Chronic Calcular Cholecystitis Research Articles

The Role of Different Systemic Inflammatory Indexes Derived from Complete Blood Count in Differentiating Acute from Chronic Calculus Cholecystitis and Predicting Its Severity.

This study aimed to evaluate the diagnostic value of the different Complete blood count-derived systemic inflammation indexes, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and neutrophil to lymphocyte × platelet ratio (NLPR) in differential diagnosing the chronic calculus cholecystitis (CCC) and the acute calculus cholecystitis (ACC), as well as determining the severity of ACC. 105 CCC and 88 ACC patients were enrolled. NLR, PLR, SII, and NLPR were evaluated in both cohorts as well as in different severity levels of ACC. The severity of ACC was determined based on the Tokyo Guidelines. Receiver operating characteristic (ROC) curve and Univariate/multivariate regression analyses were conducted. The levels of NLR, PLR, SII, and NLPR were significantly higher in the ACC group compared to the CCC group. The optimal cutoff values for NLR, PLR, SII, and NLPR were determined to be 3.89, 144.7, 896.8, and 0.031 respectively. NLR>3.89 demonstrates the highest predictive capability with an AUC of 0.801 and a sensitivity of 72.73%. Multivariate analysis showed that NLR>3.89 (OR: 4.169, p = 0.004) and NLPR>0.031 (OR: 4.304, p = 0.005) were dominant in distinguishing ACC from CCC. In ACC patients, the levels of NLR, SII, and NLPR were significantly higher in the Moderate to Severe-degree ACC (MS-ACC) group than in Mild-Degree ACC (M-ACC). NLPR > 0.044 exhibited the highest predictive ability with an AUC of 0.778 and a specificity of 91.67%. Multivariate analysis showed that NLR>6.399 (OR: 10.308, p = 0.000) was a possible independent prognostic factor for accessing the severity of ACC. Systemic inflammation indexes can be useful in predicting the risk of ACC and MS-ACC. NLR demonstrates the best distinguishing power and sensitivity for distinguishing ACC from CCC, while NLPR shows the best predictive power and specificity for predicting the severity of ACC.

Evaluation of hepatic and renal functional changes in patients undergoing laparoscopic cholecystectomy

Background: In this era of laparoscopic surgery, with the use of carbon dioxide insufflation in creating pneumoperitoneum for ease of trocar insertion and visualization of anatomy, it comes certain systemic changes in the patient due to the compression effect of the gas as well as resorption of it through peritoneum. Aims and Objectives: The aim of the study was to assess baseline standards of hepatic and renal functional status in pre-operative patients in comparison with post-operative patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: Cases were chosen among the persons who presented with chronic calculus cholecystitis to the surgical out-patient department of Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata. Pre-operative liver function tests (LFT) and renal function tests (RFT) values were recorded. Again, LFT and RFT values were evaluated on post-operative day 1 (POD1) and POD12. Results: Serum conjugated and unconjugated bilirubin, aspartate amino transaminase, alanine amino transaminase, urea, estimated glomerular filtration rate values increases immediate postoperatively on POD1 but returns to normal pre-operative levels on POD 12. Serum alkaline phosphatase, albumin, and creatinine values decrease on POD1 and return to normal pre-operative values in POD 12. Conclusion: Hepatic and renal function changes in the immediate post-operative period of 24 h following LC. This change is transient and returns to normal levels within POD 12.

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.

Clinical Observations in Patient with Triple Laparoscopic Surgery for Gastric Carcinoma, Chronic Calculus Cholecystitis, and Bilateral Incomplete Direct Inguinal Hernia at a Tertiary Hospital in Bangladesh

Background: Laparoscopic cholecystectomy is now the gold standard approach for treating cholelithiasis. Compared to open surgery, triple laparoscopy, which addresses stomach carcinoma alongside chronic calculus cholecystitis and bilateral direct incomplete inguinal hernia, may offer enhanced effectiveness and convenience for patients. This study aimed to evaluate the clinical findings of patients with stomach carcinoma, chronic calculus cholecystitis, and bilateral direct incomplete inguinal hernia who underwent triple laparoscopic surgery. But the application of triple laparoscopic surgery is very rare. In this study, we have disseminated the clinical findings of a 70 year’s male patient who underwent triple laparoscopic surgery for the management of stomach carcinoma with chronic calculus cholecystitis and bilateral direct incomplete inguinal hernia. This case study was conducted in the Department of General & Laparoscopic Surgery, Evercare Hospital, Dhaka, Bangladesh during the period from 26 August 2020 to 5 September 2020. As the clinical data, the mean (±SD) values of 3 post-operative readings were accumulated to minimize the possible error. We can conclude that electrolyte status may remain normal in such patients but, dry mouth, vomiting, abdominal distension, poor appetite, poor sleep soundly and loose stools may be considered as some very common symptoms for such cases. Triple laparoscopic surgery is an effective treatment procedure in the management of stomach carcinoma with chronic calculus cholecystitis and bilateral direct incomplete inguinal hernia.

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.

Prediction of common bile duct stones in acute cholecystitis patients at time of hospital admission

Background Early diagnosis of common bile duct stone (CBDS) is crucial since its presence affects surgical therapy and acute calculous cholecystitis (ACC) has a comparable clinical picture whether or not a CBDS is present. Aim At the time of hospital admission, we sought to discover predictors of CBD stones in acute cholecystitis (AC) patients. Methods Between January 2020 and December 2022, we chose 90 patients who had typical ACC and had previously visited the emergency room at Minia University Hospital in Egypt. The 90 AC patients were split into two groups: the 63 AC patients without CBD stones and the 27 AC patients with CBD stones. The data were obtained and compared between the two groups include gender, age, history of chronic calcular cholecystitis (CCC), white blood cells (WBC), liver function tests (LFT), and common bile duct (CBD) diameter. Results By using simple logistic regression analysis for prediction of CBD stones, old age > 55 years, CBD diameter more than 6 mm and elevated liver functions including total bilirubin, direct bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) was associated with CBD stones. By using multiple logistic regression analysis, only 2 variable showing significant association with CBD stones, including old age > 55 years (P = 0.013, odds ratio 9.26, confidence interval 1.6–53.61) and direct bilirubin (P = 0.008, Odds ratio 55.67, confidence interval 2.89–1072.35). Conclusion Age, abnormal LFTs greater than twofold, and dilated CBD >6 mm in AC patients increase the likelihood of concurrent CBDS. Knowing about these results might assist physicians develop clinical suspicions for an earlier diagnosis and improved management of CBDS.

Xanthogranulomatous Cholecystitis: A Rare form of Chronic Cholecystitis

Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis distinguished by the presence of numerous yellow-brown intramural nodules with severe fibrosis and foam cells within the gallbladder wall, which may be misdiagnosed as a Gall Bladder Carcinoma. It is typically diagnosed between the sixth and seventh decades of life, predominantly in females. Clinical signs and symptoms are comparable to those of acute and chronic cholecystitis, making it challenging to distinguish XGC prior to surgery. The case of a 52-year-old man who presented to the emergency department with right upper quadrant abdominal pain for 4 months, radiating into the right shoulder is discussed. Patient was diagnosed to have Chronic Calcular Cholecystitis on Ultrasound. Laparoscopic Cholecystectomy was performed and XGC was diagnosed post-operatively through definitive histopathological examination. Preoperatively and intraoperatively, Xanthogranulomatous Cholecystitis is difficult to diagnose and pathological examination is required for a definitive diagnosis. XGC, which exhibits clinical and radiological signs similar to those of gallbladder tumors, must be included in the differential diagnosis in order to avoid an extensive surgical procedure.

Prevalence of surgical site infection among bile spillage and non-spillage patients undergoing laparoscopic cholecystectomy: A cross-sectional study

Introduction: Laparoscopic cholecystectomy, a common procedure is not without complications, and bile spillage can cause surgical site infection (SSI). There is no local evidence in our hospital setting.
 Objective: The objective of this study was to find the prevalence of surgical site infection among bile spillage and non-spillage patients following laparoscopic cholecystectomy at BMCTH
 Methodology: A hospital-based cross-sectional study was conducted from 25 February 2021 to 25 August 2021 at the surgery department of BMCTH. We enrolled 120 patients through the total enumeration technique who underwent laparoscopic cholecystectomy. We enrolled all the eligible study participants who were more than 18 years excluding patients having age >75 years, acute calculous cholecystitis, evidence of cholangitis and/or obstructive jaundice, previous biliary tract surgery, or previous Endoscopic retrograde cholangiopancreatography, evidence of uncontrolled diabetes mellitus and patients taking immunosuppressive drugs and immunosuppressed conditions like HIV/AIDS. The surgical site infection was assessed on the 7th postoperative day.
 Results: Among 120 patients undergoing laparoscopic cholecystectomy, the majority were female 92(76.7%) and 40-50 years age group 65(54.2%). Bile spillage was found in 27(22.5%) and non-spillage in 93(77.5%). The prevalence of surgical site infection (SSI) was found to be 7.5% which was more in the bile spillage group 25.9% than the non-spillage group 2.2%. The odds of having SSI among the spillage group was 15.9 times more than the non-spillage group and was statistically significant (p <0.05). The pus culture of SSI found the predominant organism as Staphylococcus aureus 6(66.7%) followed by Escherichia coli 3(33.3%). The common indications of laparoscopic cholecystectomy were symptomatic cholelithiasis 95(79.1%) followed by chronic calculus cholecystitis 15(12.5%), gall bladder polyp 8(6.7%) and gall stone pancreatitis 2(1.7%).
 Conclusion: More than two and almost one out of ten had bile spillage and surgical site infection (SSI) respectively. A significantly higher number of SSI among the spillage group should be a concern of surgeons. We need to be extra careful with the spillage group for surgical site infection.

Mirizzi Syndrome With Bouveret Syndrome: A Rare Amalgam

Mirizzi and Bouveret syndromes are uncommon but important complications of calculous cholecystitis. Mirizzi syndrome commonly presents with jaundice due to extrinsic compression on the common bile duct by an impacted stone at the gall bladder infundibulum, whereas Bouveret syndrome presents with gastric outlet obstruction due to a large stone in the duodenum. Our case is a 65-year-old lady who presented with pain in the right upper abdomen associated with nausea and vomiting. Contrast-enhanced computed tomography and MRI of the abdomen were suggestive of calculus in the infundibulum of the gall bladder with compression over the common bile duct and a large stone in the first part of the duodenum. Upper gastrointestinal endoscopy confirmed the findings but could not retrieve the stone. Cholecystectomy with the retrieval of calculus from the infundibulum and duodenum was performed with the closure of the fistulous opening. The patient did well in the post-operative period and is doing well after nine months of follow-up. Chronic calculus cholecystitis can present in varied forms, and one should be aware of such rare complications and their management.

Spectrum of Histopathological Lesions in Cholecystectomy Specimens at Pak Red Crescent Teaching Hospital

Objective: To study the spectrum of histopathological lesions found on surgically resected gallbladder to quantify the various abnormalities in gallbladder specimen. Methodology: A descriptive observational study was carried out from Nov 2017 to Oct 2021. All the patients undergoing emergency and elective cholecystectomy regardless of age and sex were included in the study. After cholecystectomy, gallbladder specimen along with history and ultrasound findings was sent for histopathology to our own institution. Department of histopathology has the standardized method to process the gallbladder specimens. Demographic data along with diagnosis, ultrasound finding and histopathology report were collected and analyzed with Excel 2019. Results: Total number of patients in this study was 395, out of which 93 patients were male and 302 patients were female. Average age of our patients was 43.05± 13 years. Acute calculus cholecystitis was found in 55 (13.92%) patients, 298 (75.44) patents had chronic calculus cholecystitis, empyema was found in 15 (3.80) patients, cholestrolosis was found in 5 (1.27%) patients, gallbladder polyp was found in 02 (0.51%) patients, gangrenous gall bladder was found in 01 (0.25%) patient and adenocarcinoma in situ was found in 01 (0.25%) patient. Conclusion: Our study shows that, chronic cholecystitis is the most common presentation followed by acute cholecystitis in surgically resected gallbladders. Females are predominantly suffering from the gallbladder diseases. The frequency of malignant lesion was very low. Keywords: Gallbladder-histopathology, Acute Cholecystitis, Chronic Cholecystitis, Gallstones.

Frequency of Port Site Wound Infection with and Without End Gloves Techniques of Retrieval of Gallbladder in Pouch

Background: The gallbladder is a hollow organ that sits just beneath the right lobe of the liver. Chief functioning of gallbladder is to store gall, also known as bile that is required for digestion of food. Removing gallbladder through small incision in the abdomen is called laparoscopic cholecystectomy. Among benefits of cholecystectomy are decreased need for postoperative analgesia, decreased postoperative pain and shortened hospital stay from 1 week to less than 24 hours. Objective: To compare the frequency of port site wound infection with and without endogloves techniques of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis. Design: It was a randomized controlled trial. Study Settings: This study was conducted at Department of General Surgery, Midland Doctors Medical Institute Tandali Muzaffarabad from July 2019 to July 2021 Material and Methods: A total of 260 cases who fulfilled inclusion criteria were enrolled in the study through wards of Department of General Surgery. Written informed consent was obtained from all the patients. Two groups were made by random division of patients. Conventional laparoscopic cholecystectomy was performed in patients of group I. Through umbilical port gall-bladder was retrieved in these patients, exactly spot on by a sterile surgical hand glove endobag. Vicryl “O” with J-shaped needle was used to close 10mm umbilical port (fascial defect) and 5mm ports were conventionally closed. In patients of group II, conventional laparoscopic cholecystectomy was performed and gall-bladder was retrieved as in patients of group I but without using surgical sterile hand glove endobag. Results: The mean age of the patients in study group was 48.09±15.402 years and in control group it was 47.51±16.48 years. Male to female ratio was 1.06:1. The post-op wound infection was found in 11 (4.23%) patients. Statistically significant difference was found in groups (P<0.05). Conclusion: The use of endoglove technique of retrieval of gallbladder in pouch after laparoscopic cholecystectomy for chronic calculus cholecystitis is safe, cheap, simple and potentially reduces significant port site wound infection compared to without endogloves. Keywords: Laparoscopic Cholecystectomy, Endoglove, Gallbladder (GB).

English

BACKGROUND Cholecystectomy is a common surgical procedure done worldwide for both benign and neoplastic conditions. Cholecystectomy for benign conditions is performed based on clinical signs, symptoms, Ultrasound, CT. Hence there is fair chance of missing early malignant lesions like carcinoma-in-situ and other early carcinomas. Aim: The aim of the study is to analyse histopathological variations in post cholecystectomy specimens done for benign lesions. METHODS The study was conducted in Department of General Surgery, SVRRGGH, Tirupati, for a period of one year, from March 2019 to April 2020. This is a prospective Study conducted among 100 Patients, conducted over a period of one year from time of IEC approval from March 2019 to April 2020. All patients who underwent cholecystectomy for benign biliary disease and gall stone were included in the study. All patients with pre-diagnosed empyema gallbladder, gallbladder malignancy, gallbladder mass, and gallstones associated with obstructive jaundice are excluded from the study. RESULTS In our study, 100 cases of gall bladder disease were studied in the age group of 18 – 70 years, for a period of 1 year from March 2019 in the department of General surgery, SVRRGGH. Occurrence is high in patients of age group 18 – 45 years (65 %). The male to female ratio is 0.5:1 with female preponderance. The most common histopathologic finding was chronic calculus cholecystitis (59 %).Adenocarcinoma of gall bladder (2 %) of the cases with no preoperative suspicion of malignancy. CONCLUSIONS The occurrence of Incidental GBC found in my study is 2 %. Due to high estimate of residual disease, re-resection is still a curative option and is to be considered for pT2 & pT3, but not CBD removal. Prognosis usually is dismal, and five-year survival rates have been reported to be less than 5 % for more advanced stages. KEYWORDS Histopathology, Variations, Cholecystectomy, Specimen, Benign

Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

Background: Previous abdominal surgery usually lead to adhesion formation, which considered as a contraindication of laparoscopic cholecystectomy (LC). However, it had been reported that, careful adhesiolysis could be performed and thus LC becomes feasible. Aim of the work: To assess the feasibility and outcome of laparoscopic cholecystectomy in patients with previous upper abdominal surgery. Patients and Methods: This study included 30 patients, who were presented by symptomatic gallstones. All participants assessed clinically. Then, a full lab profile was performed. Finally, abdominal ultrasound was done and if there was a dilatation of common bile duct, patients were submitted to magnetic resonance cholangiopancreatography. Both intra-and postoperative data were collected and any complications were documented.Results: 26 patients (86.7%) had chronic calcular cholecystitis, two had acute calcular cholecystitis and two had mucocele of gallbladder. Adhesions were grade 1 in 13.3%, grade 2 in 46.7%, grade 3 in 20% and grade 4 in 20.0%. Adhesiolysis was needed in twenty patients (66.7%). Intraoperative complications were reported in nine patients (40%). Bleeding reported in six patients and preformation of the gall bladder in three patients (10%). Three patients (10%) were converted to open surgery. Postoperatively, 12 patients (26.7%) had complications [3, 1, 2, 1 and 5 for port site wound infection, bile leakage, bleeding, and chest infection respectively). Post operative pain was mild in half of patients and moderate in other half. Conclusion: laparoscopic cholecystectomy after previous abdominal operations is relatively feasible and relatively safe, as nearly one third of patients had difficulties and complications.

EVALUATION OF HERNIORRHAPHY FOR PARA - UMBILICAL HERNIA ASSOCIATED WITH LAPAROSCOPIC CHOLECYSTECTOMY

Background: Para-umbilical hernia repair (PUHR) combined with LC result in longer operating time, longer anesthesia, and risk of increased blood loss. But it has the advantages of single hospital stay, single anesthesia exposure, less post-operative pain and morbidity, early return to work, better cosmesis and more convenient , efficacy and cost effective for the patient. Objective: To evaluate the selected repair methods for para-umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during laparoscopic cholecystectomy. Patients and Methods: During period of January 2017 to January 2019, laparoscopic cholecystectomy was attempted in 25 patients suffering from chronic calcular cholecystitis accompanied by para-umbilical hernia, patients were assigned to two groups according to occurrence of recurrence. A retrospective analysis of parameters, including patient demographics, laboratory values, radiologic data, and intraoperative findings, was performed. Results: The operating time, postoperative pain, length of hospital stay, wound infection and the time needed for return to work were less in patients without recurrence than patients with recurrence. Recurrence occurred in cases with BMI 35.5±8.08, patient with comorbidities (DM and hypertension) and size of the defect 2.4±.07 cm. Cases with recurrence have longer operational time and hospital stay than cases without recurrence and take more days to return to work. Cases with recurrence have also other complication such as hematoma and wound infection. There was a moderate positive correlation between BMI and both operating time and length of hospital stay. There was strong positive correlation between size of hernia and both operating time and length of hospital stay. There was a strong positive correlation between comorbidity and both operating time and length of hospital stay. Conclusion: Para-umbilical hernia repair combined with laparoscopic cholecystectomy resulted in longer operating time, longer anesthesia, and risk of increased blood loss. But it has the advantages of single hospital stay, single anesthesia exposure, less postoperative pain and morbidity, early return to work, better cosmesis and more convenient, efficacy and cost effective for the patient. However, the outcomes of the para-umbilical defect repair with mesh after laparoscopic surgeries appeared to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.

RETROSPECTIVE STUDY OF CLINICAL, RADIOLOGICAL AND SURGICAL FINDINGS OF XANTHOGRANULOMATOUS CHOLECYSTITIS AN EXPERIENCE AT TERTIARY LEVEL INSTITUTION

Background: Xanthogranulomatous cholecystitis is a benign disease of gallbladder which presents almost classically similar with the chronic calculus cholecystitis, but it mimics GB carcinoma intraoperatively. Materials and methods:In our study, 54 cases were found in a study period of 2 yr in which histopathological reports was xanthogranulomatous cholecystitis whether the pt underwent lap/radical/open or lap converted open cholecystectomy for cholelithiasis and chr. cholecystitis and suspicious carcinoma GB. They were retrospectively analysed for getting an idea preoperatively to differentiate them on clinicoradiological ground and while during surgery. Datas were Results and Observation: retrospectively analysed and observed that clinical and biochemical features are non specic. Imaging in the form of USG and CT does help but not to that much extent to accurately diagnose them. intraoperatively presence of dense adhesion and loss of fat plane to surrounding structures creates a big dilemma for the operating surgeon and multiple frozen section biopsy can be of immense help here in guiding further treatment course .Frozen section analysis was not present at our institution so we did not avail its use. Our study is an attempt to derive any correlation Conclusion: between clilnicoradiological and intraoperative aspects preoperatively for the diagnosis of xanthogranulomatous cholecystitis. Although its incidence is greater here than other countries due to rising gallbladder diseases but till this time it is concluded that neither clinical nor radiologically xanthogranulomatous cholecystitis can be ruled out preoperatively. Only histopathological diagnosis is absolutely correct, and in our study we concluded that histopatholigal diagnosis is still the gold standard.

Outcome of routine histopathological examination of gallbladder specimen following elective laparoscopic cholecystectomy.

BACKGROUND:Gallstone disease is one of the commonest surgical ailments encountered in our setup. Its prevalence in India varies from 2% to 29%. Although cholelithiasis accounts for more than 95% of gall bladder related disease, routine histopathological examination (HPE) is vital. It reveals a myriad of benign as well as the malignant surgical pathology of the gallbladder (GB). This part of the world is considered as an endemic region for GB carcinoma as well as gallstone disease. This study intends to evaluate the outcome of the routine HPE of laparoscopic cholecystectomy specimens.METHODS:This retrospective observational study evaluated the results of the routine HPE of elective laparoscopic cholecystectomy specimens of single tertiary care center. Patients suspected or diagnosed with carcinoma gall bladder were excluded. Demographic data such as age, sex, and pathology results were recorded.RESULTS:From January 2017 to December 2019, HPEs of 921 patients who had undergone laparoscopic cholecystectomy specimens were analyzed. 97.6% specimens had benign lesion of which chronic calculus cholecystitis was predominantly high (95.01%) followed by cholesterosis (9.9%) and xanthogranulomatous cholecystitis (6.51%). Incidental carcinoma gall bladder was observed in 17 specimens accounting for 1.85%. Mean age of patients who underwent cholecystectomy was 43.10 ± 13.90 with female to male ratio of 3.23:1.CONCLUSION:Chronic calculus cholecystitis was the most common gall bladder disease with high female preponderance to all GB pathologies. This study affirms the importance of routine HPE after cholecystectomy as early incidental detection of carcinoma gall bladder alters the postoperative management approach and patients are expected to have a better outcome with it.

Immunohistochemical detection of TNF-α and IL -4 in chronic calculus cholecystitis

Immunohistochemical detection of TNF-α and IL -4 in chronic calculus cholecystitis

Association between gallbladder diseases and Helicobacter pylori infection

Background: Helicobacter pylorus is one of the most harmful human pathogens & carcinogen. Of the world's population, more than 50% has H. pylori in their upper gastrointestinal tracts. It has been linked to a variety of extra gastric disorders. In correlation to hepatobiliary diseases; recently, the bacterium has been implicated as a risk factor for various diseases ranging from chronic cholecystitis and primary biliary sclerosing cholangitis to gall bladder cancer and primary hepatic carcinomas. However, the association between Helicobacter pylori (H. pylori) and gallbladder diseases is still vague and is controversial.
 Aim of study: To elucidate the association of H pylori and gallbladder diseases (calculus, acalculous, polyp), the feasibility of using rapid urease test in post-operative diagnosis, and many factors related bacterium.
 Subjects & methods: This case series study was conducted in Al-Kindy Teaching hospital - surgical unit during a period extended for 2 years from September 2016 to September 2018, where patients suffered from signs and symptoms of gallbladder disease were interviewed using a predesigned questionnaire including age, gender, occupation, residency and whether the drinking water was safe (purified) or not. Physical examination was done including weight status, BMI was calculated (BMI=wt. (kg)/ height (M) [2]. Provisional diagnosis of gallbladder disease was confirmed by examination, necessary laboratory investigations (Hematology, Biochemistry, and radiology).
 Cholecystectomy was done by using Laparoscopic cholecystectomy or open surgery.
 The presence of H.pylori in the mucosa of excised gallbladder was studied by using:
 1) Rapid urease kit (HNAN C., LTD)
 2) Histopathology & chemical analysis of associated gallstone
 Results: Seventy-eight patients undergoing cholecystectomy for symptomatic gallbladder disease, the gallbladder mucosa of 30 patients were tested positive for H. pylori with any one of the tests used in this study. The rapid urease test was sensitive 57.1% and specific 58.3 % of the cholecystectomies performed in our study. The mean age of studied patients was (34 ± 4 years). Females constitute 73.1% (57 out of the total 78 of patients). Of the studied cases; 26 patients (33.3%) were obese. Employee patients constitute 43 (55.1%) of patients, and 53 patients (67.9%) lived in urban areas. Purified water consumed by 61 (78.2%) of the studied population.
 Gallstones were detected in 56 (71.8%) of studied cases, acalculus chronically inflamed gallbladder was found in 20 (25.64%), and 2 cases (2.56%). were found to have gallbladder polyp. pylori infection was diagnosed in 30 (38.5%) of total cases (of the 56 calculus confirmed cases 48.2% were H.pylori positive, and of the 22 acalculus cases 13.6% H.pylori positive).
 Conclusion:
 Significant association is found between chronic calculus cholecystitis and H.pylori infection. While no significant association was found in correlation with acalculus cholecystitis and other gallbladder pathology. In regard to feasibility of using urease kit test, it is found that this test is sensitive 57.1%, and specific 58.3%, as such it is less accurate than histopathology study. Significant correlation was found between age, gender, weight status, and non-purified water source with H.pylori infection..

Histo-morphological lesions of gall bladder

Introduction: Gall stones are the commonest gall bladder lesions with an incidence of 10 to 20% of the world population. Biliary colic is common presenting symptom in majority of the lesions. It may be asymptomatic and incidental. Histological examination of cholecystectomy reveals the type of lesions. Objective: To study the spectrum of gall bladder diseases. To study the lesion age and sex wise. Materials and Methods: An analysis of 208 cholecystectomy specimens were done from 2014-2017. Results: Cholelithiasis was more common in women, in age group of 40-50yrs. Pigmented stones were more common. Histopathologically the most common lesion was chronic calculus cholecystitis (102 cases), cholelithiasis, (40 cases) followed by Empyema (13 cases) and adenocarcinoma (04 cases) as incidental lesions. Conclusion: Inflammatory lesions were common in gall bladder. Most common disease was chronic cholecystitis in women between 40-50yrs age, presented as abdominal colic. Pigmented stones were the most common etiology of chronic cholecystitis Malignancy of the gall bladder is rare and incidental. Keywords: Gall bladder lesions, Gall stones, Chronic cholecystitis, Carcinoma.