Cases Of Cholecystitis Research Articles

Pediatric Cholelithiasis Single Center Experience Results of the Clinic for Pediatric Surgery kcu Sarajevo in Period 2010.-2022

Introduction: Cholelithiasis is occurance of one or several gallstones in the gallbladder. It can be complicated with choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. Causes for this disorder in pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia) or non hemolytic - other hereditary disorders as cystic fybrosis, Wilson's disease or ileum disordes, total parenteral nutrition, usage of certain medicaments, choledochal cysts, organ transplantation and, in adolescency, those similar to adult patients (obesity). Mostly gallstones found in children are cholesterol ones or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and its complications (as choledocholithiasis that requires ERCP). There is also some differential dyagnoses that should be taken in consideration before the tretment (billary dyskinesion, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts as well as pediatric pyelonephritis). First line of treatment of cholelithiasis is with diet, saline infusions and medicaments and if cholelithiasis is symptomatic and/or complicated then cholecystectomy is recomended. Having in mind operative approach it can be open procedure of laparascopic one. Some study show that injuries of bile ducts are more common in laparascopic tretment of pediatric cholelithiasis but nevertheless it is shown that with experienced team and good preparation this is the golden standard in the treatment of pediatric cholelithiasis. Objectives. Hereby we present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in pediatric population. Methods: Between 2010. and 2022, retrospectively, we explored data points of children who underwent laparoscopic cholecystectomy reviewed with included demographics properties, indication for cholecystectomy, used surgical technique, operative time, complications, and length of hospital stay. We performed 37 laparoscopic cholecystectomies (due to cholelithiasis and one case of cholecystitis without calculi) with 2 conversions to open procedures and via open approach we treated 3 cholecystes in this period. Male to female distribution was: 12 male patients and 25 female patients Results: Thirty-seven children (12 male patients and 25 female patients with ages ranging from 7 to 18 years, mean: 11,9 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic cholelithiasis in almost all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 120 minutes (mean: 77 minutes). Two patients were treated by open surgery. Only one patient had leakage due to choledocholithiasis, and open surgery and ERCP had to be performed. Median of hospital stay for all patients was 3-4 days. Conclusion: Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adult series.

Clinicopathologic characterization of gallbladder graft-versus-host disease in the pediatric population

Graft-versus-host disease (GVHD) is a common and important complication of allogenic hematopoietic cell transplantation. The cardinal histologic feature of GVHD in the gastrointestinal tract is the presence of apoptotic bodies. To date, no study has evaluated the pathologic characteristics of gallbladder GVHD (GB-GVHD). In this study, we sought to describe their clinicopathologic features in a cohort of pediatric patients and compared them to a control group composed of 10 and 15 recent cases of acute and chronic cholecystitis, respectively. A total of 6GB-GVHD cases were included, 5 cholecystectomies and 1 autopsy case(s), presenting in 2 boys and 4 girls, with a mean age of 6.7 years (1.5-18.6). The median days post-transplant to presentation was 261 (40-699), and all cases had GVHD involving other organs. GB-GVHD compared to the control groups was significantly associated with a younger age (P=.019), presence of apoptotic bodies and higher number of apoptotic bodies in 10 continuous mucosal folds and in 100 and 500 epithelial cells (all P<.001), and increased number of intraepithelial lymphocytes per 100 epithelial cells (P<.001). All patients were treated for GVHD with half of them achieving treatment response. Besides the autopsy case, all patients are alive with a median follow-up time of 45 months (4-212). The cause of death for the autopsy case was sepsis due to Pseudomonas aeruginosa. In our experience, the presence of both increased apoptotic bodies and intraepithelial lymphocytes in the gallbladder of hematopoietic cell transplantation patients should raise concern for GB-GVHD.

How do magnetic resonance cholangiopancreatography findings predict conversion from laparoscopic cholecystectomy for acute cholecystitis to bailout procedures?

BackgroundAcute cholecystitis is one of the most prevalent surgical abdominal conditions. The Tokyo Guidelines describe the management of acute cholecystitis and recommend bailout procedures for “difficult” cholecystitis cases. This study aimed to identify risk factors for conversion from laparoscopic cholecystectomy to bailout procedures in patients with acute cholecystitis. MethodsThis retrospective cohort study was conducted at a single center between January 2017 and December 2021. Patients who underwent laparoscopic cholecystectomy for acute cholecystitis were enrolled and classified into bailout and non-bailout groups. The patients’ characteristics and perioperative data were compared between the 2 groups. ResultsIn total, 161 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed. Fourteen were excluded because of a lack of preoperative magnetic resonance cholangiopancreatography; thus, 147 patients were enrolled (bailout group, 21; non-bailout group, 126). Age (74 vs 67 years old; P = .048), days from onset to surgery (3 vs 2 days; P = .02), or defect of cystic duct in magnetic resonance cholangiopancreatography (57% vs 29%; P = .02) were significantly associated with conversion to bailout procedures. In the logistic regression analysis, a defect of the cystic duct in magnetic resonance cholangiopancreatography was an independent predictor for bailout procedures (odds ratio, 2.793; P = .04). ConclusionIn this study, defect of the cystic duct in the magnetic resonance cholangiopancreatography can predict conversion to bailout procedures. To the best of our knowledge, this is the first report to describe magnetic resonance cholangiopancreatography finding of the cystic duct as a predictor of surgical difficulty in patients with acute cholecystitis.

79-LB: An Open-Label, Active-Controlled Phase 2 Evaluation of Novel GLP-1 Analog Ecnoglutide in Adults with Obesity

Ecnoglutide (XW003) is a novel, long-acting GLP-1 analog being developed for the treatment of type 2 diabetes mellitus (T2DM) and obesity. We conducted a multi-center, open-label, active-controlled Phase 2b study in adults with a body mass index (BMI) ≥30 to ≤40 kg/m2. The trial was conducted at nine sites in Australia and New Zealand, with 206 participants enrolled. Participants were randomized to receive target doses of ecnoglutide at 1.2, 1.8, or 2.4 mg as once weekly SC injections or liraglutide (Saxenda®) at 3.0 mg as once daily injections for 26 weeks. Doses were increased by titration for up to 14 weeks before reaching the target dose. Safety and tolerability were assessed, along with efficacy parameters including change in body weight. At baseline, participants had a mean body weight of 100.67 ± 13.54 kg and BMI of 35.29 ± 2.76 kg/m2. After 26 weeks of dosing, participants receiving 1.2, 1.8, or 2.4 mg ecnoglutide weekly achieved a least square mean (LSM) body weight reduction from baseline of -11.5%, -11.2%, and -14.7%, respectively, compared to -8.8% for those receiving 3.0 mg liraglutide daily injections. Participants receiving 2.4 mg ecnoglutide showed significantly more pronounced body weight reduction compared to liraglutide (LSM difference -5.9, 95% confidence interval -10.4, -1.5; p&amp;lt;0.001). Overall, treatment with ecnoglutide was safe and well tolerated. Treatment emergent AEs were reported in 93.5% of participants in the ecnoglutide groups and 98.0% in the liraglutide group. Gastrointestinal disorders were reported in 81.9% of ecnoglutide-treated participants and 80.4% of those receiving liraglutide, most of which were mild to moderate and most occurred during the dose escalation period. Two SAEs related to the study drug were reported. Both were cases of acute cholecystitis, one in a participant receiving 1.2 mg ecnoglutide and one in the liraglutide group. Disclosure Z. Zhu: Employee; Sciwind Biosciences. M. K. Junaidi: None. Y. Li: Employee; Sciwind Biosciences. Q. Zheng: Employee; Sciwind Biosciences. E. Adegbite: Employee; Sciwind Biosciences. S. Ross: None. L. Telusca: None. C. L. Jones: Employee; Sciwind Biosciences. M. Fenaux: Employee; Sciwind Biosciences, Stock/Shareholder; Terns Pharmaceuticals. S. Xu: Employee; Sciwind. Funding Sciwind Biosciences Co., Ltd.

Biliary Ascariasis: Overall Perspective of Management

Background: One of the common cause of admission in surgical ward with acute abdomen in Asian subcontinent is Biliary Ascariasis.The causative agent, Ascarias lumbricoides is distributed throughout the tropics &amp; subtropics &amp; mostly prevent is developing country due to unhygienic livelihood. This study deals with management of Biliary Ascariasis demonstrating the effectiveness of only conservative management in acute condition.&#x0D; Materials and methods: This was an analytical study where 47 patients diagnosed as a case of Biliary Ascariasis were observed &amp; managed accordingly. Complete history, diagnostic tool, complication of Ascarisis &amp; treatment modality were analysed.&#x0D; Result: Here we documented 47 patients throughout the period October-2018 to September -2019 age limit is 13 yrs to 70 yers. Out of which female patient was 78.72% where male was 21.27%. Among female patient 10.63% were pregnant at the time of presentation. 100% patient present with biliary colic, 57.44% had associated nausea &amp; vomiting 38.99% patient present as a case of cholecystitis. Cholangitis developed was 8.5% patient, 8.5% had obstructive jaundices, 4.2% developed liver abscess, 6.38% pancreatitis, 10.63% got cholelithiasis &amp; 8.51% develop chololadocholithiasis &amp;/ or hepaticolithiasis. USG &amp; CBC was advised for all patient as standard diagnostic tool. During conservative treatment endoscopy was advised to all, only 63.82% was able to do this &amp; successful extraction of worm was possible in 26.02%.70% improved by conservative treatment &amp; ERCP required in 10.63%.Surgery for exploring CBD was done in 1 patient (2.1%). 34.02% patient had H/O recurrent attack. 17.02% patient underwent previous endoscopic procedure &amp; 8.51% ERCP procedure. Before discharge review USG found in 68.08% patient with evidence of clear CBD &amp; then discharged with advice of taking Antihelmintic therapy in 2 months interval.&#x0D; Conclusion: Maintenance of hygienic &amp; regular anthelmintic therapy is all prevention of occurance &amp; complication. only conservative management with or without minimal invasive endoscopic retrieval of worm is very much effective for improvement of symptoms.&#x0D; JCMCTA 2019 ; 31 (1) : 9-12

Primary admission to a surgical service facilitates early cholecystectomy in acute cholecystitis but does not influence patient outcome

PurposeEarly cholecystectomy is recommended for acute calculous cholecystitis to reduce complications and lower health care costs. However, not all patients admitted to emergency services due to acute calculous cholecystitis are considered for surgery immediately. Our intention was therefore to evaluate patient management and outcome parameters following cholecystectomy depending on the type of emergency service patients are primarily admitted to.MethodsWe performed a retrospective analysis of all patients that were treated for acute cholecystitis at our hospital between 2014 and 2021. Only patients that underwent surgical treatment for acute calculous cholecystitis were included. Patients with cholecystectomies that were performed due to other medical conditions were not incorporated. Primary outcomes were the perioperative length of stay and postoperative complications. Perioperative antimicrobial management and disease deterioration according to Tokyo Guidelines from 2018 due to inhouse organization were assessed as secondary outcome parameters.ResultsOf 512 patients included in our final analysis, 334 patients were primarily admitted to a surgical emergency service (SAG) whereas 178 were initially treated in a medical service (MAG). The latency between admission and cholecystectomy was significantly prolonged in the MAG with a median time to surgery of 2 days (Q25 1, Q75 3.25, IQR 2.25) compared to the SAG with a median time to surgery of 1 day (Q25 1, Q75 2, IQR 1) (p < 0.001). The duration of surgery was comparable between both groups. Necrotizing cholecystitis (27.2% vs. 38.8%, p = 0.007) and pericholecystic abscess or gallbladder perforation (7.5% vs. 14.6% p = 0.010) were less frequently described in the SAG. In the SAG, 85.7% of CCEs were performed laparoscopically, 6.0% were converted to open, and 10.4% were performed as open surgery upfront. In the MAG, 80.9% were completed laparoscopically, while 7.2% were converted and 11.2% were performed via primary laparotomy (p = 0.743). Histologically gangrenous cholecystitis was confirmed in 38.0% of the specimen in the SAG compared to 47.8% in the MAG (p = 0.033). While the prolonged preoperative stay led to prolonged overall length of stay, the postoperative length of stay was similar at a median of 3 days in both groups.ConclusionsTo our knowledge, we present the largest single center cohort of acute calculous cholecystitis evaluating the perioperative management and outcome of patients admitted to either medical or surgical service prior to undergoing cholecystectomy. In patients that were primarily admitted to medical emergency services, we found disproportionately more gallbladder necrosis, perforation, and gangrene. Despite prolonged time intervals between admission and cholecystectomy in the MAG and advanced cases of cholecystitis, we did not record a prolonged procedure duration, conversion to open surgery, or complication rate. However, patients with acute calculous cholecystitis should either be primarily admitted to a surgical emergency service or at least a surgeon should be consulted at the time of diagnosis in order to avoid disease progression and unnecessary health care costs.

Safety of Radioembolization via the Cystic Artery in Patients with Hepatocellular Carcinoma and Parasitized Arterial Supply

PurposeTo evaluate the safety and effectiveness of radioembolization through the cystic artery supplying hepatocellular carcinoma (HCC) adjacent to the gallbladder. Materials and MethodsThis retrospective, single-center study included 24 patients who underwent radioembolization via the cystic artery between March 2017 and October 2022. The median tumor size was 8.3 cm (range, 3.4–20.4 cm). Twenty-two (92%) patients had Child-Pugh Class A disease, and 2 (8%) patients had Class B cirrhosis. Technical issues, adverse events, and tumor response were analyzed. ResultsInfusion of radioactive microspheres was performed from the main cystic artery (n = 6), the deep cystic artery (n = 9), and small feeders from the cystic artery (n = 9). The cystic artery supplied the primary index tumor in 21 patients. The median radiation activity delivered via the cystic artery was 0.19 GBq (range, 0.02–0.43 GBq). The median total radiation activity administered was 4.1 GBq (range, 0.9–10.8 GBq). There was no case of symptomatic cholecystitis requiring invasive intervention. One patient experienced abdominal pain during injection of radioactive microspheres via the cystic artery. Eleven (46%) patients received pain medication during or within 2 days of the procedure. Twelve (50%) patients had gallbladder wall thickening on a 1-month follow-up computed tomography scan. Based on follow-up imaging, 23 (96%) patients showed an objective response (complete or partial response) of the tumor supplied by the cystic artery. ConclusionRadioembolization via the cystic artery may be safe in patients with HCC partially supplied by the cystic artery.

Risks of Acute Cholecystitis, Acute Pancreatitis, and Acute Appendicitis in Patients with Dengue Fever: A Population-Based Cohort Study in Taiwan.

Although cases of acute cholecystitis, acute pancreatitis, and acute appendicitis following dengue virus infections have been documented, very few large-scale studies have investigated the postdengue risk of these acute abdominal conditions. This retrospective population-based cohort study included all patients with laboratory-confirmed dengue from 2002 to 2015 in Taiwan and 1:4 nondengue individuals matched by age, sex, area of residence, and symptom onset time. Multivariate Cox proportional hazards regression models were used to investigate the short-term (≤ 30days), medium-term (31-365days), and long-term (> 1year) risks of acute cholecystitis, pancreatitis, and appendicitis after dengue infection, adjusted for age, sex, area of residence, urbanization level, monthly income level, and comorbidities. Bonferroni correction was used for multiple testing; E-values were used to assess the robustness of the results to unmeasured confounding. This study included 65,694 individuals with dengue and 262,776 individuals without dengue. Patients with dengue had a significantly increased risk of acute cholecystitis (adjusted hazard ratio (aHR) 60.21; 95%CI 29.11-124.54; P < 0.0001, E-value = 119.92) and acute pancreatitis (aHR 17.13; 95%CI 7.66-38.29; P < 0.0001, E-value = 33.75) within the first 30days postinfection compared to those without dengue, but this increased risk was not present after that. The incidence rates of acute cholecystitis and pancreatitis in the first 30days were 18.79 and 5.27 per 10,000, respectively. No increased risk of acute appendicitis was observed among patients with acute dengue infection. This study was the first large epidemiological study to show a significantly increased risk of acute cholecystitis and pancreatitis among patients with dengue during the acute phase of dengue infection, while no such association was observed for acute appendicitis. Early identification of acute cholecystitis and pancreatitis in patients with dengue is crucial for preventing fatal complications.

EFFECTIVENESS OF TOKYOGUIDELINES 2018 IN THE MANAGEMENT OF ACUTE CHOLANGITIS AND ACUTE CHOLECYSTITIS

Acute biliary sepsis which includes Acute cholecystitis and Acute Cholangitis are life threatening surgical emergencies which needs early recognition and prompt institution of appropriate management strategies. Except for some well-known clinical signs like Murphys sign and Charcots triad there are no well-defined criteria for the diagnosis of above said biliary infections. Tokyo Guidelines 2018 is expert panel formulated Diagnostic and severity assessment criteria guidelines is the only guidelines available till date which aids in the diagnosis and management of the same. More number of patients can be diagnosed at an early stage of infection and appropriate treatment instituted at the earliest by using this guidelines, thus avoiding any foreseen complications. In this study, we have assessed the feasibility of using TG 18 guidelines in diagnosing and managing acute biliary infections in ESI Medical College and Hospital Rajajinagar, Bengaluru. Objective: To study the effectiveness of Tokyo Guidelines 2018 in diagnosing, assessing severity and management of acute cholecystitis and acute cholangitis. Material and Methods: All cases of acute cholangitis and acute cholecystitis admitted in ESI Medical College and Hospital Rajajinagar, Bengaluru. Patients who had been diagnosed as a case of acute Cholecystitis and acute cholangitis were followed up and assessed using the TG 18 guidelines criteria and the outcomes were analysed. The efficacy of Using the guidelines in our setup and reproducibility of guideline demanding parameters were analysed that were appropriate in our setup. Clinical details and lab and imaging findings were recorded using a well detailed clinical proforma that included detailed description of analysis of a case of acute cholecystitis and cholangitis. Also other contributing factors, clinical patterns ,presentation ,treatment outcomes were analysed in detail. Results: Acute Cholecystitis with most common etiology being gallstone disease is more common in females (66.6%),While Acute cholangitis is more common among elderly females(60%). 56.7 % patients diagnosed with Acute cholecystitis and 46.7% patients diagnosed with acute cholangitis presented to us in 24 - 72 hours of symptom onset. 33.3 % of cholecystitis and &gt; 50% cholangitis patients were Diabetics Under treatment for the same.

Acute Cholecystitis Associated with Eosinophilic Granulomatosis with Polyangiitis that Responded to Glucocorticoid Therapy.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic disorder characterized by tissue eosinophilic infiltration and vasculitis. Although EGPA causes multiple organ damage, it causes cholecystitis less frequently. We herein report a case of acute cholecystitis associated with EGPA in which successful treatment with glucocorticoid therapy allowed surgery to be avoided. EGPA can present as acute cholecystitis. It is important not to overlook acute cholecystitis associated with EGPA in patients with abdominal pain with peripheral eosinophilia. Furthermore, in cases of mild cholecystitis associated with EGPA that are diagnosed preoperatively, cholecystectomy might be avoided with conservative glucocorticoid treatment.

Candida albicans cholecystitis in a dog with diabetes mellitus

AbstractA 10‐year‐old, 8.9‐kg, spayed, female Jack Russell Terrier, with previously well‐controlled diabetes mellitus, presented with hyporexia of 2‐day duration. Cranial abdominal pain and weight loss were detected on clinical examination. Blood tests, urinalysis, urine protein:creatinine ratio, blood pressure, abdominal ultrasound and liver aspirate cytology revealed hyperglycaemia, elevated serum liver enzyme activities, glucosuria, proteinuria, hypertension, rounded liver edges, irregular hyperechoic gall bladder wall thickening, irregular hyperechoic gall bladder content and vacuolar hepatopathy. Bile cytological examination demonstrated fungal organisms, which were identified as Candida albicans on bile fungal culture. No bacteria were detected on bile cytological examination or bile bacterial aerobic and anaerobic culture. The dog was diagnosed with Candida albicans cholecystitis and recovered after a 12‐week course of oral ketoconazole. This case report highlights the value of performing bile cytology in suspect canine cholecystitis cases and is the first to describe Candida albicans fungal cholecystitis without bacterial coinfection in dogs.

A case of acute cholecystitis with abnormally high CA19-9

BackgroundCA19-9 is strongly expressed in malignant tumors of the digestive system and is widely used as a marker for gastrointestinal cancer. In this report, we describe a case of acute cholecystitis in which CA19-9 was markedly elevated.Case presentationA 53-year-old man was admitted to our hospital with a diagnosis of acute cholecystitis after being referred to our hospital with a chief complaint of fever and right hypochondrial pain. CA19-9 was abnormally high at 17,539.1 U/ml. Although the possibility of malignancy was considered, there was no obvious malignant lesion on imaging; the patient was diagnosed with cholecystitis, and laparoscopic cholecystectomy was performed the day after admission. The surgical specimen showed no malignant findings either grossly or in the final pathological examination. There were no complications in the patient’s postoperative course, and he was discharged from the hospital on the third postoperative day. CA19-9 level quickly returned to within normal range after surgery.ConclusionsIn acute cholecystitis, CA19-9 levels exceeding 10,000 U/ml are very rare. We report a case of acute cholecystitis without malignant findings despite a high CA19-9 level.

Xanthogranulomatous Cholecystitis is not always a Cancer

Introduction: Xanthogranulomatous cholecystitis is a rare condition with a specific symptoms. The main differential diagnosis is vesicular adenocarcinoma. It can be revealed by abdominal pain, hemorrhage or fistulas. We report here the case of a patient with xanthogranulomatous cholecystitis revealed by febrile abdominal pain. We report a case of xanthogranulomatous cholecystitis in a 45 year old woman, revealed by febrile abdominal pain. Case Report: The patient was 45 years old and had no particular pathological history. She presented with acute febrile abdominal pain. The clinical examination revealed a conscious patient, hemodynamically and respiratorily stable, febrile (fever 39°C), with abdominal defence of the right hypochondrium, the rest of the examination was without anomaly. An abdominal CT scan was requested urgently revealing a circumferential and regular parietal thickening of the gallbladder, hypodense with spontaneous contrast enhanced after injection of PDC measuring 12 mm of maximum thickness, with individualization of multiple fissured calculi, seat of air bubbles realizing the sign of "Mercedes-Benz sign", It is associated with an important infiltration of the mesenteric fat of the neighborhood. A complementary MRI scan with T1, T2, Diffusion, 3DMRCP sequence was performed, showing a parietal thickening in T1 hyposignal, T2 intermediate signal, diffusion hypersignal, multiple liquid structures in T2 hypersignal associated with multiple stones in signal void on all sequences, and a dilatation of the main bile duct measuring 13 mm upstream of a regular eccentric stenosis of the lower bile duct with an inflammatory appearance. Discussion and Conclusion: Xanthogranulomatous cholecystitis is a pathology that is difficult to diagnose preoperatively, as it can be mistaken for a vesicular adenocarcinoma. CT and MRI scans can sometimes help to clarify the diagnosis, particularly in the presence of a diffuse and continuous thickening of the wall with a con

Evaluation of the relationship of obesity with some vital factors as a predictive indicator of cholecystitis in Thi-Qar Governorate

Cholecystitis represents inflammation of the gallbladder. It can lead to many complications,cholecystitis can be either acute or chronic. The inflammation is caused by a blockage in the gallbladder, which stops the flow of bile that flows directly into the small intestine to digest fats. Often this blockage is caused by gallstones, which leads to condensation and stagnation of bile. Adults who haveobese, are at increased risk of many chronic diseases such as diabetes, gallstones, high blood pressure and heart disease. Obesity is associated with increased bile cholesterol excretion. The study has included (175) samples of cholecystitis patients who attended the hospital for the period from January to September 2022, the samples were divided according to gender and obesity status. It was found that the highest incidence of cholecystitis in males was in the age group (55-64) and it was (14%), then the age groups (35-44) and (&gt;65) was (12%).The highest incidence of cholecystitis among women in the age group (35-44) was (27%), then the age group (45-54) was (23%) and then the age group (55-64) was (15%). This study has found that, both obesity status and (BMI &gt;25) were higher in women (79%) while it was in males (52%), and it hasfound that, blood pressure, diabetes and metabolic syndrome arethe most common comorbid conditions associated with cholecystitis.

Acute hemorrhagic cholecystitis related to diffuse neurofibroma of gallbladder in a patient with neurofibromatosis type 1

BackgroundWe report the first case of acute hemorrhagic cholecystitis with large hemoperitoneum related to gallbladder wall fragility caused by neurofibroma cell infiltration.Case presentationA 46-year-old man with neurofibromatosis type 1 (NF1), who had been hospitalized for retroperitoneal hematoma and treated by transarterial embolization 9 days earlier, complained of right upper quadrant pain, bloating, nausea, and emesis. Computed tomography revealed fluid collection and a distended gallbladder with high-density contents. The patient was taken to the operating room for laparoscopic cholecystectomy, with consideration of the hemodynamic tolerance, for acute hemorrhagic cholecystitis. An initial laparoscopy revealed a significant amount of blood in the abdominal cavity exuding from the gallbladder. Due to its fragility, the gallbladder was easily ruptured by surgical manipulation. After conversion to open surgery, subtotal cholecystectomy was performed. Seventeen days after surgery, the patient was transferred to another hospital for rehabilitation. Histological examination revealed diffuse and nodular proliferation of spindle cells that had replaced the muscularis propria of the gallbladder wall.ConclusionThis clinical case highlights how NF1 can cause various symptoms in the blood vessels and gastrointestinal tract, including the gallbladder.

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre.

Background In comparison to a traditional cholecystectomy (open), the laparoscopic cholecystectomy approach provides a number of benefits and has been demonstrated in some studies to have a greater complication rate. The conversion rate from laparoscopic to open surgery ranged between 2% and 15%. A preoperative scoring or grading system (based on age, sex, history, clinical examination, laboratory, and sonographic results)was developed byNassar et al., to anticipate the challenge of laparoscopic cholecystectomy. So, we conducted this study to assess the degree of difficulty in faced during laparoscopic cholecystectomy using an intraoperative scoring system and validate the same using the preoperative scoring system. Methods We conducted this study in the department of General Surgery among 105 patients who underwent laparoscopic cholecystectomy during the defined study period of one year. We performed the preoperative workup for all patients. A preoperative scoring or grading system developed by Nassar et al., in 2020was used. In our study, laparoscopic cholecystectomy was performed by surgeons having a minimum of eight years of hands-on experience in laparoscopic surgeries. An intraoperative scoring or grading system for the degree of difficulty during laparoscopic cholecystectomy, developed by Sugrue et al., in 2015 was used. The Chi-square test was applied to assess the association between preoperative variables and the intraoperative score grading. We have also performed the receiver operating characteristic (ROC) curve analysis to validate the preoperative score in predicting the intraoperative findings. All tests were considered statically significant if the p-value was < 0.05. Results In our study, a total of 105 patients were included in the study and the mean age of patients was 57.6±16.4 years. The male patients were 58.1% and the remaining 41.9% were females. The primary diagnosis was cholecystitis among 44.8% of patients and 2.9% of patients were diagnosed with pancreatitis. Among enrolled patients, laparoscopic cholecystectomy was done on an emergency basis among 2.9% of subjects. During the laparoscopic cholecystectomy, among 21.0% and 30.5% of patients, there was a severe and extreme degree of difficulty respectively. In our study, the conversion rate from laparoscopic to open cholecystectomy was 8.6%. In our study, we found that at a preoperative score of 6, the sensitivity and specificity for predicting easy cases were 88.2% and 73.8%, respectively, and had an accuracy of 88.6% for easy cases and 68.5% for difficult cases. Conclusion When grading the difficulties of doing a laparoscopic cholecystectomy and determining the severity of cholecystitis, this intraoperative scoring system is effective and accurate. Additionally, it signifies the need for conversion from laparoscopic to open cholecystectomyin cases of severe cholecystitis.

THE IMPACT OF BODY MASS INDEX ON SEVERITY OF ACUTE CALCULOUS CHOLECYSTITIS

INTRODUCTION: Acute Calculous cholecystitis(ACC) represents &gt;90% of all cases of acute cholecystitis and accounts for 3–11% of hospital admissions. Obesity is dened as global epidemic by WHO. Obesity is an established risk factor for the cholesterol gallstone and subsequent cholecystectomy. Despite many reports on association of body-weight to gallstone disease, the effect of body-weight in severity of the cholecystitis has been rarely reported. Hence, this study was undertaken to assess the severity of association between the body mass index and severity of acute Calculous cholecystitis. OBJECTIVES: 1. To compare the association of obesity with severity of acute cholecystitis. 2. To study the associated pathological changes in the gall-bladder. METHODOLOGY: A cross-sectional study was carried out over a period of 18months from October2019-July2021 in the department of generalsurgery, Bapuji Hospital, Chigateri General Hospital, Davangere among 50 obese-patients with acute cholecystitis along with obesity(BMI &gt;25kg/sq.mt) undergoing cholecystectomy. The data analysis was done using IBM statistical-package for social sciences(IBM SPSS). RESULTS: The mean age of the study population was 45.22±9.25yrs. The mean BMI of the patients was 29.85±2.76 Kg/sq.mt. 56% were overweight, 38% were obese classI and 6% were obese classII. Based on Tokyo guidelines2013 on acute cholecystitis in the present study 32% had GradeI (mild), 54% had GradeII (moderate) and 14% cases had GradeIII (severe) cholecystitis. There was a statistical signicant association between BMI and severity of cholecystitis with more severe cases with increased BMI. Among 50cases posted for laparoscopic-cholecystectomy 18%cases were converted to open-cholecystectomy. Obesity is a documented risk factor for the forma CONCLUSION: tion of gall-stone and BMI is used as a tool to measure obesity. In our study we found a positive association of body mass index and severity of acute CALCULOUS cholecystitis

Acute Acalculous Cholecystitis Associated with Abscesses-An Unknown Dual Pathology.

(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/-16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis.

Laparoscopic Cholecystectomy in Cases of Acute Cholecystitis

Objective: To evaluate the laparoscopic cholecystectomy procedure in cases of acute cholecystitis. Study Design: Cohort study Place and Duration of Study: Department of Surgery, Surgical Unit-1, SIMS/Services Hospital Lahore from 1st January 2021 to 30th June 2022. Methodology: One hundred and ninety eight cases which suffered from acute cholecystitis were enrolled. The age of the cases was within 35-60 years. The cases were divided into 3 groups; group A, group B and group C. The group selection was dependent on the interval period (between the onset of acute attack and the time of presentation for treatment). Group A was the one where interval period was &lt;3 days, Group B has 3 to 7 days while it was &gt;7 days in group C. The laparoscopic cholecystectomy was performed and operative outcomes were evaluated. Results: The mean age of the patients was 40.66±1.5 years with more females in each group than males. The cases of gall bladder empyema/mucocele were presented at the highest 68.8%. This was followed by the cases having Gall Bladder phlegmon identified in 24.74% of the cases. The rate of complication was highest in Group B while operation time and post-operative hospital stay was highest in Group A. The conversion rate from Laparoscopic to open cholecystectomy was measured as 3.03%. Conclusion: Laparoscopic cholecystectomy is a procedure which can be successfully achieved in acute cholecystitis cases with reduced conversion rate and complication attained through surgical expertise. Keywords: Laparoscopic cholecystectomy, Acute cholecystitis, Conversion rate

Vasculitis of the gallbladder: a case series of an unusual pattern of cholecystitis

Vasculitis isolated to the gallbladder is uncommon, with few cases reported in the literature. We present a series of nineteen cases of cholecystitis with associated vasculitis. The male to female ratio was 7:12 and average age 75.6 (range 49–97). Most resections were performed for the clinical or imaging impression of cholecystitis, with two removed at the time of a larger resection for malignancy elsewhere. The majority (18/19) of cases showed venous involvement (phlebitis), sparing arteries. Most of the vasculocentric infiltrates were lymphohistiocytic, with five cases showing granulomatous vasculitis. The background mucosal inflammatory pattern in just over half (11/19) of cases showed a lymphofollicular cholecystitis, with the remainder showing typical chronic cholecystitis (6/19) or active chronic cholecystitis (1/19). Two of the cases (2/19) showed striking intraepithelial lymphocytosis. Eight of the samples were acalculous. It is unclear why this pattern occurs, with no patients in this series having a known history of vasculitis, and no association with IgG4 or autoimmune disease identified. The pattern may represent an unusual response to local mucosal injury or to constituents/metabolites in bile. The clinical significance is uncertain. The purpose of this case series is to contribute to the sparse literature describing this striking but uncommon histological reaction pattern.