear and free passage of bile into the duodenum occurred. Thick inspissated bile can cause intrinsic echoes in the gallbladder that can be mistaken for gallstones.
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9/10. Mutagenic activity in stones from a patient with a congenital choledochal cyst.

    A 12-year-old boy presenting a congenital choledochal cyst complicated with stones and chronic recurrent cholangitis was subjected to surgery for cyst resection with a Roux-Y hepatojejunostomy. Potential carcinogenic factors were looked for in the cyststones using the salmonella typhimurium plate test of Ames. High mutagenic activity was found in the stone extract incubated with the TA 98 tester strain, but not with the TA 100 strain. The test was negative with stone extracts obtained from seven patients operated on for chronic gallbladder disease. This study demonstrates the presence of a mutagenic chemical in the biliary tree of a patient with a clinical condition commonly associated with biliary tract cancer.
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10/10. Crohn's disease of the gallbladder.

    In a 57-year-old woman, Crohn's disease involving the gallbladder and duodenum caused biliary tract obstruction and necessitated surgery. The patient's symptoms did not improve postoperatively until corticosteroids provided rapid resolution. Inflammatory bowel disease often involves the hepatobiliary tree, yet the gallbladder is rarely involved directly. This patient highlights a rare complication of Crohn's disease.
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