Chronic Cholecystitis Research Articles

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.

XANTHOGRANULOMATOUS CHOLECYSTITIS – A RARE HISTOLOGICAL VARIANT

Xanthogranulomatous cholecystitis is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe foam cells, and fibrosis. It can be an inducement of difficulty in cholecystectomy. In this case series, we describe four cases of cholecystitis which was diagnosed post-operatively to have xanthogranulomatous inflammation in the gallbladder on histopathological examination.

The structure of gastrointestinal tract pathology in patients receiving hemodialysis treatment

BACKGROUND. Hemodialysis patients are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, gastrointestinal tract disorders in these patients remains largely unexplored. Patients receiving treatment with programmed hemodialysis are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, the pathology of the gastrointestinal tract in this category of patients remains largely unexplored.AIM: to investigate the structure of digestive diseases in patients receiving hemodialysis treatment.PATIENTS AND METHODS. This study included 180 hemodialysis patients. The median age was 60[47;68] years. Gastrointestinal Symptoms Questionnaire (GSQ) was used to evaluate gastrointestinal symptoms over the last month. The results of abdomen ultrasound, gastroscopy, colonoscopy, and complex laboratory examination were also analyzed.RESULTS. The overall prevalence of gastrointestinal symptoms was 77.2 % (139/180). The most frequent complaints were constipation (46.8 %) and abdominal pain (41 %). The most common stool frequency was one bowel action per day. The third, fourth, fifth type of stool according to the Bristol Stool Form Scale were noted by the majority of participants. Abdominal ultrasound revealed diffuse liver changes in 115 (63.9 %), signs of cirrhosis – in 7(3.9 %) patients. Ultrasound pathology of the gallbladder was represented by anomalies of its shape in 11.1 %, signs of chronic cholecystitis – in 10 %, stones (sludge) – in 7.2 %, polyps – in 2.2 % of patients. Diffuse changes in pancreatic parenchyma, steatosis, pseudocysts and dilatation of the main pancreatic duct were diagnosed respectively in 39(21,7 %), 21(11,7 %), 10(5,6 %) and 3(1.7 %) hemodialysis patients. According to 154 gastroscopies, the most common endoscopic finding in the stomach was chronic gastritis, detected in 86(55.8 %) of the subjects. Erosive gastritis was diagnosed in 22(14.3 %), gastric ulcer – in 3(2.0 %) patients. Endoscopic duodenal pathology was represented by erythematous duodenitis in 53(34.4 %), erosive duodenitis in 15(9.7 %), ulcer in 2(1.3 %), duodenal bulb abnormalities in 23(14.9 %) patients. Combined gastric and duodenal lesions were found in 88(57.1 %) patients. Сolonoscopy was performed in 56 patients, of whom 15 (26.8 %) had signs of colitis (mainly sigmoiditis), 2(3.6 %) – diverticulitis, 10(17.9 %) – diverticulosis, 12(21.4 %) – colon polyps, 8(14.3 %) – angiodysplasia mucosa, in 3(5.4 %) – dolichocolon. Despite the abundance of gastrointestinal symptoms and instrumental findings, no significant deviations in laboratory parameters (including an increase in AST, ALT, total bilirubin, amylase, lipase) were found.CONCLUSION. Hemodialysis patients are characterized by a high prevalence of gastrointestinal symptoms and various pathological changes in the gastrointestinal tract, the diagnosis and treatment of which require an individual multidisciplinary approach.

Increases in pediatric cholecystectomy during the COVID-19 pandemic: An interrupted time series analysis

BackgroundHistorically, cholecystectomy is infrequently performed in children. Lifestyle changes, delays in healthcare access, and increases in childhood obesity occurred during the COVID-2019 pandemic. It is unclear whether these changes impacted pediatric gallbladder disease and the need for cholecystectomy. MethodsA retrospective study of children ≤18 years old undergoing cholecystectomy from January 1, 2016, to July 31, 2022, at a tertiary children’s hospital was conducted. On March 19, 2020, a statewide mandatory coronavirus disease 2019 stay-at-home policy began. Differences in children undergoing cholecystectomy before and during the pandemic were identified using bivariate comparisons. An interrupted time series analysis identified differences in case volume trends. ResultsOverall, 633 children were identified—293 pre-pandemic and 340 pandemic. A majority were female sex (76.3%) and Hispanic (67.5%), with a median age of 15 years (interquartile range: 13.0–16.0). Children who underwent cholecystectomy during the pandemic had significantly higher body mass index (28.4 versus 25.8, P = .002), and obesity (body mass index >30) was more common (45.3% versus 31.7%, P = .001). During the pandemic, significant increases in complicated biliary disease occurred—symptomatic cholelithiasis decreased (41.5% versus 61.8%, P < .001) and choledocholithiasis (17.9% versus 11.6%, P = .026), gallstone pancreatitis (17.4% versus 10.6%, P = .015), and chronic cholecystitis (4.7% versus 1.0%, P = .007) increased. The number of cholecystectomies performed per month increased during the pandemic, and on interrupted time series analysis, there was a significant increase in month-to-month case count during the pandemic (P = .003). ConclusionCholecystectomy case volume significantly increased during the coronavirus disease 2019 pandemic, possibly secondary to increases in childhood obesity. Future studies are needed to determine whether this increased frequency of pediatric cholecystectomy is representative of broader shifts in pediatric health and healthcare use after coronavirus disease 2019.

Pathologic examination of ectopic pancreatic tissue in the gallbladder: A case report

Abstract Introduction/Objective Ectopic pancreatic tissue (EPT) is an entity defined by the presence of pancreatic tissue at its non-physiological site, while co-existing with original tissue in its correct anatomical location. While EPT is a rare process in locations such as the stomach, duodenum, and esophagus; it is even more uncommon for it to occur in the gallbladder. To our knowledge, fewer than thirty cases of EPT in the gallbladder have been reported. The following case report presents a 47-year-old woman with ectopic pancreatic tissue in the gallbladder. Methods/Case Report A 47-year-old female presented to our emergency department with her third episode of colicky right upper quadrant pain. Ultrasound imaging demonstrated cholelithiasis with additional ill-defined findings of the gallbladder wall, which included but were not limited to acute emphysematous cholecystitis and chronic cholecystitis with features of porcelain gallbladder. Laparoscopic cholecystectomy was performed without complications. Pathologic evaluation of the specimen demonstrated a cystic structure at the fundus of the gallbladder with coexisting EPT, fundic-type adenomyomatosis, and cholelithiasis. Results (if a Case Study enter NA) NA Conclusion Ectopic pancreatic tissue is a rare incidental finding which is often confused for a malignant process. While it is more commonly seen in the gastrointestinal tract from the esophagus to the duodenum, it can present in other sites such as in this case. Currently, there is no specific imaging method to determine the presence of EPT. Ultrasonography is nonspecific and EPT can be confused for a number of conditions ranging from benign to malignant. Gross examination is fairly unremarkable, however microscopic examination is a straightforward diagnosis. While it is a benign process, malignant transformation can occur and pathologists should be aware of this possibility. For this reason, additional sections may be recommended to rule out occult malignancy.

Factors causing conversion in laparoscopic cholecystectomy

Introduction and purpose: Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure in the treatment symptomatic gall bladder disease. Conversion is not a failure or complication. It is only a step taken to ensure patient safety and to avoid complications. The objective of our study was to investigate the rate and the causative preoperative and intraoperative factors of conversion and to help surgeons have an idea about potential intraoperative challenges. Materials and methods: Laparoscopic cholecystectomy procedures performed on 4433 patients with signs and symptoms of cholelithiasis-cholecystitis who were diagnosed with abdominal ultrasonography were retrospectively reviewed. The patients were grouped on the basis of age, gender, length of hospitalization, history of preoperative endoscopic retrograde cholangiopancreaticography (ERCP), diabetes mellitus (DM), chronic fibrotic cholecystitis, gall bladder polyps, and urgent-elective surgery. The rate and causative factors of conversion were investigated. Statistical analyses were carried out using IBM SPSS for Windows, version 17.0 (IBM statistics for Windows version 17, IBM Corparation, Armonk, New York, United States) software package. Result: In our study, the conversion rate was 0.85%. Male gender, advanced age, increased length of hospitalization, history of preoperative ERCP, urgent surgery (acute-hydropic cholecystitis), and chronic fibrotic cholecystitis were the significant risk factors for conversion. DM had no effect on conversion. Conclusion: Conversion should not be necessarily regarded as a complication in laparoscopic cholecystectomy. Identifying patients with significant risk factors for conversion can significantly minimize the complications of the laparoscopic procedure. This may assist in identifying high-risk patients and reviewing surgical strategy in this patient group.

HPB P07 HIDA scan utilisation and its influence on the management of patients with Gallbladder Dysmotility Disorders – A Retrospective Multicentre Cohort Study

Abstract Background Hepatobiliary Iminodiacetic Acid (HIDA) - Cholecystokinin (CCK) and fatty meal scan is widely used in the investigation of patients with acalculour biliary-like pain as they present a significant diagnostic and management challenge to the healthcare system. This scan detects functional capacity of gallbladder in the form of gallbladder ejection fraction (GBEF). GBEF of &amp;lt;35% is consistent with biliary dyskinesia and &amp;gt;80% with hyperkinesia, a recently postulated pathology. Laparoscopic cholecystectomy (LC) remains the treatment of choice of for both the entities. We performed audit of utility of HIDA scan and interpretation of its results across three sites. Methods A retrospective cohort study of patents undergoing HIDA scan across three hospitals between January 2015 and December 2022. Patients with biliary pain according to ROME IV criteria of functional GI disorders were included. Electronic case notes were reviewed and demographics, laboratory results of bilirubin and ALP, radiological investigations, endoscopy result and HIDA scan result. Results A total of 225 patients underwent HIDA scan; median age was 42 years (IQR 34-53) and 194 (86.2%) were female. Median time form the onset of symptoms to HIDA scan was 19 months (IQR 6-24). 35 (15.5%) had GBEF &amp;lt;35%, 157 (69.7%) with GBEF 36-79%, and 33 (14.6 %) had GBEF ≥80. 36 patients had LC after HIDA scan: 19 (52.7%) for biliary dyskinesia, 12 (33.3%) for microlithiasis and/or biliary sludge on EUS and 5 (13.8%) had it for symptoms but normal GBEF. Histopathology of 4 patients had normal gallbladder, while 27 had chronic cholecystitis and/or cholesterosis. Conclusions HIDA scan is vital investigation for recurrent biliary-like pain without presence of gallstones and gallbladder dysmotility is not uncommon in this group of patients. HIDA scan should be more liberally utilised to rule out gallbladder dysmotility. Reporting method of HIDA scan should also be standardised to help interpret the results accurately.

HPB P55 An audit of the quality standards for Laparoscopic Cholecystectomy. Compliance with the AUGIS standards (AUGIS: Association of Upper Gastrointestinal Surgery of Great Britain and Ireland)

Abstract Background Laparoscopic cholecystectomy, which is a minimally invasive operation, is one of the most common surgical procedures in the UK and worldwide. Indications for LC include acute or chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia, acalculous cholecystitis, gallstone pancreatitis, and gallbladder masses or polyps. The purpose of this audit was to assess and compare the outcomes after LC with the standards published by the association of upper GI surgeons (AUGIS) and to formulate measures to improve services at Royal Albert Edward Infirmary. Methods A data of 56 patients who underwent cholecystectomy was analysed retrospectively by two different auditors. All patients who underwent both open and laparoscopic cholecystectomies were included in this study. Results Our results showed that the majority of the patients (40/56) were females. Only 3 patients had open cholecystectomy while the rest of the 53 patients had LC. 67% (38/56) were done as a day case and discharged home the same day after surgery. None of the patients had an emergency and thus timely management of the disease in terms of surgery within the first 7 days of presentation. 7/56 patients were readmitted with different complications. No bile duct injuries were recorded. Conclusions Our hospital was found out to be compliant with only ⅙ criteria assessed. This study concludes that there is a need to improve outcomes in all domains especially the easily reversible factors such as day case rates and readmission due to complications.

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.

HPB P08 Is Biliary Hyperkinesia a true Pathology? Should cholecystectomy be considered? A prequel towards Pilot study

Abstract Background Biliary Hyperkinesia (BH) is defined as a condition where gallbladder contracts and empties more rapidly than usual causing recurrent biliary colic with no evidence of gallstones on ultrasound or MRCP. Hepatobiliary iminodiacetic acid (HIDA) scan is the investigation of choice and shows gallbladder ejection fraction (EF) of &amp;gt;80% in BH. A recent systematic review and meta-analysis suggested that laparoscopic cholecystectomy (LC) could alleviate the symptoms. Similar results have been highlighted in case reports published about this relatively new gallbladder dysmotility. This study investigates the number of patients with BH on HIDA scan who might qualify for LC. Methods This was a 7-year (2015 to 2022) retrospective cohort study of adult patients with biliary pain in the absence of gallstones who underwent HIDA scan. Patient with EF &amp;gt;80% on HIDA scan were included in the study. Electronic case notes were reviewed for demographics, body mass index (BMI), smoking status, liver function tests, duration of symptoms, radiology investigations and endoscopy result including endoscopic ultrasound (EUS). Results 225 patients had HIDA scan of which 37 (16.4%) patients had BH. Median age was 49 years (IQR 38-62) and 32 (86.4%) were female. Median BMI 28 (IQR 23.3-32.4) and 48.3% were smokers. 5 (13.5%) were referred for pH manometry and gastric emptying studies while 25 (67.5%) have been formally discharged from surgery clinic follow-up. 7 (18.9%) are still waiting for further review. Only two patients had LC; one 3 years post HIDA when repeat ultrasound eventually showed gall stones and histopathology confirmed chronic cholecystitis. The second patient had sludge seen on EUS and histopathology confirmed chronic cholecystitis. Conclusions The hypothesis that overactive emptying of gallbladder represented by a high EF on HIDA scan leads to pain is somewhat convincing. High biliary pressure in a short circuit bounded by gallbladder/cystic duct junction and sphincter of Oddi causes gallbladder mucosal damage and cholecystitis. However, could there be missed stones or sludge is something that still needs to be considered. EUS might be of additional value before diagnosing patient with biliary hyperkinesia. Surgeons should consider LC in patients with BH once other pathologies have been ruled out. Further studies are needed to understand the outcome of cholecystectomy in BH.

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 &amp; 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.

Peculiarities of the formation of exocrine pancreatic insufficiency in patients with primary osteoarthritis under conditions of comorbidity

Summary. The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study.&#x0D; The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI).&#x0D; Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints.&#x0D; Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI.&#x0D; Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP ˃ T2DM ˃ chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system ˃ chronic gastroduodenitis (p ˂0.05).

The role of phytocomponents in the complex therapy of chronic non-calculous cholecystitis

Non-calculous cholecystitis is a form of cholecystitis caused by dysfunction or hypokinesis of the gallbladder. The polyetiology and multiplicity of the pathogenesis of this disease requires different approaches to its correction. In this situation, phytopreparations containing components of origin provide special attention in combination with the main therapy. Curcumin has a strong protective effect against cholestasis through farnesoid X receptors, resulting in a release of bile acid homeostasis and counteracting inflammatory inflammation and as a manifestation of cholestasis. Several studies show that curcumin requires a contraction of the gallbladder. Despite the presence of many useful properties, the widespread use of curcumin in medical practice was limited by its limited bioavailability. Forms with increased bioavailability have been synthesized, such as kavacarcumin. The use of artichoke leaf extract in gastroenterology is based on its strong antidyspeptic effect, mediated by choleretic activity. As study show, the choleretic effect of the artichoke was more pronounced than that of the reference drug. In the description, there is no direct effect of chamomile phytocomponents on the state of bile compatibility and the function of bile outflow, however, an indirect effect on its work is possible. The results make chamomile flower extract a good addition to therapy. Thus, due to the occurrence of synergistic components, the complex is found in individuals, in patients with chronic diseases of the biliary tract, with functional disorders, the period of treatment in long-term complex therapy, with the prevention of exacerbation and prolongation of remission, as well as in healthy individuals for the prevention of these diseases.

Predictors for Gangrene and Perforation of Gallbladder Wall in Patients with Acute Cholecystitis

Summary Perforation of the gallbladder wall leads to a local perivesical abscess or progression to biliary peritonitis. The study aimed to analyse clinical, laboratory, and imaging indicators that have the strongest relationship with the presence of gangrenous cholecystitis and perforation of the wall and to design a predictive scoring system that highlights the risk of developing gangrenous cholecystitis with perforation. We performed a retrospective analysis of a total of 331 patients operated for five years (2016-2020) at the Department of Surgical Diseases” of Medical University - Pleven, with histologically verified chronic cholecystitis (120 patients; 36.4%), acute cholecystitis (100 patients; 30.1%), and destructive cholecystitis (111 patients; 33.5%). The statistical analysis identified nine main factors with the most substantial statistical significance in patients with gangrene and perforation of the gallbladder wall: age &gt;65, male gender, diabetes mellitus, cardiovascular pathology, tachycardia&gt;90 bpm, WBC&gt;14.109, the thickness of gallbladder wall &gt; 4 mm with pericholecystic fluid, ASAT and ALAT &gt; 40 UI, CRP&gt;150 ng/l. The total possible score was 11 points. The positive predictive value of the scale was 96% and identified the cases with micro-perforation and perivesical abbesses among the group with the highest total score.

Biliary diseases: from universal treatment programs to personalized solutions

Objective — to inform practicing doctors about the possibilities of using the drug Сholoplant®‑Tau in diseases of the biliary system and for the prevention of gallstone disease. Biliary diseases are represented by a wide spectrum of pathology. Among them, both functional disorders and a number of organic conditions with a predominance of gallstone disease (GD) are identified. In recent years, the number of patients with chronic cholecystitis has doubled. In general, there is a rapid increase in the number of cases of the GD disease worldwide. In view of the evolution of the state of the biliary system towards the deterioration of the patients’ health, the use of passive diagnostic and treatment tactics by doctors is not approved. The drugs that have the most physiological mechanisms of correction, is the basis of modern therapy. The combination of components with hepatoprotective and choleretic activity is considered the most promising. Сholoplant®‑Tau (Propharma Plant LLC, Ukraine) belongs to such agents for restoring and maintaining the function of the liver, biliary tract, and gallbladder. The peculiarity of it is a unique combination of 4 components: artichoke leaf extract (Cynara scolymus L.) 200 mg, angelica root extract (Angelica sinensis) 50 mg, ursodeoxycholic acid (UDCA) 100 mg and taurine 100 mg.&#x0D; Information is provided in the form of questions and answers, which reflect the key points of patient management to obtain a better clinical result. The experience of application by Ukrainian doctors has been highlighted. The paper is aimed at practicing doctors.&#x0D; Conclusions. The four components of the drug Сholoplant®‑Tau (artichoke, angelica, UDHC, taurine) complement and enhance the effect of each other, which contributes to the effective normalization of the functions of the entire hepatobiliary system, stimulates the increase in the production of bile and bile acids, normalizes the intestinal microflora, eliminates inflammation and ulcerative spasms of the gallbladder and intestines. Сholoplant®‑Tau is a good choice for solving many problems of the biliary system.&#x0D;

Incidental Finding of Gall Bladder Carcinoma in Post-Menopausal Females in Cholecystectomy Specimen

Objective: To highlight the significance of histopathological examination of gallbladder and to evaluate incidental gallbladder cancer in post-menopausal females. Study Design: Cross-sectional Study. Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad Pakistan, from Jan 2020 to Dec 2021. Methodology: Two thousand nine hundred fifty-nine (n=2959) gallbladder specimens with a clinical diagnosis of cholelithiasis and cholecystitis were analyzed. The clinical history of patients was taken from computer storage data. Results: Out of the total 2959 cases, on histopathological examination, chronic cholecystitis was the commonest finding (1990, 67.25%), followed by acute cholecystitis 410(13.85%) cholesterolosis (396,13.38%) and gallbladder carcinoma 42(1.42%). Out of 42 cases of gallbladder carcinoma, 34(80.95%) were female and 8(19%) were male. Most cases were post-menopausal age group 21(61.76%) compared to premenopausal 13(38.23%).Conclusion: In our study, Incidental gallbladder carcinoma in post-menopausal women was higher than expected.

Canine Gallbladder Erosion/Ulcer and Hemocholecyst: Clinicopathological Characteristics of 14 Cases.

(1) Background: Gallbladder mucosal erosion and/or ulceration are illnesses associated with unexpected gallbladder intra-cystic bleeding (hemocholecyst), an under-reported problem in dogs. (2) Methods: Clinicopathological characteristics of 14 dogs with gallbladder erosion/ulcer were investigated in this single-center retrospective study using clinical data and archived gallbladder tissues of client-owned dogs. (3) Results: Canine gallbladder erosion/ulcer tends to occur in older, neutered dogs of various breeds. Vomiting, lethargy, and anorexia are common. Concurrent gallbladder rupture occurred in 5/14 cases (35.7%), while rupture was absent in 6/14 cases (42.8%) and undetermined in 3/14 (21.4%) cases. Histologically, the gallbladder wall was markedly thickened due to mucosal hyperplasia, inflammatory infiltrates, fibrosis, edema, hemorrhage, and smooth muscle hyperplasia/hypertrophy. Twelve out of fourteen cases (85.7%) had concurrent cholecystitis of varying severity. Bacteria were detected by Giemsa or Warthin-Starry stain in 8/14 (57.1%) cases. Bacterial rods immunoreactive to the anti-Helicobacter antibody were present in one case. Mucosal epithelial cells of the gallbladder erosion/ulcer cohort were immunopositive for the cyclooxygenases COX-1 or COX-2 in only 5/14 (35.7%) cases. In contrast, COX-1 and COX-2 were more frequently expressed in a reference pool of cases of gallbladder mucocele (n = 5) and chronic cholecystitis (n = 5). COX-1 was expressed in 9/10 cases (90.0%) of gallbladder mucocele and chronic cholecystitis and in 10/10 cases (100%) for COX-2. (4) Conclusions: Canine gallbladder erosion/ulcer is an under-reported condition which requires active clinical intervention. Based on the clinicopathological information reported in this study in addition to the COX-1 and COX-2 IHC results, we suggest that canine gallbladder erosion/ulcer may be related to decreased cytoprotection physiologically provided by arachidonic acid, but which is decreased or absent due to reduced COX expression because of yet undetermined etiologies.

Missed gall bladder malignancy: A result of ignoring predisposing factors

The underestimation of the prevalence of gallbladder carcinoma, which constitutes a predominant form of malignant neoplasm affecting the biliary tract, poses a significant threat due to its asymptomatic progression. Therefore, this study aimed to analyse the clinical, imaging, and intraoperative outcomes in cases of gallbladder carcinoma. This retrospective investigation was conducted from September 2022 to March 2023 at the Department of General Surgery of FH Medical College. A total of 153 patients deemed suitable for surgery participated in this study and underwent the relevant procedures. Various diagnostic and laboratory tests were administered to the patients, including blood analysis, random blood sugar determination, viral markers, chest X-ray, renal and hepatic functional tests, and comprehensive abdominal ultrasound. Gallbladder specimens were subjected to histopathological examination, and the results were documented and analysed. In histopathological reports, signs of precancerous lesions were noted in 30 out of 153 patients who underwent surgical treatment. The frequency of the disease was higher among women. Among these 30 patients, 22 had ultrasound-diagnosed gallstone disease with acute or chronic cholecystitis, while 8 patients had gallstone disease without gallbladder wall thickening. Additionally, 9 of these patients exhibited focal/irregular/thickening of the wall ≥10 mm. Overall, 16 patients showed elevated liver function, and 4 had an increased glucose level among those with histopathological evidence of precancerous lesions. This study underscores the elusive nature of gallbladder cancer, emphasizing the necessity for a comprehensive assessment, meticulous preoperative evaluation, and a multidisciplinary approach to facilitate early detection and 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.

A case of Vagococcus fluvialis isolated from the bile of a patient with calculous cholecystitis

BackgroundChronic cholecystitis, characterized by persistent inflammation of the gallbladder, predominantly stems from the prolonged presence of gallstones. Calculous cholecystitis has demonstrated a consistent escalation in its incidence over time.Gallbladder stones have been recognized as a predisposing factor for the development of biliary tract infections.Concomitantly, there have been substantial shifts in the distribution and resistance profiles of pathogenic microorganisms responsible for biliary tract infections. The timely acquisition of bile samples for pathogen analysis is of paramount importance, given its critical role in guiding judicious clinical pharmacotherapy and enhancing patient prognosis.Case PresentationWe present a case involving a 66-year-old female patient who had previously undergone subtotal gastrectomy due to diffuse large B-cell lymphoma. The patient was admitted to our institution with complaints of abdominal pain. Subsequent diagnostic evaluation revealed concurrent choledocholithiasis and cholecystolithiasis. The patient underwent surgical cholecystectomy as the therapeutic approach. Histopathological examination of the excised gallbladder disclosed characteristic features indicative of chronic cholecystitis. Subsequent laboratory analysis of the patient’s bile specimen yielded Gram-positive cocci, subsequently identified through biochemical assays, mass spectrometry, and 16 S rRNA analysis as Vagococcus fluvialis. Further in vitro antimicrobial susceptibility testing using disk diffusion and microfluidic dilution showed that this strain exhibited inhibition zone diameters ranging from 12.0 to 32.0 mm in response to 26 antibiotics, including ampicillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ampicillin/sulbactam, piperacillin, ciprofloxacin, cefoperazone/sulbactam, imipenem, meropenem, piperacillin/tazobarb, penicillin, erythromycin, chloramphenicol, vancomycin, methotrexate/sulfamethoxazole, teicoplanin, linezolid, tigecycline, cefoxitin, ceftazidime, levofloxacin, minocycline and tobramycin. However, the inhibition zone diameters were 6.0 mm for amikacin, oxacillin, clindamycin, and tetracycline. The patient received ceftazidime anti-infective therapy both preoperatively and within 24 h postoperatively and was discharged successfully one week after surgery.ConclusionIn this study, we present the inaugural isolation and identification of Vagococcus fluvialis from bile specimens of patients afflicted with calculous cholecystitis. This novel finding lays a substantial experimental groundwork for guiding clinically rational antimicrobial therapy and advancing the exploration of relevant pathogenic mechanisms pertaining to Vagococcus fluvialis infections.