Cases Of Cholelithiasis Research Articles

ThP5.15 - "Unusual Impaction: A Rare Case of Gallstone Ileus''

Abstract Introduction Gallstone-related mechanical gastrointestinal tract obstruction is infrequent, manifesting in only 0.3%-0.5% of cholelithiasis cases. Typically, stones exceeding 2 cm find themselves lodged in the terminal ileum. However, in Bouveret's syndrome which is observed in 1 to 3% of instances the impaction occurs in the duodenum causing gastric outlet obstruction. The epidemiology and prevalence of gallstone impaction in the proximal jejunum remain inadequately documented, making this a rare case. Case Report An 83-year-old patient with known cholelithiasis and choledocholithiasis presented with acute abdominal pain and vomiting a week after undergoing ERCP, sphincterotomy and partial duct clearance. The presence of repeated bilious vomiting prompted investigation with abdominal CT scan. This revealed an approximately 4.5 cm gallstone impacted in the proximal jejunum, prompting emergency laparotomy which confirmed that the stone was impacted 10-15 cm from the dudeno-jejunal junction. Jejunotomy, stone extraction with primary closure was performed. Post-operative recovery was uneventful. Conclusion This case demonstrates gallstone impaction in the proximal jejunum causing bowel obstruction and necessitating emergency intervention. Timely diagnosis and prompt surgical intervention led to a successful outcome. The case highlights the need for awareness and consideration of the entire spectrum of possible gallstone-related complications in the acutely presenting patient with gall stones.

The use of propofol to induce anesthesia can mitigate the oxidative stress created by laparoscopic cholecystectomy, but not thiopental

Aim: Laparoscopic cholecystectomy is one of the treatment methods in symptomatic cholelithiasis cases, and pneumoperitoneum has been shown to increase oxidative stress. Our aim is to compare propofol and thiopental in terms of their effects on oxidative stress parameters in laparoscopic cholecystectomy cases. Materials and Methods: After obtaining Ethics Committee permission, patients who underwent laparoscopic cholecystectomy were divided into thiopental and propofol groups according to the agent used for anesthesia induction in the randomized and prospective study. Serum serum oxidative stress parameters levels were measured in all patients two times, before induction of general anesthesia and at the 30th minute postoperatively. Results: When comparing the preoperative period with the postoperative period, TAS levels increased statistically significantly in the propofol group (preoperatively 1.21±0.21 mmolH2O2/L, postoperatively 1.31±0.18 mmolH2O2/L, p

Once-weekly semaglutide in people with HIV-associated lipohypertrophy: a randomised, double-blind, placebo-controlled phase 2b single-centre clinical trial

HIV-associated lipohypertrophy, which is characterised by an abnormal accumulation of abdominal visceral adipose tissue, remains problematic in people with HIV. Effective interventions are lacking, despite HIV-associated lipohypertrophy carrying a substantial risk of cardiometabolic comorbidity. The primary aim of this trial was to investigate effects of the GLP-1 receptor agonist, semaglutide, on adipose tissue in HIV-associated lipohypertrophy. This randomised, double-blind, placebo-controlled phase 2b clinical trial was conducted at a single US site. Key inclusion criteria included people with HIV aged 18 years or older with controlled HIV-1, a BMI of 25 kg/m2 or more, and lipohypertrophy but without type 1 or type 2 diabetes. Participants were randomly assigned 1:1 to receive 32 weeks of once-weekly subcutaneous semaglutide (8-week dose titration and 24 weeks at 1·0 mg) or placebo; all research personnel and participants remained masked to treatment assignment. Primary outcomes were changes at 32 weeks in adipose tissue quantity by body compartment. Analyses, including safety, were performed using intention-to-treat principles. This trial was registered ClinicalTrials.gov (NCT04019197) and is complete. Between June 10, 2019, and July 28, 2022, 108 participants were randomly assigned to receive semaglutide (n=54) or placebo (n=54). Eight (15%) in each group withdrew prematurely. Significant effects of semaglutide were seen over the 32-week study period in sex-adjusted multiplicative regression analyses for the primary outcome, abdominal visceral adipose tissue (β -30·82 cm2, 95% CI -50·13 to -11·51; % change -30·6%). Decreases were also seen in other key measures, including abdominal subcutaneous adipose tissue (β -42·01 cm2, 95% CI -75·49 to -8·52; % change -11·2%) and total body fat (natural logarithmic -0·21 kg, 95% CI -0·33 to -0·08; % change -18·9%). There were no statistically significant differences in possibly related or related adverse events (absolute risk difference 0·1111, 95% CI -0·0727 to 0·2869); however, one semaglutide-related grade 4 elevated lipase and two possibly related cases of cholelithiasis (grades 1 and 2) were observed. Semaglutide holds promise as an effective treatment for HIV-associated lipohypertrophy. The potential risk of serious adverse events deserves further scrutiny in large trials in people with HIV. National Institutes of Health.

Prescription Pattern of Cholelithiasis at Surgery Ward in Tertiary Care Hospital

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation.The number of surgical procedures for cholelithiasis has risen markedly in developed countries since 1950. An estimated 90% of cholecystectomies are now performed by the laparoscopic approach worldwide. Objectives: The aim of the study was to study prescription pattern of Cholelithiasis at surgery ward in B&C medical college teaching hospital and research Centre Pvt. Ltd. Materials and Methods: A Retrospective study was conducted and data of Cholelithiasis cases admitted at Surgery ward from 2077/01/01 BS to 2077/12/31 BS were collected. Coding of data , result and interpretation of data were drawn using SPSS version 16 and MS Excel 2016 . Result: The present study included 137 patients.Among them,80.3% were females and 19.7% were males. The high incidence of cholelithiasis was found in the age group 30-39 years (27%). 98.5% of total hospitalized patient were prescribed with antibiotics followed by Proton Pump inhibitors (93.4%) and NSAIDS(92%) .Among antibiotics, Ceftriaxone (65.7%) were the most prescribed one. During discharge , antibiotics (98.5%) were the most prescribed group of medicine followed by Proton Pump Inhibitors (88.3%) and NSAIDS(67.9%). And among antibiotics, Cefixime (52.6%) were mostly prescribed. While analyzing prescription pattern of discharge medication it was found that percentage of drugs prescribed by generic name was 13.86% and percentage of drugs prescribed from essential drug list was 43.36%. Conclusion: The present study revealed that there was greater incidence of Cholelithiasis in females (80.3%) than in males and in the age group 30-39 years (27%) .The results obtained from this study showed that most commonly prescribed medicines were antibiotics. Prescription through generic name and essential drug list was low. Therefore, prioritization on prescribing drugs by generic name and from essential drug list needs to be encouraged.

Ayurvedic Management of Cholelithiasis (Pittashmari) – A CaseStudy

Gallstone formation, or cholelithiasis, is caused by a number of factors, including supersaturation of bile with cholesterol, accelerated nucleation of cholesterol monohydrate in bile, bile stasis, or delayed gallbladder emptying due to impaired gallbladder motility. After carefully rewriting Ayurvedic scriptures, we find that, because of its resemblance in location and function, the bile secreted from the gallbladder can be compared to the Accha Pitta stated in Ayurveda. We report that a case of cholelithiasis (Pittashmari) in a 31-year-old female patient had been complaining of severe abdominal pain, distension of the abdomen, and vomiting. Oral medications such as Arogyavardhini vati, tablet Trikatu, Kashaya of Trivrit, Katuki, Sanaya, Arghvad, and Daruharidra were administered to the patient for 3 months. A significant response was observed over clinical symptoms and USG reports. Ayurvedic remedies were used to treat the patient for 3 months. This case study demonstrates the efficacy of Ayurvedic treatment for cholelithiasis (Pittashmari). The study reached the conclusion that Ayurvedic therapy was significantly effective in the treatment of cholelithiasis (Pittashmari).

THYROID FUNCTION ABNORMALITIES IN PATIENTS WITH CHOLELITHIASIS: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

Objective: The objective of the study is to analyze the association between thyroid function abnormalities and cholelithiasis, focusing on the prevalence and types of thyroid dysfunctions in patients with gallstone disease compared to a healthy control group. Methods: A comparative, hospital-based cross-sectional study was conducted in the department of general surgery at a tertiary care medical college. The study included 60 patients diagnosed with cholelithiasis (Group A) and 60 age-matched healthy individuals (Group B). Detailed history, physical examinations, ultrasound imaging, and thyroid function tests (TFTs) were performed. TFTs included measurements of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone. Patients were categorized based on thyroid status into euthyroid, subclinical and clinical hypothyroidism, and hyperthyroidism. Statistical analysis was performed using SPSS version 21.0, with significance set at p<0.05. Results: The study revealed a female preponderance in cholelithiasis cases (76.67% in Group A vs. 65.00% in Group B). The mean age and BMI were comparable between the groups. Thyroid function abnormalities were more prevalent in the cholelithiasis group (p=0.0251), with a higher incidence of hypothyroidism compared to the control group. Subclinical hypothyroidism was the most common thyroid dysfunction in cholelithiasis patients. Common complaints in the cholelithiasis group included anemia, menstrual irregularities, skin changes, and weakness. Conclusion: The study demonstrates a significant association between cholelithiasis and thyroid function abnormalities, particularly hypothyroidism. The findings suggest the need for routine thyroid function evaluation in patients with cholelithiasis, which could influence management strategies and improve patient outcomes.

A Case of Cholelithiasis Treated by Acupuncture

A Case of Cholelithiasis Treated by Acupuncture

Microbial Association with Gallstone Disease in Maysan Province, Iraq

Good health and well-being are among the UN Sustainable Development Goals. Based on this, the present study aimed to investigate a prevalent disease in Iraq, namely gallstone disease, along with the microbial infections associated with cholelithiasis and their antibiotic sensitivity patterns. The study was conducted at Teaching al-Sadr Hospital and Al-Zahrawi Surgical Hospital in Maysan, Iraq, from November 2021 to December 2022. Sixty cases of cholelithiasis in men and women between the ages of 20 and 50, who underwent cholecystectomy, were selected. The most common organism identified was Escherichia coli, found in 20 patients (33%). This was followed by Pseudomonas fluorescens in 7 patients (11.6%), Klebsiella pneumoniae in 6 patients (10%), Serratia marcescens in 6 patients (10%), Pseudomonas aeruginosa in 5 patients (8.3%), Kluyvera cryocrescens in 5 patients (8.3%), Proteus vulgaris in 5 patients (8.3%), Raoultella orithinolytica in 3 patients (5%), Klebsiella oxytoca in 2 patients (3.3%), and Enterobacter cloacae in 1 patient (1.6%). The biliary organisms showed various antibiotic sensitivity patterns. The highest sensitivity was observed with Cefotaxime (71%). The other antibiotics arranged as following; Amikacin (56%), Gentamicin (50%), Ciprofloxacin (46%), Meropenem (40%), Ceftazidime (35%), Imipenem (35%), Ertapenem (10%), Ampicillin (10%), Amoxicillin clavulanate (10%), and Cefepime (8%). In addition, female gender and advanced age were noted as contributing factors to gallstones. Cholesterol stones were found to be more common than other kinds of gallstones.

A Case of Cholelithiasis with Severe Abdominal Organ Malposition after Omphalocele Surgery

A Case of Cholelithiasis with Severe Abdominal Organ Malposition after Omphalocele Surgery

Clinical and genetic diagnosis for 26 paitents with hereditary spherocytosis.

Hereditary spherocytosis (HS) is the most common hereditary defect of the red cell membrane, mainly characterized by anemia, jaundice, and splenomegaly. Due to the atypical clinical manifestations and negative family history of some patients, as well as the low sensitivity and specificity of traditional laboratory examinations, it is easy for it to escape diagnosis or be misdiagnosed. At present, it has been confirmed that the mutation of ANK1, SPTB, SPTA1, SLC4A1 and EPB42 genes can cause the deletion of their corresponding coding proteins, and thus lead to the defect of erythrocyte membrane. This study aims to analyze the feasibility and clinical application value of HS gene diagnosis. Data of 26 patients from Hunan, China with HS admitted to the Department of Hematology, Second Xiangya Hospital of Central South University from January 2018 to September 2021 were retrospectively collected, and their clinical manifestations and results of laboratory examinations were analyzed. Next-generation sequencing (NGS) combined with Sanger sequencing were applied. The mutation of HS pathogenic gene and the variation of uridine diphosphate-glucuronosyl transferase 1 family polypeptide A1 (UGT1A1), a key enzyme in the regulation of bilirubin metabolism, were detected. The results of pathogenic gene variations were interpreted pathogenic gene variations in accordance with the Standards and guidelines for the interpretation of sequence variants published by the American College of Medical Genetics and Genomics (ACMG). The clinical characteristics of patients with different gene variants were analyzed, and the clinical diagnosis and genetic diagnosis were compared. Among the 26 patients with HS, there were 23 cases of anemia, 25 cases of jaundice, 24 cases of splenomegaly, and 14 cases of cholelithiasis. There were 16 cases with family history and 10 cases without family history. The results of HS mutation test were positive in 25 cases and negative in 1 case. A total of 18 heterozygous mutations of HS pathogenic genes were detected in 19 families, among which 14 were pathogenic, 1 was likely pathogenic and 3 were of unknown significance. SPTB mutations (12) and ANK1 mutations (4) were the most common. The main variation types were nonsense mutation (9). There were no significant differences in peripheral blood cell parameters and hemolysis indicators between the SPTB mutant group and the ANK1 mutant group (all P>0.05). The rate of splenectomy in ANK1 mutation group was higher than that in SPTB mutation group, and the difference was statistically significant (χ2=6.970, P=0.014). There were no significant differences in peripheral blood cell parameters and hemolysis indicators among different mutation types (nonsense mutation, frameshift mutation, splice site mutation and missense mutation) (all P>0.05). Among the 18 clinically confirmedpatients, there were 17 cases whose diagnosis is consistent with the genetic diagnosis. Eight patients were clinically suspected, and all of them were confirmed by detection of HS gene mutation. Twenty-four patients with HS underwent UGT1A1 mutation detection, among which 5 patients carried UGT1A1 mutation resulting in a decrease in enzyme activity, and 19 patients had normal enzyme activity. The level of total bilirubin (TBIL) in the group with reduced enzyme activity was higher than that in the group with normal enzyme activity, and the difference was statistically significant (U=22, P=0.038). Most patients with HS have anemia, jaundice and splenomegaly, often accompanied by cholelithiasis. SPTB and ANK1 mutations are the most common mutations in HS pathogenic genes among patients in Hunan, China, and there was no significant correlation between genotype and clinical phenotype. Genetic diagnosis is highly consistent with clinical diagnosis. The decrease of UGT1A1 enzyme activity can lead to the aggravation of jaundice in HS patients. Clinical combined gene diagnosis is beneficial for the rapid and precision diagnosis of HS. The detection of UGT1A1 enzyme activity related gene variation plays an important role in evaluation of HS jaundice.

Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy.

Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.

Early Cholecystectomy versus Conservative Management in Mucocele Gall Bladder

Aim: To compare the early cholecystectomy versus conservative management in mucocele gall bladder. Study design: Retrospective study Place and duration of study: Department of General Surgery, Ward-2, JPMC/Jinnah Sindh Medical University, Karachi from 1st October 2020 to 30th September 2022. Methodology: One hundred patients suffering from cholelithiasis with mucocele gall bladder were included. The patients were divided into two groups on the basis of stone location. Group 1 was those where the stone was found on the base of common bile duct (CBD) and elective/early surgery was conducted for the cases of cholelithiasis. Group 2 was those where conservative/delayed surgical technique was applied due to stone location not in the CBD for treatment. While in each group there were 50 cases which were age and gender matched. The first priority for surgical option was through laparoscopic surgery. Results: The mean age of the patients was 45.2±3.3 years. Out of the total cases in group 1 the process of ERCP was conducted in 64% of the cases before laparoscopy. There were 1% and 10% cases which were shifted to open surgery from laparoscopic in group1 and 2 respectively. Consequently, the mean operative time and hospital duration was increased in group 2. Within the Group 2 cases the risk of sepsis, wound contamination and perforation of gall bladder was much higher than in the Group 1 by a value of 10%, 12% and 6% respectively. There was 1 case of mortality and 2 cases of pancreatitis in group 2. Conclusion: The early cholecystectomy is a much safer and efficient procedure on treatment of mucocele gall bladder cases verses conservative management. Keywords: Early cholecystectomy, Conservative management, Mucocele gall bladder

Laparoscopic cholecystectomy in a patient with situs inversus totalis: report of a case with surgical tips

Background: Situs inversus totalis (SIT) is a rare congenital anomaly characterized by the mirror-image transposition of organs. To date, approximately 100 cases of laparoscopic cholecystectomy (LC) have been reported in patients with situs inversus. Although laparoscopic surgery was successfully completed in all these cases, the operation is known to be technically challenging in patients with situs inversus. Herein, we report a case of cholelithiasis with SIT in a patient who underwent successful LC. Additionally, we have discussed surgical tips that could serve as guidelines for clinicians who encounter such cases in surgical practice.

Gallstone Obstruction In Jejunum: A Rare Case

Gallstone ileus refers to mechanical obstruction of the small intestine due to impaction of one or more gallstones. It occurs as a complication of cholelithiasis, more in elderly females [1]. CECT is the best diagnostic tool and the definitive treatment of gallstone ileus is surgical removal. The prevalence of cholelithiasis among American Indians may reach upto 70% and is much lower in Asians[6]. However most cases of cholelithiasis are asymptomatic and are found as an incidental finding and it is reported that on an average 1-2.3% of patients experience complications[8]. Gallstone ileus occurs due to inflammation and erosion of any part of the biliary tree leading to enterobiliary fistula through which the stone passes. Patients usually present with non-specific symptoms and acute cholecystitis is present in 10–30% cases[9]. Diagnosis clinically poses a challenge due to vague presentation with nonspecific symptoms but a radiological diagnosis on CECT and MRCP can be made. Enterolithotomy is a definitive procedure with or without cholecystectomy, fistula closure. The ongoing inflammation may complicate cholecystectomy and fistula repair. Considering that most patients are older with multiple comorbidities with added physiological stress, multiple procedures are not done in the same setting. Though laparoscopic/ laparoscopy assisted surgeries have reported better efficiency and lesser complications, less availability of equipment and surgeon’s skills and training are often a limiting factor. As there are variabilities in the surgical approaches the patient factors and surgeon factors must be kept well in mind and then to proceed with the surgery of choice. With all these at the back of the mind, higher success rates with lesser hospital stay, perioperative events and mortalities are achievable.

Effectiveness of homoeopathy in treatment of cholelithiasis: A retrospective study

Cholelithiasis or Gallstone is a very common problem among worldwide. In developed countries gallstones occurs in 15:7 ratio among females and males, showing female predominance, and 11% of overall prevalence. Gastro Intestinal Quality of Life Index rating (GQLI) scale is a tool which assess the quality of life in patients those who are suffering with gastrointestinal symptoms. Homoeopathy is a unique system of medicine based on law of similars. It is a unique method of treatment which treats patients with individualization. Aims and Objective: Exploring the role of individualized homoeopathic medicines in treating cholelithiasis by using GIQLI rating scale. Study design: Retrospective study. Site: Patients who had visited Gastrointestinal Out Patient Department of National Homeopathy Research Institute in Mental Health, Kottayam, Sample size: 12 diagnosed cases of cholelithiasis with 12 follow-ups. Inclusion Criteria: Patients whohad diagnosed with cholelithiasis and having minimum 12 follow-ups were included inthis study. Discussion: Out of 12 patients enrolled for the study, 10 (83.33%) were female and 2 (16.67%) were male. Lycopodium clavatum was indicated in 4 patients (33%), followed by Nux vomica 3(25%), Bryonia alba 2 (16.5%), Sulphur 2 (16.5%), Calcarea carb 1 (9%).9 (75%) patients in our study. The study also showed a higher prevalence in female (83%) than in males (17%). Conclusion: Homoeopathic system of medicine treats the patient as a whole and not the disease, the totality of symptoms were considered in selection of medicine. The above study showed marvelous improvement which proves that homoeopathy is effective in treatment of cholethiasis.

A O01 Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study

Abstract Background Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. Methods This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. Results Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and were excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months. Conclusions UDCA 500 mg once daily for 12 months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.

Correlation Between Body Mass Index, Gender, and Age With Cholelithiasis

BACKGROUND : Gallstones are formed due to deposit or hypersaturation of one or more of the bile components, namely cholesterol, bilirubin, bile salts, calcium, protein, fatty acids, and phospholipids. BMI, gender, and age are the factors that can trigger the formation of gallstones. In Indonesia, cholelithiasis cases have received less attention because they are often asymptomatic, making it difficult to detect and often misdiagnosed, resulting in a lack of official publication about the incidence of gallstones in Indonesia. AIM : To determine the correlation between BMI, Gender, and Age with cholelitiasis in Dr. Kariadi Hospital. METHOD : This was an observational study using cross-sectional design. Data were taken from medical records of patients in Digestive Surgery Department Dr. Kariadi Hospital from January 2018 until March 2020. A total of 100 patients were selected as subjects (50 patients with cholethiasis and 50 patienst without cholelithiasis). Pearson Chi-Square correlation was used for statistical analysis. RESULTS : Pearson Chi-Square test of BMI (p = 0.001) and Age (p = 0.041) was statistically significant for cholelithiasis risk (p < 0.05). While Gender (p = 0.224) was not statistically significant for cholelithiasis risk. CONCLUSION : There wa a significant correlation between BMI and Age with Cholelithiasis and there was no significant correlation between Gender with Cholelithiasis. KEYWORDS : Body Mass Index (BMI), Gender, Age, Cholelithiasis.

Difficult Laparoscopic Cholecystectomy Predictors and its Significance: Our Experience.

Laparoscopic cholecystectomy (LC) has become the procedure of choice for the management of symptomatic gallstone disease. In LC, the surgeons encountered difficulties with acutely inflamed or gangrenous gallbladder (GB), dense adhesions at Calot's triangle, fibrotic and contracted GB, and cholecystoenteric fistula. Depending on the difficulty faced during the surgery, the outcome of LC may vary from abandoning the procedure or partial cholecystectomy to conversion into open cholecystectomy. Complications related to biliary tract or adjoining structures or vessels may also occur. Our aim was to assess the different preoperative factors in patients of cholelithiasis and ascertain the validity of the scoring system devised by Randhawa and Pujahari in preoperatively predicting the difficult LC in our hospital scenario. This hospital-based observational study was conducted in the Department of General Surgery for a period of 2 years. All diagnosed cases of cholelithiasis admitted for elective LC during the study period in our hospital were included in the study. In total, 154 patients, aged≥50 years, history of hospitalization for acute cholecystitis (AC), body mass index of 25 kg/m2 and more, abdominal scar, palpable GB, GB wall thickness ≥4 mm, pericholecystic collection, impacted stone found to be significant factors to predict difficult LC preoperatively. Endoscopic retrograde cholangiopancreatography and pancreatitis were found as independent risk factor for difficult LC. We recommend that the scoring system should be regularly used as a protocol for predicting difficulty levels preoperatively in LC. It can help to decide the surgical approach, counsel the patients, and reduce the complication rate, rate of conversion, and overall medical cost. The scoring system proposed by Randhawa and Pujahari is effective but has some lacunae.

Approach of Individualised Medicine in a Complicated Case of Cholelithiasis, Elongated Uterus with Ovarian Cyst—An Evidence-Based Case Report

AbstractGallstones are the most common biliary pathology. They are formed because of abnormal bile composition. Symptomatic gallstones present as pain in the right upper quadrant or epigastric region, which may radiate to the back. Ultrasonography of the gallbladder is very accurate in the identification of gallstones. Laparoscopic cholecystectomy is a minimal-access approach for the removal of the gallbladder together with its stones. A 28-year-old lady presented with complaints of pain in the right upper quadrant of abdomen, which was relieved by pressure, nausea and occasionally vomiting especially after having a rich meal for 1 month with constant dull pain in lower abdomen during menses for 2 to 3 months. Her ultrasonography of whole abdomen revealed cholelithiasis (stone size 8mm), elongated uterus with left ovarian cyst. Individualised medicine Natrum muriaticum was prescribed in a centesimal scale which showed a positive effect in the case within a short span of time. Causal attribution of changes in her condition to the homoeopathic treatment was assessed by Modified Naranjo Criteria. Future observational studies and randomised control trials are suggested to ascertain the efficacy of homoeopathic medicine in such cases.

Usefulness of Ursodeoxycholic Acid in Management of Gallstone Disease in Children

Objective − The aim of the study is to assess the usefulness of ursodeoxycholic acid in management of gallstone disease in children. Materials and Methods − The prospective study aimed to assess the management of gallstone disease in children. We analyzed all new cases of cholelithiasis during the period from January 2016 to March 2020. Forty-eight new cases of cholelithiasis were enrolled in the study. The diagnosis was established by ultrasound examination due to different complaints in previously healthy patients, or during regular follow-up visits in patients with a chronic disease. A Student t-test, Fisher’s test and χ2-test were used in the statistical processing, where appropriate. Results − A 6-month course of treatment with ursodeoxycholic acid was conducted in 72.9% of cases (N=35). In 27.1% (N=13) of patients this treatment was not administered. Successful dissolution of gallstones was observed in 31.4% (N=11) of treated patients (N=35), over a period of 1 to 6 months. In the group of nontreated patients (N=13), successful dissolution of gallstones was achieved in 38.5% (N=5). Cholecystectomy was performed in 10.4% (N=5) patients, and 1 patient underwent endoscopic retrograde cholangiopancreatography. No early complications, relapse or postcholecystectomy syndrome were observed in the 12-month follow-up period. Conclusion − Management of cholelithiasis in children can often be a challenge. In a selected patient group, conservative treatment may be successful. Use of ursodeoxycholic acid can lead to dissolution of gallstones in patients with preceding dehydration. The effectiveness of ursodeoxycholic acid, except in children with dehydration, was higher