Absence Of Gallbladder Research Articles

Outcomes of pregnancies diagnosed with absent or abnormal fetal gallbladder in a tertiary center.

The objective of this study was to investigate the ultrasonographic characteristics and outcomes of fetuses with atypical and non-visualized fetal gallbladder in our tertiary care hospital. A retrospective analysis was conducted on cases in which the fetal gallbladder was not visualized or exhibited atypical characteristics at our institution over a four-year period. The patients were divided into two groups: absent gallbladder and atypical gallbladder. The groups with isolated and additional anomalies were analyzed according to their ante- and postnatal characteristics. The study comprised 78 patients (37 absent, 41 atypical gallbladder). In the isolated fetal absence of gallbladder group, the gallbladder was visualized in three of 13 patients during antenatal ultrasonographic follow-up and in half of the remaining 10 patients during postnatal follow-up. In the postnatal period, five newborns with absent isolated gallbladder are being followed up with suspicion of biliary atresia and isolated gallbladder agenesis. In the absence of a gallbladder with an additional anomaly group, 58% of fetuses died during the intrauterine and neonatal period. Fetuses in the isolated atypical gallbladder group are being followed as healthy after birth. Pregnancies with atypical gallbladder appearance and additional anomalies resulted in 33% neonatal death, 12% intrauterine demise, and 25% termination of pregnancy. In instances where the fetal gallbladder is not consistently discernible, it is imperative to exercise caution with regard to the possibility of biliary atresia. In the event that the fetal gallbladder exhibits unusual characteristics, a meticulous examination for the presence of additional anomalies is recommended.

Gall bladder agenesis in a crossbreed dog

AbstractA 17‐month‐old, male, crossbreed dog was presented with anorexia and vomiting. Biochemistry revealed a severe increase of liver parameters with unremarkable haematology results. Abdominal ultrasound showed microhepatia and absence of gall bladder. Laparoscopic exploration and computed tomography scan confirmed the ultrasound findings. Histopathology of the liver showed multiple changes compatible with a possible ductal plate malformation. One and a half months after the discharge being on a low‐fat diet, S‐adenosylmethionine and antiemetics blood work showed a decrease in alanine transferase, alkaline phosphatase and gamma‐glutamyl transpeptidases. Nevertheless, the patient continued vomiting intermittently despite the treatment.

Gallstone Ileus in the Absence of Gallbladder, Rare Etiology of Bowel Obstruction: A Case Report and Literature Review

Background: Gallstone ileus post-cholecystectomy is extremely rare surgical emergency causing mechanical bowel obstruction. This condition is usually misdiagnosed due to its non-specific clinical features. Radiological investigations are essential to evaluate and diagnose gallstone ileus cases. Case Presentation: A 92-year-old female patient, cholecystomized, presented to our hospital with a one-week history of an acute confusional state, generalized abdominal pain, and vomiting. The physical examination showed a disoriented patient with a distended abdomen and generalized tenderness, especially in the epigastric area. Hyperactive bowel sounds were audible. Laboratory investigations were non-specific. A plain abdominal X-ray was insignificant. The abdominal ultrasound showed marked abdominal gaseous distention. Then, an abdominal CT scan was performed, revealing an impression of gallstone ileus causing small bowel obstruction with no evidence of fistula formation. So, surgical intervention was decided, and an 8-gram gallstone was exteriorized through an enterolithotomy. The postoperative period was uneventful. Discussion: Gallstone ileus is an unusual entity that often affects elderly females. The clinical features of gallstone ileus include abdominal pain, abdominal distension, nausea, and vomiting. Diagnosis of gallstone ileus relies on imaging and physical examination. Abdominal CT with contrast provides a definitive diagnostic tool. The surgical options to manage the gallstone ileus can be either one or two-staged enterolithotomy. Conclusion: Due to the rare etiologic origin of the gallstone ileus in post-cholecystectomy cases, we report the case of a 92-year-old female with an acute confusional state and generalized abdominal pain, found to be caused by detected gallstone ileus, lacking evidence of fistula formation.

S1712 Choledochal Cyst Mimicking the Gallbladder With a Surprising Twist

Introduction: Choledochal cysts are congenital rarities and often a pediatric diagnosis but 20% go undetected until adulthood. Etiology remains unclear but an obstructed common bile duct (CBD) has been identified as a pathogenic feature. We present a rare case of choledochal cyst initially mimicking the gallbladder in an elderly female. Case Description/Methods: A 90-year-old woman presented to the hospital for abdominal pain and unintentional weight loss. Past medical history was notable for breast cancer and colorectal cancer status post resection. Liver function tests and pancreatic markers were normal with mildly elevated alkaline phosphatase. CT abdomen and pelvis revealed a 2.8 cm dilated common bile duct (CBD), choledocholithiasis, pancreatic duct dilation and absent gallbladder. Patient however denied undergoing a cholecystectomy. Given the discrepancy of imaging and history, an abdominal ultrasound was performed demonstrating large gallstones in the gallbladder with normal CBD size. Endoscopic ultrasound (EUS) revealed a 28x26 mm mass in the ampulla (Figure). FNB was performed. The distal CBD measured 7 mm with a 35 mm proximal CBD consistent with a choledochal cyst full of large stones. Pancreatic duct measured up to 8 mm. Gallbladder was confirmed to be surgically absent. ERCP was performed which revealed an infiltrative 3-4 cm mass at the major papilla. Pancreatic and biliary sphincterotomies were performed and metal stents were placed in the ventral pancreatic duct and CBD. Biopsies taken revealed pancreatic adenocarcinoma. The following month, hepatobiliary surgery performed a Whipple procedure (pancreaticoduodenectomy). Pathology findings confirmed pancreatic adenocarcinoma with metastasis to one of twelve lymph nodes. Patient was arranged to follow up with outpatient oncology. Discussion: Choledochal cysts can be an elusive diagnosis in elderly adults given its rarity, prevalence in children, and common presentation of vague abdominal pain. Choledochal cyst should be part of the differential diagnosis regardless of patient age especially in cases of accompanying weight loss due to its increased risk of biliary malignancy. In our case, the patient was found to have choledochal cyst misrepresented as the gallbladder and incidentally found to have pancreatic adenocarcinoma. Additionally, patients may be unreliable historians leading to misinterpretation of imaging results. Further investigation is therefore warranted in these perplexing cases for an accurate diagnosis and appropriate management.Figure 1.: A. Ampullary mass B. Pancreatic duct dilation C. Choledochal cyst. D Post ERCP.

S1823 Recurrent Gallstones in a Patient With a Congenitally Absent Gallbladder and Cholangiocarcinoma

S1823 Recurrent Gallstones in a Patient With a Congenitally Absent Gallbladder and Cholangiocarcinoma

652 Quality of Ultrasound Report in Patients with Biliary Symptoms in the Context of Surgical Diseases

Abstract Aim The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities. Method Patients presenting to Bedford hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs. Results A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP. Conclusions This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.

WE2.9 Quality of ultrasound report in patients with biliary symptoms in the context of surgical diseases

Abstract Aim The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities. Methods Patients presenting to our hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs. Results A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP. Conclusions This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.

Case report of a gallbladder agenesis, a diagnostic challenge.

Introduction and importanceAgenesis of the gallbladder is an underdiagnosed entity. It can be an asymptomatic pathology, usually diagnosed incidentally as a finding on imaging techniques or in necropsies. There are symptomatic cases presenting as biliary colic too, attributed to cholecystitis or cholangitis, leading to exploratory surgeries.Case presentationWe present a 14-year-old boy admitted to the outpatient Pediatric Gastroenterology Department with a history of daily abdominal pain for the past 2 months. Blood and fecal tests were normal. Coeliac disease, inflammatory intestinal diseases and Helicobacter pylori infection were ruled out. An abdominal US was informed of a hypodistensed gallbladder with no other findings. A CT scan was performed, which reported of an absent gallbladder. Upon these findings, a Magnetic Resonance Cholangiopancreatography (MRCP) was carried out, confirming the diagnosis of agenesis of the gallbladder.Clinical discussionIts diagnosis still poses a challenge, as an absent gallbladder may not always be apparent by US, with the MRCP being the gold-standard test for examining the biliary tract. The prognosis is usually good, and the treatment of choice consists of antispasmodics when needed. There are few cases reported in literature, for this reason, our article discusses the most important aspects of agenesis of the gallbladder in order to suspect it, request the appropriate tests and saving unnecessary surgical interventions.ConclusionGallbladder agenesis is a rare entity that can lead to unnecessary diagnostic tests and interventions. The MRCP is the gold-standard test. Despite its benign nature, symptomatic treatment might be required in order to improve the patient's quality of life.

The Utility of Gallbladder Absence on Ultrasound for Children With Biliary Atresia

Background: Biliary Atresia (BA) is congenital condition, where infant intra- and extrahepatic bile ducts become obliterated, leading to cholestasis, and cirrhosis if untreated. This study aims to assess the predictive measure of absent gallbladder on ultrasounds (US) performed in infants with cholestasis for diagnosing BA.Method: After Institutional Review Board approval, retrospective chart reviews of 61 infants with cholestasis found 43 (70.5%) were diagnosed with BA. A pediatric radiologist provided interpretations of all ultrasounds in a blinded fashion. Statistical analysis was used to assess the utility of absence of gallbladder on US in predicting BA, confirmed intraoperatively.Results: Absent gallbladder on US predicts absent gallbladder with 77% accuracy, 92% sensitivity, 73% specificity, PPV 43%, and NPV 97% (P < 0.001, Fisher exact test). To diagnose BA, absent gallbladder on US has 66% accuracy, 53% sensitivity, 94% specificity, 96% PPV, and 46% NPV (P < 0.001, Fisher exact test).Conclusion: Sonographic gallbladder absence has high specificity and PPV, indicating utility for BA diagnosis; however, it is not useful for ruling out BA given its low sensitivity.

Frequency of Anatomical Variations and Congenital Anomalies in Pancreatobiliary Tract through Magnetic Resonance Cholangiopancreatography

Objective: To determine the frequency of anatomical variations and congenital anomalies of pancreatobiliary tract in adults through the Magnetic Resonance Cholangiopancreatography (MRCP).Methods: This cross-sectional observational study was done on patients suspected to have pancreatobiliary disease referred to MRI unit. MRCP was performed on a 1.5 Tesla in MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSF-SE technique. Axial and coronal source images and reformatted images were evaluated together for the possibility of any anomaly and variation in pancreatobiliary tract. Analysis was done by SPSS version 20.Results: Total no of 377 patients included in this study. The patients presented with epigastric pain, obstructive jaundice, pancreatitis and post-cholecystectomy epigastric pain and jaundice. MRCP was performed on these patients to examine the pancreatobiliary tract. In this study, 52% were females and 48% were males. The variations and anomalies were found in 24.93 and 75.07% had normal anatomy of pancreatobiliary tract. The most observed frequency was low insertion of cystic duct and least observed frequency was duct of Santorini. High insertion of cystic duct, absent gallbladder and aberrant hepatic ducts were not found in this study.Conclusion: Majority of the patients in this study were found to be free from pancreatobiliary disease. It is important to clarify the anatomy of the pancreatobiliary tract by preoperative evaluation. Congenital anomalies and anatomical variation in pancreatobiliary tract present a complex spectrum, which areworthy of alteration in both the clinical and surgical setting and are readily identified by MRCP.

Development and Validation of a Nomogram Incorporating Ultrasonic and Elastic Findings for the Preoperative Diagnosis of Biliary Atresia

To develop and validate a nomogram that incorporates the gallbladder morphology, hepatic elasticity, and demographic information for the prediction of biliary atresia (BA) in children. A total of 294 consecutive patients under the age of 70 days with cholestasis and suspected symptoms of BA were enrolled in this study, who were divided into a training cohort (150 patients) and a validation cohort (144 patients). Ultrasonography and two-dimensional shear wave elastography were performed for each patient prior to knowing the final diagnosis. Multivariate logistic regression was used to analyze the gallbladder morphologic feature in the sonogram (absence of gallbladder, small gallbladder, lower postprandial gallbladder contractibility, or abnormal gallbladder wall), hepatic elasticity and clinical data from the training cohort, and a diagnostic nomogram for BA was subsequently developed. The performance of the nomogram was respectively evaluated with respect to the discrimination and calibration in every cohort. The multivariate analysis showed that the factors of age (p = 0.009), gallbladder morphology (p = 0.001) and hepatic elasticity (p < 0.001) could serve as independent predictive factors to differentiate between BA and other causes of cholestasis. The nomogram incorporating these three parameters showed good discrimination and satisfactory calibration, indicating a better performance compared to using only the gallbladder morphologic features and hepatic elasticity. The observed area under the receiver operator characteristic curve in the training cohort and validation cohort was 0.939 (p < 0.001) and 0.942 (p < 0.001), respectively, with a sensitivity of 95.5% and a specificity of 83.4% in the combined cohort. The established nomogram shows a favored and improved predictive value for the diagnosis of BA.

Acute pancreatitis following coronary angiography: case report and review of contrast-induced pancreatitis

Acute pancreatitis is a common surgical presentation with a multitude of causative factors. While the pathogenesis is not completely understood, new potential triggers have been described in recent literature. Contrast-induced pancreatitis is one of these rare phenomena. We present a case of acute pancreatitis in a patient who underwent coronary angiography and discuss the suspected pathogenesis behind contrast-induced pancreatitis. A 65-year-old man with background of cholecystectomy and UroLift procedure underwent two-stage elective coronary angiography following an episode of angina. He had been started on perindopril, rosuvastatin, aspirin and clopidogrel the week prior following first-stage percutaneous transluminal angioplasty of the right coronary artery. The patient underwent uncomplicated angiography, receiving 120 ml of Omnipaque 350. After transfer to the ward, he complained of progressive epigastric pain and nausea. On examination, the patient was afebrile, haemodynamically stable and tender in the epigastrium. His lipase was 888 U/l. Liver ultrasound showed an absent gallbladder but no other abnormalities. Total cholesterol was 2.7 mmol/l and IgG subclasses within normal range. There was no indication to perform an EUS. His symptoms resolved and his lipase normalised within three days. Although contrast-induced pancreatitis is rare, it should be considered in patients exposed to intravenous contrast who manifest symptoms. It occurs due to reduced capillary flow resulting from increased viscosity of radiographic contrast. The rate of invasive coronary investigations continues to rise with cardiovascular disease affecting one in five Australians. Therefore contrast-induced pancreatitis will likely become more common in this population hence it is important to be recognised.

Pancreatic Insufficiency and an Absent Gallbladder: Connecting the Dots

Question: A 47-year-old patient, with a history of insulin-treated diabetes mellitus and surgical correction of a persistent ductus arteriosus, was referred to our tertiary center after a diagnosis of endocrine and exocrine pancreatic insufficiency. For almost 2 years, the patient had experienced fatty, loose stools compatible with steatorrhea (13C mixed triglycerides breath testing: 13C-CO2-excretion 10.8% after 6 hours, normal, >23%). No episodes of pancreatitis had occurred, nor was there a familial history of pancreatic disorders or diabetes mellitus.

Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease.

Cholecystectomy is a frequently performed surgical procedure for symptomatic cholelithiasis, which is reported to be more common in patients with non-alcoholic steatohepatitis (NASH), given the common risk factors. However, the data remains unclear on the association of cholecystectomy with NASH. We performed a retrospective study to examine the association of cholecystectomy and NASH. Medical charts of patients with steatohepatitis related liver disease at a tertiary care center from 2004 to 2011 were stratified by cholecystectomy and defined by its history and/or absence of gallbladder on ultrasonography. Logistic regression model was built for predictors of cholecystectomy. Patients with NASH were stratified based on timing of cholecystectomy. The diagnosis of NASH and timing of cholecystectomy were compared based on baseline characteristics and outcomes (liver disease complications and survival) on follow up. Kaplan-Meier curves were generated for the two group comparisons. Chi-square and unpaired t-tests were used for comparing outcomes on follow up. P value <0.05 was considered significant. Analysis of 584 patients [379 non-alcoholic fatty liver disease (NAFLD)] showed that patients with cholecystectomy (N=191) were more likely to be female (57% vs. 44%), diabetic (53% vs. 37%), have liver biopsy (43% vs. 25%) and diagnosis of NAFLD (80% vs. 58%) P<0.001 for all. NAFLD diagnosis was associated with 2.79 folds odds of cholecystectomy. Among 379 (192 cholecystectomy) NAFLD patients, cirrhosis and female gender were associated with over 2 and 1.5 folds of cholecystectomy. Of 141 patients with data on timing of cholecystectomy, 55 (39%) with cholecystectomy at or after NAFLD diagnosis vs. 86 with cholecystectomy within median of 6 years prior to NAFLD diagnosis were similar on all characteristics except on model for end-stage liver disease (MELD) score (9.2±8.4 vs. 6.4±7.1, P=0.045). Of 28 with available histology data, there were no differences on histology based on timing of cholecystectomy. On a median follow up of 5 years, timing of cholecystectomy did not impact on development of cirrhosis (74% vs. 67%, P=0.45), ascites (31% vs. 38%, P=0.76), variceal bleeding (11% vs. 16%, P=0.44), hepatic encephalopathy (22% vs. 29%, P=0.74), hepatocellular carcinoma (HCC) (15% vs. 9%, P=0.59), and patient survival (95% vs. 98%, P=0.3). Cholecystectomy is associated with NAFLD diagnosis. We did not find cause and effect of cholecystectomy in the development of severity of NAFLD. Prospective studies are suggested to examine the role of cholecystectomy and bile acids in the pathogenesis of NAFLD.

3031 Severe Acute Pancreatitis Secondary to Topical Cannabinoid Use

INTRODUCTION: Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admission in the US. While almost 80% of cases are associated with alcohol or gallstones, the remainder often remain idiopathic with no identifiable cause. Here, we present the case of 74-year old male who presented with severe pancreatitis after topical cannabinoid use who eventually expired from complications of the disease. CASE DESCRIPTION/METHODS: 74 year-old male with history of HTN, ischemic cardiomyopathy, stage 3 CKD, multiple strokes and lumbar spinal stenosis presented with sudden onset of abdominal pain. The pain began one day prior and was described as a sharp sensation in the epigastrium radiating to the chest. It was associated with dry heaving but no vomiting. The patient was having non-bloody diarrhea since the pain began. No fevers, but chills and diaphoresis were present. He denies any recent alcohol use and is s/p cholecystectomy. He endorses recently using topical cannabinoid oil for chronic low back pain. He was afebrile on arrival but hypertensive to 214/97. His labs were remarkable for WBC 23, H&amp;H 17/54, lipase 47082, Cr 1.56, Tbili 1.9, ALT 210, AST 330, Alk Phos 211, EtOH level &lt;5. CT abdomen/pelvis showed moderate acute, interstitial pancreatitis with small, non-loculated fluid collections. Despite aggressive fluid resuscitation, the patient required pressor support and was intubated. Abdomen US revealed no pancreatic or biliary dilation and surgically absent gallbladder. His condition continued to worsen and Nephrology initiated CRRT for anuric renal failure. He developed atrial fibrillation with hypotension requiring continuous amiodarone infusion. H&amp;H began to drop and DIC developed rapidly. The patient expired after 10 days. DISCUSSION: After extensive work-up, no specific etiology was found for acute pancreatitis in this patient. The recent use of topical cannabinoid oil for chronic back pain showed a temporal correlation with the patient's medical condition and was thought to be the inciting factor leading to this patient's demise. Given the increased availability of cannabis in managing chronic pain, patients should be aware of the association between cannabis and acute pancreatitis. Additionally, health care providers should include cannabis (including all marijuana varieties and methods of consumption) in the differential diagnosis of acute pancreatitis cases with unknown etiology.

1268 The Hidden Gallbladder: An Unusual Case of Bouveret Syndrome

INTRODUCTION: Bouveret syndrome is the most infrequent variant of gallstone ileus characterized by a biliary fistula with the stomach or small intestine. The fistula occurs from recurrent gallbladder inflammation causing adhesion to the GI tract followed by local necrosis. Patients generally present nausea, vomiting, and abdominal pain/distention with variable lab abnormalities, with jaundice and hepatic enzyme alternations in only 1/3 of patients. 43-68% of patients have a history of recurrent biliary colic and given the delay in diagnosis, patients can present very late with dehydration and weight loss. CT scan is diagnostic modality of choice with an overall 93% sensitivity, 100% specificity, and 99% diagnostic accuracy. We present a rare case of Bouveret Syndrome missed by CT scan and diagnosed by ERCP. CASE DESCRIPTION/METHODS: Our patient is an 81-year-old male who presented with jaundice and intermittent fever/chills. He reported 7 months of intermittent nausea, vomiting, and abdominal pain and reportedly lost approximately 80 pounds in the past year. The patient denied any prior cholecystectomy. He was noted to have total bilirubin of 8.1 and an alkaline phosphatase of 523. RUQ U/S showed a 1.5 cm common bile duct (CBD) and non-visualization of the gall bladder. CT scan was performed showing CBD of 2.0 cm but no clear cholelithiasis and reported absence of the gallbladder. Patient subsequently had EUS/ERCP. EUS showed a shrunken decompressed gallbladder with cholelithiasis (Figure 1) and bilious output into the lesser curvature of the stomach concerning for fistulous process. ERCP showed dilated CBD with multiple large gallstones with sphincterotomy and balloon extraction (Figure 2). Impaction cholangiogram with cinematic fluoroscopy confirmed a cholecystogastric fistula (Figure 3). The patient was a poor surgical candidate but had improvement in his symptoms and liver function tests and was safely discharged home. DISCUSSION: Bouveret syndrome is a very rare complication of gallstone ileus that can have high mortality due to its late and nonspecific presentation. There have been approximately 300 cases of documented Bouveret syndrome with 60% of cases involving a cholecystoduodenal fistula. 5% of cases present with a cholecystogastric fistula. As CT is the mainstay of diagnosis, our case is further unique in that CT scan and RUQ U/S reported an absent gallbladder (which the patient denied), likely due to the contracted nature noted on EUS and required endoscopic visualization and ERCP to confirm.

Quality Assurance of the Gallbladder and Relationship Between Gallstones and Abdominal Panniculus Thickness in Adult Hospital Autopsies

Abstract Objectives Inconsistency in the autopsy report can be a liability issue. We studied the discordance between the presence of the gallbladder and a corresponding abdominal scar and suggest how to improve this error. To our knowledge, the relationship between abdominal panniculus thickness in adult hospital autopsies and the presence of gallstones has not been reported in the literature. We report the correlation between age, sex, average panniculus thickness, and gallstones. Methods The laboratory information system was searched for autopsies performed between 1/1/09 and 12/21/18. Patients &lt;18 years old and partial, nonabdominal autopsies were excluded. Autopsy reports were reviewed, and the following data were recorded: age, sex, presence or absence of gallbladder, abdominal scars, abdominal panniculus thickness, and gallbladder pathology. Results Out of 385 autopsies reviewed, 48 (12.5%) had cholecystectomies. Of these 48 patients, 6 (12.5%) abdominal scars were not documented. The presence of the gallbladder was not mentioned in 6 (1.6%) reports. The most common pathology was gallstones, 78 (20.3%); cholesterolosis, 9 (2.3%); and cholecystitis, 6 (1.6%). The average age of females and males with gallstones was 68.9 and 66.4 years, respectively. The average abdominal panniculus thickness in males with and without gallstones and in females without gallstones was 3.3 cm. In contrast, the average abdominal panniculus thickness in females with gallstones was 4.0 cm. Conclusion Our study demonstrated that 12.5% of our autopsy reports failed to document the presence of abdominal scars in patients who surgically lacked a gallbladder. There is a need to improve documentation of abdominal scars and the presence or absence of the gallbladder. This can be achieved by creating mandatory fields (eg, gallbladder present/surgically absent) in the autopsy report template. Also, our study found that females with gallstones have a thicker abdominal panniculus than females without gallstones and males with or without gallstones.

Case series of 200 laparoscopic cholecystectomy, their intra-operative finding and post-operative complication

Background: In the current era of laparoscopic procedure, laparoscopic cholecystectomy are most commonly performed surgery all over the world. The biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. So adequate recognition and awareness of anatomical abnormalities of encounter during laparoscopic cholecystectomy can decrease the morbidity and mortality related to surgery.Methods: It is prospective study including 200 patients based on intra-operative finding and their postoperative complication in Bhopal Memorial Hospital and research centre Bhopal, during period of Jan 2017 to Jan 2019.Results: In 200 cases 154 were Female and 46 were male. Mucocele of gallbladder in 22 cases, pyocele of gall-bladder in 7 cases. Gallbladder wall thickened and fibrosis in 13 cases. Gallbladder with duodenal fistula in 1case, gall bladder with colon and gall bladder with stomach fistula both in 1 case, and gall bladder with stomach fistula in 1 case. In one case there is absent gall bladder but patient havingCBD stone. Cystic artery cant separated from cystic duct and clipped along with cystic duct in 16 cases. In 3 cases there were gall bladder malignancy two were suspected intra-operatively and procedure abandoned other one after post lap cholecystectomy, confirm with biopsy report. Two cases develop post op incisional hernia. In 8 cases lap cholecystectomy converted into open cholecystectomy.Conclusions: This case series of laparoscopic cholecystectomy will help surgeons to be aware of such intra-operative finding and complication, so as to prevent undesirable outcome.

Gall stone ileus in the absence of gall bladder: a case report

Post cholecystectomy gall stone ileus is very rare with only few cases reported in the literature. This condition poses diagnostic challenges both because of its rarity and since the gall bladder had been removed previously. A high index of suspicion is needed for the diagnosis. Here, we report the case of a young female presented to the emergency room with acute intestinal obstruction. Patient underwent cholecystectomy followed by LSCS 20 yrs back. Patient was managed with explorative laparotomy which revealed an adherent, fibrosed and narrow segment of ileum containing a small impacted gall stone 120 cm from ileocaecal junction. Following the Resection anastomosis the patient made a satisfactory recovery and was discharged without any complication and is doing well.

Feline abdominal ultrasonography: what's normal? what's abnormal? The biliary tree.

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. The biliary tree encompasses the liver, gall bladder and bile ducts, although only diseases affecting the latter two are discussed here. Diseases of the bile ducts and gall bladder are more common than those of the liver parenchyma and ultrasound plays an important role in their diagnosis. Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. In addition, a lack of pathological change does not necessarily rule out disease; for example, absence of gall bladder and/or extrahepatic biliary distension is not sufficient to exclude the possibility of biliary obstruction, and in many cases of cholangitis the liver and biliary tree are unremarkable on ultrasound examination. Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. This review, part of an occasional series on feline abdominal ultrasonography, discusses the appearance of the normal and diseased biliary system. It is aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Percutaneous ultrasound-guided cholecystocentesis is also covered. Ultrasound examination of the liver was discussed in an article published in January 2019 and an upcoming article will cover hepatic vascular anomalies. Information provided in this article is drawn from the published literature and the author's own clinical experience.