Chronic Calculous Cholecystitis Research Articles

Acute Cholecystitis Due to Lactococcus lactis and Single-Center Experience with Infections Due to Lactococcus spp.

Background: Lactococcus species are used to ferment milk to yogurt, cheese, and other products. The gram-positive coccus causes diseases in amphibia and fish and is a rare human pathogen. Patients and Methods: A 51-year-old male underwent laparoscopic cholecystectomy for acute and chronic calculous cholecystitis. Lactococcus lactis was isolated from pus from his gallbladder empyema. Results: Our institutional database was searched for other cases of Lactococcus spp. infections and four patients (2 males, 2 females; aged 51, 64, 78, and 80 years) were identified during a four-year period. The three other patients had positive blood cultures associated with pneumonia, toxic megacolon, and severe gastroenteritis. All isolates were monocultures with Lactococcus lactis (2), Lactococcus garvieae (1) and Lactococcus raffinolactis (1). Two patients died related to their sepsis. We report the second case of cholecystitis involving Lactococcus. Conclusions: Lactococcus is a very rare pathogen mainly causing blood stream infections but needs to be considered to cause serious surgical infections in humans.

Laparoscopic cholecystectomy in calculous cholecystitis: are antibiotics necessary?

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

Tissue structure transformations of the gallbladder in chronic calculous cholecystitis

Aim. To determine the morphofunctional characteristics of tissue changes in the structure of the gallbladder in chronic calculous cholecystitis.Materials and Methods. The macro- and microscopic structural walls of the gallbladder were studied using the method of injection anatomical dissection, histology, and morphometry in 61 patients (aged 36 to 60) with chronic calculous cholecystitis.Results and Discussion. The results of a morphological study show that in chronic calculous cholecystitis, changes are always observed in all layers of the gallbladder wall. The most severe dystrophic and sclerotic changes are observed in the mucous membrane and submucosal base, since, this layer has in functional, topographical and quantitative features, as well as a direct contact with stones (mechanical impact).Conclusion. Transformation of the gallbladder in chronic calculous cholecystitis are characterized by vascular tissue restructuring of the structures of the organ wall, accompanied by the phenomena of adaptive, exudative and proliferative transformations, and in the later stages (5-6 years) undergo sclerotic changes in the gallbladder wall.

Role of the cytokine system in patients with acute and chronic calculous cholecystitis

Introduction and Aim: Interleukin 1 (IL-1a and IL-1b), IL-6, and tumor necrosis factor-alpha (TNF-alpha), which are mostly released by monocytes and macrophages, are three cytokines that are effective, have multiple uses, and act as proinflammatory proteins during immune response and inflammation. The objective of this study was to evaluate the role of cytokine system in patients with acute calculous cholecystitis (ACC) and chronic calculous cholecystitis (CCC) when the disease got worse after medical and surgical treatment.   Materials and Methods:  One hundred and thirty-three patients with acute cholecystitis who were hospitalized in our department and were divided into two groups. 79 patients with ACC made up Group 1. 54 patients with CCC made up Group 2. Based on clinical symptoms and an ultrasound scan, the clinical diagnosis was confirmed.   Results: A comparison of cytokines revealed that in purulent cholecystitis, the value of IL-6 becomes considerably higher than in ACC, and TNF-alpha becomes significantly higher, whereas IL-1 and IL-4 do not reach significant levels. A comparison of the concentration-time patterns of cytokines in the two groups when they left the hospital showed that IL-1beta and TNF-alpha in group 2 patients were higher than in group 1, but IL-4 was lower.   Conclusion: Following drug and surgical treatment, ACC resolves with a significant drop in the levels of pro-inflammatory cytokines and a rise in anti-inflammatory IL-4.

Comparison of three-port versus four-port laparoscopic cholecystectomy

Background: In the era of laparoscopic surgery, early recovery and less post-operative pain are major goals to improve patient care and cut down cost. Several studies have demonstrated less post-operative pain and early recovery with the reduction in size and number of ports. Aims and Objectives: To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, intraoperative difficulties, post-operative pain, incidence of complications, and cosmetic results. Materials and Methods: The study was done in Maharani Laxmi Bal Medical College, Jhansi, between April 2021 and November 2022, including 2 groups of patients (Group A-50 patients of three-port LC and Group B-50 patients of four-port LC). Results: Most of the participants were from 18 to 30 years (32%, 38%) and 31 to 40 years (30%, 12%) in both the groups. The mean duration of surgery in three-port and four-port group was 41.64±6.972 and 42.22±13.784 min, respectively (p=0.79). Hospital stay was three-port and four-port group was 3.33±0.789 and 3.86±0.707 days, respectively (p=0.0001). 100 patients were included, with 2085 patients. The mean age of the studied patients was 46.38 years with female preponderance. The mean operative time for three ports was 66.90 min and for four ports, it was 75.45 min. The mean duration of post-operative stay for three-port was 4.66, and for the conventional group, it was 5.30. Conclusion: Three-port lap cholecystectomy can be advocated to be better than the 4-port technique, but especially in experienced hands, and 4-port LC is better for beginners.

The possibilities of the thrombodynamics test in predicting, diagnosing and monitoring the effectiveness of the treatment of venous thromboembolic complications in planned surgical interventions

Introduction. The problem of venous thromboembolic complications after planned surgical interventions remains relevant and requires special research and analysis, which was the purpose of this work. Objective. To study and evaluate the possibilities of the thrombodynamics test for predicting, diagnosing, and monitoring the effectiveness of treatment of postoperative venous thromboembolic complications in planned surgical interventions. Materials and methods. In this study, we implemented the thrombodynamics test in parallel with ultrasound examination of the veins of the lower extremities and pelvis before planned surgery and in the postoperative period on 1–3, 7–9, 14–16, and 30 days in 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias, and varicose veins of the lower extremities) stratified into risk groups for postoperative venous thromboembolic complications. Results. It was revealed that, in the preoperative period, 16.6 % of patients have hypercoagulation at normal standard blood counts and 65 % of them are patients from a low-risk group of venous thromboembolic complications. In the postoperative period, the number of cases of hypercoagulation increased to 34.2 % due to elderly and senile patients from groups with an estimated moderate and high risk of venous thromboembolic complications. Deep vein thrombosis was detected in 18 (15 %) subjects (6 patients from each risk group) within 2–15 days after surgery and in all cases it developed in the presence of preoperative hypercoagulation. Conclusions. It is shown that the thrombodynamics test is highly informative in predicting, diagnosing and evaluating the effectiveness of venous thromboembolic complications treatment during planned surgical interventions.

HPB P47 Torsion of a wandering gallbladder

Abstract Background Gallbladder torsion is an uncommon cause of acute abdomen. Despite over 500 reports published since 1898, only 10 cases of wandering gallbladder have been reported. In this anatomical variant (4-5% of the population) the gallbladder has no attachments to the liver. It is suspended only by the cystic duct and artery, which predisposes to twisting of the pedicle. Subsequent gallbladder necrosis can lead to rupture, peritonitis, sepsis and death (6%). Patients are typically elderly females, above the age of 70. A palpable gallbladder is described in 54% of cases. We report a rare case of wandering gallbladder leading to torsion. Methods An 89-year-old lady presented to emergency department with abdominal pain associated with vomiting and bowel not opened for five days. A palpable mass was evident on the right lower side of her small abdomen. Vital signs and lactate level were within normal range. Despite CRP was only moderately elevated on admission, it suddenly climbed to 504 within 24 hours. An abdominal CT scan showed a distended thick-walled gallbladder with a large stone, reported as “consistent with chronic calculous cholecystitis”. Results The patient was urgently brought to theatre for a laparoscopy where a free-floating gallbladder was found at the right lower quadrant, distended and gangrenous, rotated around its vascular axis. The surgery was converted to open due to lack of sufficient intra-abdominal space to accomplish the procedure. Her gallbladder was in the end successfully removed with no further concern and a washout of the peritoneal cavity was performed. The subhepatic drain was removed on day 1 postoperative. She recovered uneventfully and was discharged 12 days later due to social issues. Conclusions Despite rarely encountered, gallbladder torsion should be considered in the differential of patients presenting with acute abdomen, especially in case of rapid deterioration. Symptoms are nonspecific, as well as radiographic signs. A preoperative diagnosis is rarely made. If delayed, the condition may potentially become life-threatening. Surgical exploration is thus warranted and, once recognized, cholecystectomy remains the only resolutive treatment.

Combination of Mucocele of the Appendix and Chronic Calculous Cholecystitis: Case Report

Background: The analysis of the data presented in the foreign and national literature shows that a combination of the appendix mucocele and calculous cholecystitis is extremely rare, and the implementation of simultaneous surgical treatment in the laparoscopic version is the optimal approach. Clinical case description. Here, we present a clinical case of chronic calculous cholecystitis in combination with mucocele of the appendix in an 84-year-old patient. The main complaint was pulling pain in the right iliac region. The diagnosis was made on the basis of the main and additional methods of examination: clinical picture, ultrasound, multispiral computed tomography and magnetic resonance imaging of the abdominal organs. In a planned manner, a simultaneous surgical intervention was performed consisting of laparoscopic appendectomy and cholecystectomy. The operation duration was 1 hour 15 minutes. The morphological examination confirmed the diagnosis of calculous cholecystitis and mucocele of the appendix. The patient was discharged in a satisfactory condition on the 4th day. Conclusion. This clinical case shows that the dynamic observation of mucocele of the appendix, even in elderly patients with a comorbid pathology, is unjustified. A simultaneous surgical intervention in the form of laparoscopic appendectomy and cholecystectomy treats the two nosologies and prevents repeated hospitalization and surgery.

The thrombodynamics test as a new opportunity for a polyclinic surgeon to monitor postoperative venous thromboembolic complications

Introduction. Postoperative venous thromboembolic complications – a frequent and difficult to control problem for a polyclinic surgeon. Aim. To study and evaluate the possibilities of using the thrombodynamics test for the control of postoperative venous thromboembolic complications. Materials and methods. In 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias and varicose veins of the lower extremities), who underwent planned surgical treatment, stratified into risk groups of postoperative venous thromboembolic complications: low, moderate and high, in the postoperative period for 2–3, 7–9, 14–16, 30 days, a study of D-dimer, thrombodynamics test was conducted in parallel with ultrasound examination of the veins of the lower extremities. Results. It was revealed that hypercoagulation according to the thrombodynamics test was present in 34.2% of patients already at the first study, an increase in D-dimer was noted in 28.3% of patients at late follow-up, venous thrombosis was detected on ultrasound in 15% of the studied 6 people from each risk group within 2–15 days after surgery, carried in 83.3% The cases were asymptomatic, localized mainly in the deep veins of the lower leg and were always combined with hypercoagulation according to the thrombodynamics test and an increased level of D-dimer. It was noted that hypercoagulation against the background of the use of standard doses of anticoagulants in 61% of cases takes a positive trend, and in 39% remains unchanged. Discussion. Hypercoagulation recorded by the thrombodynamics test in the first days after surgery indicates insufficient effectiveness ofstandard thromboprophylaxis in the perioperative period. An increase in the D-dimer cannot be used as a prognosis of a prethrombotic state. Conclusions. Hypercoagulation as a precursor of venous thrombosis is well detected by the thrombodynamics test, its dynamics reflects the individual effectiveness of the use of anticoagulants, which justifies the possibility of using this indicator by a polyclinic surgeon in the control of postoperative venous thromboembolic complications.

COMPARISON OF SAFETY OF MINILAPAROSCOPIC AND CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY

Abstract. Aim: to assess the safety of mini-laparoscopic cholecystectomy (MLC) compared to traditional laparoscopic cholecystectomy (LC) based on a critical view of safety (CVS).
 Materials and methods: an analysis of 46 video recordings of MLC surgeries and 156 LC surgeries performed for chronic calculous cholecystitis and gallbladder polyps between 2015 and 2022 was conducted, using the concept of CVS and the quality of its achievement. An analysis of anatomical variations was also performed.
 Results and discussion: the average age was 38.5 years in the MLC group and 53.8 years in the LC group, with an average operation time of (59.4±2.13) minutes and (63.01±2.01) minutes, respectively. CVS was achieved in 97.8 % of cases in MLC and 93.0 % in LC. Anatomical variations were present in 31.1 % of cases in MLC and 30.1% in LC. There were no complications of MLC, conversions from MLC to LC, or open surgery.
 Conclusions: The frequency of achieving CVS in MLC was higher than in LHE (97.8 % vs. 93.0 %). Anatomical variations of the biliary system should always be considered for the safe cholecystectomy. MLC is a safe technique that is not inferior to standard LCE in elective surgery in patients with a normal BMI, and at the same time has better cosmetic results.

The first experience of using the "Senhance" robotic surgical system during cholecystectomy

The aim of our study was to evaluate the differences in intra­operative and postoperative outcomes of cholecystectomy using the Senhance robotic platform and laparoscopic cholecystectomy. A retrospective analysis of medical cases history of patients who underwent cholecystectomy from December 2021 to February 2022 was conducted. The treatment outcomes of patients with chronic calculous cholecystitis who underwent robotic cholecystectomy (RC) were compared with those who underwent laparoscopic cholecystectomy (LC). Robotic cholecystectomy was performed using the Senhance robotic platform. The RC and LC groups were matched for age, sex, body mass index and compared for the duration of the operation and hospital stay. For normally distributed data, the mean and standard deviation, determined using the Shapiro-Wilk test (p-value>0.05), were applied. Median and interquartile range (IQR) were also used. Difference between cohorts - 95% confidence interval (95% Confidence Interval) were estimated for normally distributed data. Data analysis was performed using standard summary statistics on the Jamovi 2.2.5 platform. Data were processed using application program packages. All surgical procedures were performed by two surgeons from Odesa National Medical University. Robotic cholecystectomy was performed on 18 pa­tients and laparoscopic cholecystectomy was performed on 20 patients. There were no statistically significant differences between the groups in terms of length of hospital stay, blood loss or complications. There were no bile duct injuries, intra­operative complications, or conversions in either group. The only statistically significant difference was the total time under anesthesia (p>0.05), which was longer in the robotic cholecystectomy group. Cholecystectomy using the Senhance robotic platform was found to be safe, with an average operative time of 35.2±5.0 minutes, while the duration of laparoscopic cholecystectomy was 32.2±3.3 minutes. The study results showed that robotic cholecystectomy using the Senhance system is safe and effective. The use of robotic systems can improve precision and control during surgery, reduce blood loss and complications.

Surgical Audit of Operated Patients in a Tertiary Care Hospital in Karachi, Pakistan

Objectives To audit operated patients in emergency and electively from 1st January 2018 to 31st December 2019 in all three surgical departments to know the outcome of the patients at a tertiary care hospital in Karachi, Pakistan. Material and Methods A retrospective study conducted in all three Abbasi Shaheed Hospital surgical units from 1st January 2018 to 31st December 2019. In this study total of 5079 patients were included who were admitted through the emergency and surgical outpatient department. They were operated in emergency and elective theaters in all three surgical departments of Abbasi Shaheed Hospital. Data was collected on pre-designed performa from emergency and elective theater, wards, High-dependency unit and Intensive care unit maintained registers by staff. Results A total of 5079 cases were operated during January 2018 to December 2019. Among all the age ranges 1282 belongs to the age range of 21-30 years. Amongst which 59.6% were males. The most common diagnosis made in elective patients was chronic calculous cholecystitis (25.8%) and an abscess in emergency (39.4%). The most common procedure performed in elective surgeries was combined laparoscopic and open cholecystectomy (26.8%) and incision and drainage in the emergency (39.4%). Elective surgeries were mainly performed by Associate Professors (28.7). While, emergency surgeries were mainly performed by post-graduate trainees (70.2%). Surgical unit II has performed most surgeries (39.5%). Elective procedure constitutes about (51.60%). Total 19 patients expired out of 350 patients who were shifted or admitted in surgical ICU and 12 patients expired in all three wards. Conclusion We have a higher number of elective surgeries as compared to the emergency surgeries. Consultants have performed most of the elective surgeries. Emergency surgeries mostly by residents and senior registrars. We have zero mortalities in our elective surgeries in comparison with emergency surgeries. We call attention to conduct continuous audits at our hospitals and all levels of health care and demand from higher authorized personnels to incorporate audit awareness in our teaching. Along with it, a proper database should be installed with updated records maintenance to improve the lack of health care.

Th1/Th2 cytokine profile in patients with acute and chronic calculus cholecystitis.

Relatively little is known about the relationship between Th1/Th2 cytokines and calculus cholecystitis (CC). The purpose of this study was to investigate the correlation between serum Th1 and Th2 cytokine expression and CC, including both acute and chronic cases. In total, 102 patients with chronic calculous cholecystitis (CCC), 64 patients with acute calculous cholecystitis (ACC), and 55 healthy controls (HCs) were recruited for the study. Serum concentration of Th1 (IL-2, TNF-α, IFN-γ) and Th2 cytokines (IL-4, IL-6, IL-10) was measured at admission and on the fifth day after cholecystectomy using flow cytometry. In addition, the ratio of IL-6/IL-10 was calculated. Correlation of the corresponding factors was then analysed, and univariate and multivariate Cox regression analyses were performed to identify independent markers of ACC severity. Compared to HCs, CCC patients exhibited significantly elevated expression levels of IL-6 and IL-10, while ACC patients demonstrated higher expression of IL-2, TNF-α, and IL-6/ IL-10 in addition to IL-6, and IL-10. In ACC patients, there was a strong positive correlation between IL-6 and IL-10 concentration, the expression of IL-2 was observed to positively correlate with serum ALT and AST concentration, and TNF-α expression positively correlated with the duration of hospitalization. Moreover, patients with moderate-to-severe ACC presented with higher expression of IL-10 compared to those with mild ACC. Cox regression analysis confirmed that IL-10 and IL-6 were independent factors for the severity of ACC. Following surgery, the levels of IL-6 and IL-6/IL-10 significantly decreased but did not fully return to baseline levels in ACC patients. Our study reveals atypical Th1/Th2 cytokine expression profiles in patients with acute and chronic CC, and further highlights the significant potential of these cytokines, particularly IL-6 and IL-10, in assessing the severity and progression of CC.

Chronic calculus cholecystitis: A prospective clinico-pathological study with lab based evidence

Chronic calculous cholecystitis is an inflammatory disease which affects the gallbladder wall and causes dysfunction of the biliary system. It is the most common benign disease of the gall bladder. To study the pattern of age and sex distribution, diet and clinical feature of patients, the laboratory and radiological investigations of patients presenting with the associated pathology, the intraoperative pathological changes of the gall bladder. This study was conducted from July 2021 to June 2022 at Department of General Surgery, Santosh Medical College and Hospital, Ghaziabad. 100 patients were included in this study. The age, gender, symptomatology, laboratory and radiological findings, intraoperative findings, and histopathological changes where analysed and documented. In our study maximum patients were found in 31-40 years of age. It was found to be most common in females, who consumed mixed diet. The most common symptom was abdominal pain. In ultrasound whole abdomen gall bladder wall thickness was found in majority of the patients. 98% of the patient underwent laparoscopic cholecystectomy and intraoperatively gall bladder was found contracted in 51% of patients. On histopathological examination mild degree of inflammation was seen in 60%, gall bladder wall thickness seen in 50% and the most common type of gall stone was found to be mixed type in 58% patients. We observed the intraoperative pathological changes of the gall bladder, radiological investigations of patients, laboratory investigations of patients and the pattern of age and sex distribution, diet, and clinical feature of patients.

Complex Antegrade Percutaneous Transhepatic and Retrograde Endoscopic Lithotripsy and Extraction

We report a clinical case of elimination of megacholedocholithiasis using complex antegrade percutaneous transhepatic and retrograde endoscopic contact electropulse lithotripsy and extraction. Since an attempt of antegrade extraction failed due to megacholedocholithiasis, the patient underwent complex contact electropulse lithotripsy followed by lithotripsy through antegrade and retrograde access, which made it possible to eliminate megacholedocholithiasis without the development of postoperative complications, restore the lumen of the bile ducts and ensure the possibility of subsequent planned surgical treatment of chronic calculous cholecystitis.

Computed tomography in the diagnosis of oncopathology in end-stage renal disease: A case report

BACKGROUND: In recent years, an increasing tendency of oncopathology in patients with chronic kidney disease (CKD) was observed. Clinical data demonstrate an increased risk of malignization in patients with decreased renal function. The cohort study (2022) reported a cumulative incidence of cancer in nephrology patients ranging from 10.8% to 15.3%. A high percentage of stage IV cancers were detected in patients with CKD at the time of diagnosis. In 2022, the American Association for Cancer Research published the results of a Mendelian Randomization Study examining the causal relationship between CKD and the risk of developing 19 local cancers, including renal cell cancer, cervical cancer, leukemia, and colorectal cancer. Several studies found a direct correlation between a decreased glomerular filtration rate and the development of oncopathologies. Therefore, cancer awareness is important in the management of patients with CKD. In patients with end-stage chronic renal disease (ESRD) who are on hemodialysis, X-ray diagnosis with iodine-containing radiopaque agents is possible without additional risk of kidney damage.
 AIM: To demonstratу the role of computed tomography (CT) in the diagnosis of oncopathology in a patient with CKD to attract the attention of physicians to the importance of using advanced diagnostic techniques in patients with CKD.
 METHODS: A clinical case of a 32-year-old patient M. who was hospitalized in the Therapeutic Department of Multidisciplinary City Hospital No. 2 in Astana was presented.
 RESULTS: A patient with ESRD resulting from chronic glomerulonephritis in a hypertensive form complained of dyspnea at rest, cough with difficult sputum, right thoracic pain, general weakness, and weight loss of 8 kg in 1 month. Past medical history showed that the patient was on alternate program hemodialysis for 4 years. Deterioration occurred within 3 months. The patient was examined at the place of residence. CT scan showed signs of tuberculosis of the upper right lobe (?) and lymphadenopathy of intrathoracic and axillary lymph nodes. A neoplasm was not excluded. The patient was consulted by a phthisiatrician, GeneXpert sputum was performed, and tuberculosis was excluded. In dynamics, ultrasound was conducted due to increasing dyspnea. Fluid accumulation in the pericardial and pleural cavities was detected. A pulmonologist assessed the situation as uremic pericarditis, pleurisy on the right side, and right-sided pneumonia in the upper lobe of unclear genesis. Antibacterial therapy was prescribed. Due to a significant deterioration of the condition, the patient went to the city hospital. At admission, respiratory failure, pain syndrome in the chest area, and marked asthenization up to cachexia were observed. Ultrasound of pleural cavities showed free fluid in the pleural cavity on the right (770 ml) and left (110 ml), whereas abdominal ultrasound revealed cavernous hemangiomas of the liver (?), echogenic suspension of the gallbladder, and splenomegaly. Echocardiography showed diffuse hypokinesis of all left ventricular walls. Grade 12 pulmonary hypertension was detected. Systolic function of the left ventricle was moderately decreased. Effusion in the pericardial cavity in the volume of 430 ml and congestion in the inferior vena cava were found. A patient with ESRD was on program hemodialysis for 4 years, which allowed the use of contrast-enhanced X-ray imaging techniques without the risk of additional renal damage. Contrast-enhanced chest CT showed pronounced right-sided pleurisy. Given the presence of foci of contrast agent accumulation in the structure of the parietal pleura, malignancy was not excluded (mesothelioma?). Indolent left-sided pleurisy, segmental and subsegmental compression atelectasis of the right lung, distinct edema and thickening of interlobular septa of both lungs, and single dense foci of I/II, III segments of the left lung up to 4.2 mm in diameter were detected. In addition, chronic bronchitis, pericarditis, and lymphadenopathy of subclavian, intrathoracic, and axillary lymph nodes up to 15.0 mm in diameter (malignancy not excluded) were revealed. Osteosclerosis foci of the Th3 vertebral body measuring 4.75.1 mm was observed. Contrast-enhanced abdominal and retroperineal CT scan showed a focal mass of the IVa segment of the liver measuring 17.315.916.4 mm (malignancy not excluded), chronic calculous cholecystitis, chronic pancreatitis, lymphadenopathy of intra-abdominal para-aortic and mesenteric lymph nodes up to 18.0 mm in size (malignancy not excluded), reduced size of both kidneys (contracted kidneys), and a cystic mass in the left ovary measuring 39.442.034.5 mm (35 HU). Patient was consulted by an oncologist: pleural mesothelioma? Metastasis in the liver? Consultation with a thoracic surgeon to decide on morphological verification was recommended. A biopsy was planned at the place of residence; however, morphological verification of oncopathology was not performed due to the patients lethal outcome.
 CONCLUSIONS: This clinical case of a patient with ESRD on hemodialysis demonstrates the importance of contrast-enhanced CT to diagnose oncopathology.

Acute Cholecystitis, Chronic Cholecystitis, and Associated Complications: Findings on Imaging

Mr. Barr is a Radiology Resident, University of New Mexico School of Medicine, MSC10 5530, 1, University of New Mexico, Albuquerque, NM 87131, email: [email protected]; Dr. Arif-Tiwari is Professor and Chief of Abdominal Imaging, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona; and Dr. Thompson is Professor, Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico. After participating in this educational activity, the radiologist should be better able to identify acute and chronic calculous cholecystitis on imaging, and differentiate the many complications that may develop as a result of acute cholecystitis. All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This continuing medical education activity expires on April 29, 2025.

Endoscopic retrograde contact electro-impulse lithotripsy and lithotomy

The paper presents clinical observation of a patient with cholelithiasis and so-called “difficult” choledocholithiasis. Considering the developed complications – mechanical jaundice and purulent cholangitis, as well as large operative risk, it was decided to refrain from open surgical intervention. Traditionally-performed endoscopic stone extraction did not provide any success. Contact electro-impulse lithotripsy and lithotomy were performed. This enabled choledocholithiasis and cholangitis to be eliminated, bile ducts patency to be restored, and ensured the possibility of safe elective surgical intervention for chronic calculous cholecystitis.

Wall thickness is an important predictor of gallbladder malignancy in patients surgically treated for gallbladder disease

Background: Gallbladder wall thickening is relatively common on imaging. GB thickening is a frequent finding caused by a spectrum of conditions. It is observed in many intracholecystic as well as intrinsic GB conditions. The study aimed to determine the relationship between the wall thickness of gallbladder malignancy in patients with gallbladder diseases. Methods: The Prospective cross-sectional and observational study was carried out in the department of general surgery and hepato-biliary-pancreatic surgery, BIRDEM general hospital, Dhaka from August 2019 to February 2021. Patients admitted to the general surgery and hepato-biliary-pancreatic surgery department of BIRDEM hospital who underwent gallbladder surgery were recruited for this study. Consecutive sampling was done in this study. Results: 86% of patients underwent laparoscopic cholecystectomy, while 14% had open cholecystectomy, of which 9 were simple and 6 were radical en block. The average wall thickness of the gallbladder was 7.5mm, with 52.7% moderate thickness, 37.3% mild, and 10% severe. 20% of patients with gallbladder disease had carcinoma, and the most common diagnosis was chronic calculous cholecystitis. A cut-off value of 8.25mm for gallbladder wall thickness had 81.8% sensitivity and 72.7% specificity in predicting carcinoma, and gallbladder wall thickness ≥8.25 mm had the highest significant odds ratio in predicting gallbladder carcinoma after adjusting for age, gender, and smoking history. Conclusions: GB carcinoma patients had significantly thicker gall bladder walls (9.80 vs 6.93 mm) and a higher frequency of severe GB wall thickness (36.36 vs. 3.41%) compared to patients without GB carcinoma. Gall bladder wall thickness is an important variable requiring consideration for the proper evaluation to exclude malignancy for undertaking proper surgical management, thus improving the long-term outcome.

Investigating the Relationship between Gallbladder Malignancy and Various Factors in Surgically Treated Gallbladder Disease Patients

Introduction: Gallbladder cancer is a rare but aggressive disease with a poor prognosis. Factors that may contribute to the development of gallbladder cancer include chronic inflammation, gallstones, and obesity. This study will examine the prevalence of these factors in patients who have undergone surgery for gallbladder disease, and determine if there is a correlation with the development of gallbladder cancer. This information will be valuable in identifying high-risk individuals and developing strategies for the early detection and prevention of gallbladder cancer. Methods: This prospective cross-sectional and observational study was carried out in the Department of General Surgery and Hepato-Biliary-Pancreatic surgery, BIRDEM General Hospital, Dhaka from August 2019 to February 2021. Patients admitted to the General Surgery and Hepato-Biliary-Pancreatic Surgery Department of BIRDEM hospital who underwent gallbladder surgery were recruited for this study. Consecutive sampling was done in this study. Result: The present study findings showed that the majority (65.45%) of the participants were between the age of 50-59 years, with 38.18% being male and 61.82% being female. The most common comorbidities were diabetes (62.73%), hypertension (43.64%) and anaemia (40%). The most common clinical presentation was abdominal pain (76.36%) and the most common histopathological diagnosis was chronic calculous cholecystitis (49.09%), while 20% of participants had gallbladder carcinoma. The study found an association between age, gallbladder wall thickness and gallbladder malignancy. Participants who were 60 years or older were 4.865 times more likely to have gallbladder carcinoma and those with severe wall thickness (>10mm) were 13.32 times more likely to have gallbladder carcinoma. Conclusion: The present study found that the majority of participants were between the age of 50-59 years, with a higher female prevalence. The most common comorbidities were diabetes, ..........