BACKGROUND Gallbladder mucocele,also known as gallbladder hydrops,is a rare condition characterized by the distention of the gallbladder due to the accumulation of fluid or mucus within its lumen,primarily attributed ...BACKGROUND Gallbladder mucocele,also known as gallbladder hydrops,is a rare condition characterized by the distention of the gallbladder due to the accumulation of fluid or mucus within its lumen,primarily attributed to obstruction arising from a gallstone in the cystic duct or gallbladder neck.CASE SUMMARY We present a case of a 67-year-old woman with an incidentally discovered gallbladder mucocele,shedding light on the clinical presentation,causes,and histopathological findings.We performed a literature review including an analysis of 27 case reports,revealing the diverse spectrum of causative factors,clinical manifestations,diagnosis,and management.CONCLUSION This study underscores the importance of considering alternative diagnoses and highlights the significance of imaging techniques in narrowing down the differential diagnosis and histopathologic examination for a definitive diagnosis.展开更多
BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography...BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.展开更多
BACKGROUND Gallstones are frequently observed in patients with cholecystitis,but the migration of free gallstones into the abdominal wall leading to chronic sinus formation is exceedingly rare.CASE SUMMARY We report a...BACKGROUND Gallstones are frequently observed in patients with cholecystitis,but the migration of free gallstones into the abdominal wall leading to chronic sinus formation is exceedingly rare.CASE SUMMARY We report a case of a 72-year-old woman who experienced recurring fever and abdominal pain following laparoscopic cholecystectomy for acute cholecystitis,during which gallbladder rupture was noted.Despite initial conservative management and temporary T-tube placement,the patient developed a chronic sinus in the abdominal wall 9.5 years later,characterized by an area of thickened soft tissue with ulceration and purulent discharge.Surgical exploration revealed the presence of a migrated gallstone at the base of the sinus tract,necessitating careful surgical removal and postoperative wound care.CONCLUSION This case highlights the potential long-term complications of retained free gallstones and the importance of thorough surgical retrieval.展开更多
BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency c...BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecy...BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecystitis after LC remains unclear.AIM To analyze the impact of rapid recovery nursing in patients with acute calculous cholecystitis undergoing LC.METHODS A retrospective study was conducted with a total of 120 patients with acute calculous cholecystitis who underwent LC at our hospital between October 2023 and October 2024.The patients were divided into two groups with 60 patients in each group according to the different nursing methods:Conventional nursing and rapid recovery nursing groups.Data was recorded from the electronic medical records.Gastrointestinal recovery,pain,quality of life,and nursing satisfaction were compared between the two groups before and after nursing.RESULTS Following nursing intervention,the visual analog scale scores on Days 3 and 7 post-surgery in the rapid recovery nursing group were notably lower than those of the conventional nursing group(P<0.05).The rapid recovery nursing group experienced significantly reduced times for bowel sound recovery,getting out of bed,hospital stay,passing flatus,and first defecation compared with the conventional nursing group(P<0.05),thereby experiencing significantly better quality of life and nursing satisfaction(P<0.05).CONCLUSION Rapid recovery nursing effectively promoted the recovery of gastrointestinal function,reducing pain and improving the quality of life of patients who underwent LC for acute calculous cholecystitis.展开更多
Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,s...Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.展开更多
Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity hav...Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.展开更多
Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise...Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.展开更多
AIM:To study relationship of injury induced by nitric oxide, oxidation, peroxidation,lipoperoxidation with chronic cholecystitis.METHODS:The values of plasma nitric oxide (P-NO), plasma vitamin C (P-VC), plasma vitami...AIM:To study relationship of injury induced by nitric oxide, oxidation, peroxidation,lipoperoxidation with chronic cholecystitis.METHODS:The values of plasma nitric oxide (P-NO), plasma vitamin C (P-VC), plasma vitamin E (P-VE), plasma beta-carotene (P-beta-CAR), plasma lipoperoxides (P-LPO), erythrocyte superoxide dismutase (E-SOD), erythrocyte catalase (E-CAT), erythrocyte glutathione peroxidase (E-GSH-Px) activities and erythrocyte lipoperoxides (E-LPO) level in 77 patients with chronic cholecystitis and 80 healthy control subjects were determined, differences of the above average values between the patient group and the control group and differences of the average values between preoperative and postoperative patients were analyzed and compared, linear regression and correlation of the disease course with the above determination values as well as the stepwise regression and correlation of the course with the values were analyzed.RESULTS:Compared with the control group, the average values of P-NO, P-LPO, E-LPO were significantly increased (P【0.01), and of P-VC, P-VE, P-beta-CAR, E-SOD, E-CAT and E-GSH-Px decreased (P 【0.01) in the patient group. The analysis of the linear regression and correlation showed that with prolonging of the course, the values of P-NO, P-LPO and E-LPO in the patients were gradually ascended and the values of P-VC,P-VE, P-beta-CAR, E-SOD, E-CAT and E-GSH-Px descended (P【0.01). The analysis of the stepwise regression and correlation indicated that the correlation of the course with P-NO, P-VE and P-beta-CAR values was the closest. Compared with the preoperative patients, the average values of P-NO, P-LPO and E-LPO were significantly decreased (P 【0.01) and the average values of P-VC, E-SOD, E-CAT and E-GSH-Px in postoperative patients increased (P 【0.01) in postoperative patients. But there was no significant difference in the average values of P-VE, P-beta-CAR preoperative and postoperative patients.CONCLUSION:Chronic cholecystitis could induce the increase of nitric oxide, oxidation, peroxidation and lipoperoxidation.展开更多
BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cho...BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.METHODS: In 91 patients(American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment(48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average(range 7-29).RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16(33%) vs 4(9%); P=0.006],a mean postoperative hospital stay(5.3±3.3 vs 3.0±2.4 days;P=0.001), and a frequency of complications [17(35%) vs 4(9%);P=0.003].CONCLUSION: In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.展开更多
Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute...Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.展开更多
AIM: To compare cases of xanthogranulomatous cholecystitis(XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.METHODS: From April 2000 to December 2013, 6 XGC patients rec...AIM: To compare cases of xanthogranulomatous cholecystitis(XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.METHODS: From April 2000 to December 2013, 6 XGC patients received extended surgical resections. During the same period, 16 patients were proven to have gallbladder(GB) cancer, according to extended surgical resection. Subjects chosen for analysis in this study were restricted to cases of XGC with indistinct borders with the liver as it is often difficult to distinguish these patients from those with advanced GB cancer. We compared the clinical features and computed tomography findings between XGC and advanced GB cancer. The following clinical features were retrospectively assessed: age, gender, symptoms, and tumor markers. As albumin and the neutrophil/lymphocyte ratio(NLR) are prognostic in several cancers, we compared serum albumin levels and the NLR between the two groups. The computerized tomography findings were used to compare the two diseases, determine the coexistence of gallstones, the pattern of GB thickening(focal or diffuse), the presence of a hypoattenuated intramural nodule, and continuity of the mucosal line.RESULTS: Based on the preoperative image findings, we suspected GB carcinoma in all cases includingXGC in this series. In addition, by pathological examination, we found that the group of patients with XGC developed inflammatory disease after surgery. Patients with XGC tended to have abdominal pain(4/6, 67%). However, there was no significant difference in clinical symptoms, including fever, between the two groups. Serum albumin and NLR were also similar in the two groups. Serum tumor markers, such as carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9), tended to increase in patients with GB cancer. However, no significant differences in tumor markers were identified. On the other hand, gallstones were more frequently observed in patients with XGC(5/6, 83%) than in patients with GB cancer(4/16, 33%)(P = 0.0116). A hypoattenuated intramural nodule was found in 3 patients with XGC(3/6, 50%), but in only 1 patient with GB cancer(1/16, 6%)(P = 0.0024). The GB thickness, continuous mucosal line, and bile duct dilatation showed no significant differences between XGC and GB cancer.CONCLUSION: Although XGC is often difficult to differentiate from GB carcinoma, it is possible to obtain an accurate diagnosis by careful intraoperative gross observation, and several intraoperative frozen sections.展开更多
Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis.The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas.Three...Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis.The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas.Three patients presented mass lesions that infiltrated the hepatic hilum,provoked biliary dilatation and jaundice,and were indicative of malignancy.Surgical excision was performed following oncological principles and included extirpation of the gallbladder,extrahepatic bile duct,and hilar lymph nodes,as well as partial hepatectomy.Postoperative morbidity was minimal.Surgical pathology demonstrated XGC and absence of malignancy in all three cases.All three patients are alive and well after years of follow-up.XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology.In such cases,the best option may be radical resection following oncological principles performed by expert surgeons,in order that postoperative complications may be minimized if not avoided altogether.展开更多
Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. ...Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.展开更多
AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patient...AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.展开更多
AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patien...AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.展开更多
AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis(XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our h...AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis(XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma(GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section(FS) analysis and surgical procedure data of these patients were collected and analyzed.RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven(17%) cases presented with mild jaundice without choledocholithiasis. Thirtyfive(83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29(69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40(95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups(21% vs 20%, P > 0.05).CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide apractical and effective standard in the differential diagnosis between XGC and GBC.展开更多
AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） i...AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.展开更多
BACKGROUND: Laparoscopic cholecystectomy (LC) has become the 'gold standard' in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecyst...BACKGROUND: Laparoscopic cholecystectomy (LC) has become the 'gold standard' in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecystectomy (LSC) a feasible option in more complex procedures. In recent years, few studies with a few cases of LSC have reported good results in patients with various types of cholecystitis. This study was designed to evaluate the feasibility, indications, characteristics and benefits of LSC in patients with complicated cholecystitis. METHODS: Altogether, 3485 patients were scheduled to receive LC during the past 4 years at our institute. Among them, 168 patients with various complicated forms of cholecystitis were treated by LSC. Meanwhile, the other 3317 patients who received standard LC were enrolled as the control group. Perioperative data from the two groups were collected and retrospectively analyzed. RESULTS: In the LSC group, 135 patients suffered from acute calculic cholecystitis, 18 from chronic calculic cholecystitis with cirrhotic portal hypertention, and 15 from chronic calculic atrophy cholecystitis with severe fibrosis. These patients constituted 4.8% of the total patients who underwent LC (168/3485) in the same period at our institute. In 122 patients, the cystic duct and artery were clipped before division. In another 46 patients, the gallbladder was initially incised at Hartmann's pouch. Five patients (3.0%) were converted to open subtotal cholecystectomy. The median operation time for LSC was 65.5±15.2 minutes, estimated operative blood loss was 71.5±15.5 ml, and the time to resume diet was 20.4±6.3 hours. Thirteen patients (7.7%) had local complications. The mean postoperative hospital stay was 4.2±2.6 days. In the LC group, 2887 had chronic calculic cholecystitis, 312had acute calculic cholecystitis, 47 had chronic calculic atrophy cholecystitis, and 71 had polypus. Seventeen patients (0.5%) were converted to open cholecystectomy. The median operation time was 32.6±10.2 minutes, the estimated operative blood loss was 24.5±8.5 ml, and the time to resume diet was 18.3±4.5 hours. Thirty- nine patients (1.2%) had local complications. Mean postoperative hospital stay was 3.8±1.4 days. There was no bile duct injury or mortality in either group. CONCLUSIONS: LSC for patients with complicated cholecystitis is difficult, with a longer operation time, more operative blood loss and higher conversion and complication rates than LC. However, it is feasible and relatively safe. LSC is advantageous over open surgery, but it remains a non-routine choice. It is important to know the technical characteristics of LSC, and pay attention to perioperative bleeding and bile leak.展开更多
Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography （FDG-PET） is useful in differentiating between benign and malignant lesions in the gallbladder. However, t...Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography （FDG-PET） is useful in differentiating between benign and malignant lesions in the gallbladder. However, there is a limitation in the ability of FDG-PET to differentiate between inflammatory and malignant lesions. We herein present a case of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma by ultrasonography and computed tomography. FDG-PET also showed increased activity. In this case, FDG-PET findings resulted in a false-positive for the diagnosis of gallbladder carcinoma.展开更多
文摘BACKGROUND Gallbladder mucocele,also known as gallbladder hydrops,is a rare condition characterized by the distention of the gallbladder due to the accumulation of fluid or mucus within its lumen,primarily attributed to obstruction arising from a gallstone in the cystic duct or gallbladder neck.CASE SUMMARY We present a case of a 67-year-old woman with an incidentally discovered gallbladder mucocele,shedding light on the clinical presentation,causes,and histopathological findings.We performed a literature review including an analysis of 27 case reports,revealing the diverse spectrum of causative factors,clinical manifestations,diagnosis,and management.CONCLUSION This study underscores the importance of considering alternative diagnoses and highlights the significance of imaging techniques in narrowing down the differential diagnosis and histopathologic examination for a definitive diagnosis.
文摘BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.
文摘BACKGROUND Gallstones are frequently observed in patients with cholecystitis,but the migration of free gallstones into the abdominal wall leading to chronic sinus formation is exceedingly rare.CASE SUMMARY We report a case of a 72-year-old woman who experienced recurring fever and abdominal pain following laparoscopic cholecystectomy for acute cholecystitis,during which gallbladder rupture was noted.Despite initial conservative management and temporary T-tube placement,the patient developed a chronic sinus in the abdominal wall 9.5 years later,characterized by an area of thickened soft tissue with ulceration and purulent discharge.Surgical exploration revealed the presence of a migrated gallstone at the base of the sinus tract,necessitating careful surgical removal and postoperative wound care.CONCLUSION This case highlights the potential long-term complications of retained free gallstones and the importance of thorough surgical retrieval.
文摘BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)is the primary treatment for acute calculous cholecystitis.Although rapid recovery nursing is commonly implemented in postoperative care,its effect on acute calculous cholecystitis after LC remains unclear.AIM To analyze the impact of rapid recovery nursing in patients with acute calculous cholecystitis undergoing LC.METHODS A retrospective study was conducted with a total of 120 patients with acute calculous cholecystitis who underwent LC at our hospital between October 2023 and October 2024.The patients were divided into two groups with 60 patients in each group according to the different nursing methods:Conventional nursing and rapid recovery nursing groups.Data was recorded from the electronic medical records.Gastrointestinal recovery,pain,quality of life,and nursing satisfaction were compared between the two groups before and after nursing.RESULTS Following nursing intervention,the visual analog scale scores on Days 3 and 7 post-surgery in the rapid recovery nursing group were notably lower than those of the conventional nursing group(P<0.05).The rapid recovery nursing group experienced significantly reduced times for bowel sound recovery,getting out of bed,hospital stay,passing flatus,and first defecation compared with the conventional nursing group(P<0.05),thereby experiencing significantly better quality of life and nursing satisfaction(P<0.05).CONCLUSION Rapid recovery nursing effectively promoted the recovery of gastrointestinal function,reducing pain and improving the quality of life of patients who underwent LC for acute calculous cholecystitis.
文摘Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.
基金This study was approved by the Ethics Committee of Kyushu Rosai Hospital Moji Medical Center(No:04-01,date of approval:June 2,2022).This study was conducted in compliance with the principles of the Declaration of Helsinki.
文摘Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.
文摘Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.
基金The item of scieace and technology research plans of Zhejiang Province (No 1999-2-121)
文摘AIM:To study relationship of injury induced by nitric oxide, oxidation, peroxidation,lipoperoxidation with chronic cholecystitis.METHODS:The values of plasma nitric oxide (P-NO), plasma vitamin C (P-VC), plasma vitamin E (P-VE), plasma beta-carotene (P-beta-CAR), plasma lipoperoxides (P-LPO), erythrocyte superoxide dismutase (E-SOD), erythrocyte catalase (E-CAT), erythrocyte glutathione peroxidase (E-GSH-Px) activities and erythrocyte lipoperoxides (E-LPO) level in 77 patients with chronic cholecystitis and 80 healthy control subjects were determined, differences of the above average values between the patient group and the control group and differences of the average values between preoperative and postoperative patients were analyzed and compared, linear regression and correlation of the disease course with the above determination values as well as the stepwise regression and correlation of the course with the values were analyzed.RESULTS:Compared with the control group, the average values of P-NO, P-LPO, E-LPO were significantly increased (P【0.01), and of P-VC, P-VE, P-beta-CAR, E-SOD, E-CAT and E-GSH-Px decreased (P 【0.01) in the patient group. The analysis of the linear regression and correlation showed that with prolonging of the course, the values of P-NO, P-LPO and E-LPO in the patients were gradually ascended and the values of P-VC,P-VE, P-beta-CAR, E-SOD, E-CAT and E-GSH-Px descended (P【0.01). The analysis of the stepwise regression and correlation indicated that the correlation of the course with P-NO, P-VE and P-beta-CAR values was the closest. Compared with the preoperative patients, the average values of P-NO, P-LPO and E-LPO were significantly decreased (P 【0.01) and the average values of P-VC, E-SOD, E-CAT and E-GSH-Px in postoperative patients increased (P 【0.01) in postoperative patients. But there was no significant difference in the average values of P-VE, P-beta-CAR preoperative and postoperative patients.CONCLUSION:Chronic cholecystitis could induce the increase of nitric oxide, oxidation, peroxidation and lipoperoxidation.
文摘BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy.METHODS: In 91 patients(American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis ≥72 hours at hospital admission and who did not respond to nonoperative treatment(48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at ≥4 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average(range 7-29).RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding ≥100 mL [16(33%) vs 4(9%); P=0.006],a mean postoperative hospital stay(5.3±3.3 vs 3.0±2.4 days;P=0.001), and a frequency of complications [17(35%) vs 4(9%);P=0.003].CONCLUSION: In patients with acute cholecystitis who presented to the hospital ≥72 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.
文摘Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.
文摘AIM: To compare cases of xanthogranulomatous cholecystitis(XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.METHODS: From April 2000 to December 2013, 6 XGC patients received extended surgical resections. During the same period, 16 patients were proven to have gallbladder(GB) cancer, according to extended surgical resection. Subjects chosen for analysis in this study were restricted to cases of XGC with indistinct borders with the liver as it is often difficult to distinguish these patients from those with advanced GB cancer. We compared the clinical features and computed tomography findings between XGC and advanced GB cancer. The following clinical features were retrospectively assessed: age, gender, symptoms, and tumor markers. As albumin and the neutrophil/lymphocyte ratio(NLR) are prognostic in several cancers, we compared serum albumin levels and the NLR between the two groups. The computerized tomography findings were used to compare the two diseases, determine the coexistence of gallstones, the pattern of GB thickening(focal or diffuse), the presence of a hypoattenuated intramural nodule, and continuity of the mucosal line.RESULTS: Based on the preoperative image findings, we suspected GB carcinoma in all cases includingXGC in this series. In addition, by pathological examination, we found that the group of patients with XGC developed inflammatory disease after surgery. Patients with XGC tended to have abdominal pain(4/6, 67%). However, there was no significant difference in clinical symptoms, including fever, between the two groups. Serum albumin and NLR were also similar in the two groups. Serum tumor markers, such as carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9), tended to increase in patients with GB cancer. However, no significant differences in tumor markers were identified. On the other hand, gallstones were more frequently observed in patients with XGC(5/6, 83%) than in patients with GB cancer(4/16, 33%)(P = 0.0116). A hypoattenuated intramural nodule was found in 3 patients with XGC(3/6, 50%), but in only 1 patient with GB cancer(1/16, 6%)(P = 0.0024). The GB thickness, continuous mucosal line, and bile duct dilatation showed no significant differences between XGC and GB cancer.CONCLUSION: Although XGC is often difficult to differentiate from GB carcinoma, it is possible to obtain an accurate diagnosis by careful intraoperative gross observation, and several intraoperative frozen sections.
基金Supported by Nacif LS was supported by an International Travel Scholar Award from the International Liver Transplantation Society(ILTS)
文摘Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis.The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas.Three patients presented mass lesions that infiltrated the hepatic hilum,provoked biliary dilatation and jaundice,and were indicative of malignancy.Surgical excision was performed following oncological principles and included extirpation of the gallbladder,extrahepatic bile duct,and hilar lymph nodes,as well as partial hepatectomy.Postoperative morbidity was minimal.Surgical pathology demonstrated XGC and absence of malignancy in all three cases.All three patients are alive and well after years of follow-up.XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology.In such cases,the best option may be radical resection following oncological principles performed by expert surgeons,in order that postoperative complications may be minimized if not avoided altogether.
文摘Acute calculous cholecystitis(ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.
文摘AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.
文摘AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.
基金Supported by The Science and Technology Support Project of Sichuan Province,No.2014SZ0002-10
文摘AIM: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis(XGC) clinically.METHODS: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma(GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section(FS) analysis and surgical procedure data of these patients were collected and analyzed.RESULTS: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven(17%) cases presented with mild jaundice without choledocholithiasis. Thirtyfive(83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29(69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40(95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups(21% vs 20%, P > 0.05).CONCLUSION: Neither clinical manifestations and laboratory tests nor radiological methods provide apractical and effective standard in the differential diagnosis between XGC and GBC.
文摘AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.
文摘BACKGROUND: Laparoscopic cholecystectomy (LC) has become the 'gold standard' in treating benign gallbladder diseases. Increasing laparoscopic experience and techniques have made laparoscopic subtotal cholecystectomy (LSC) a feasible option in more complex procedures. In recent years, few studies with a few cases of LSC have reported good results in patients with various types of cholecystitis. This study was designed to evaluate the feasibility, indications, characteristics and benefits of LSC in patients with complicated cholecystitis. METHODS: Altogether, 3485 patients were scheduled to receive LC during the past 4 years at our institute. Among them, 168 patients with various complicated forms of cholecystitis were treated by LSC. Meanwhile, the other 3317 patients who received standard LC were enrolled as the control group. Perioperative data from the two groups were collected and retrospectively analyzed. RESULTS: In the LSC group, 135 patients suffered from acute calculic cholecystitis, 18 from chronic calculic cholecystitis with cirrhotic portal hypertention, and 15 from chronic calculic atrophy cholecystitis with severe fibrosis. These patients constituted 4.8% of the total patients who underwent LC (168/3485) in the same period at our institute. In 122 patients, the cystic duct and artery were clipped before division. In another 46 patients, the gallbladder was initially incised at Hartmann's pouch. Five patients (3.0%) were converted to open subtotal cholecystectomy. The median operation time for LSC was 65.5±15.2 minutes, estimated operative blood loss was 71.5±15.5 ml, and the time to resume diet was 20.4±6.3 hours. Thirteen patients (7.7%) had local complications. The mean postoperative hospital stay was 4.2±2.6 days. In the LC group, 2887 had chronic calculic cholecystitis, 312had acute calculic cholecystitis, 47 had chronic calculic atrophy cholecystitis, and 71 had polypus. Seventeen patients (0.5%) were converted to open cholecystectomy. The median operation time was 32.6±10.2 minutes, the estimated operative blood loss was 24.5±8.5 ml, and the time to resume diet was 18.3±4.5 hours. Thirty- nine patients (1.2%) had local complications. Mean postoperative hospital stay was 3.8±1.4 days. There was no bile duct injury or mortality in either group. CONCLUSIONS: LSC for patients with complicated cholecystitis is difficult, with a longer operation time, more operative blood loss and higher conversion and complication rates than LC. However, it is feasible and relatively safe. LSC is advantageous over open surgery, but it remains a non-routine choice. It is important to know the technical characteristics of LSC, and pay attention to perioperative bleeding and bile leak.
文摘Recently, several reports have demonstrated that fluorine-18 fluorodeoxyglucose positron emission tomography （FDG-PET） is useful in differentiating between benign and malignant lesions in the gallbladder. However, there is a limitation in the ability of FDG-PET to differentiate between inflammatory and malignant lesions. We herein present a case of xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma by ultrasonography and computed tomography. FDG-PET also showed increased activity. In this case, FDG-PET findings resulted in a false-positive for the diagnosis of gallbladder carcinoma.
