Concomitant Cholecystitis Research Articles

Anicteric Gallbladder Rupture with Elevated Bile Acids in Abdominal Effusion in a Dog with Cholecystitis.

Anicteric gallbladder rupture has been rarely described in veterinary medicine, and, generally, it has been related to gallbladder wall necrosis secondary to gallbladder mucocele. A 5 yr old, male, neutered Labrador retriever presented for acute onset anorexia, lethargy, and vomiting. Cholecystitis was diagnosed based on the ultrasonographic findings and bactibilia, and, consequently, medical treatment was established. Despite improvement of the patient, a focal ultrasound of the hepatobiliary tract was performed 72 hr after admission for reassessment, revealing gallbladder wall thickening and abdominal effusion. Intracellular bacteria were present in nondegenerated neutrophils, and the effusion was categorized as septic exudate, compatible with septic peritonitis. Exploratory laparotomy confirmed an anicteric gallbladder rupture potentially secondary to cholecystitis and/or previous cholecystocentesis. The patient was not icteric the day of the surgery, serum bilirubin was within normal limits, abdominal fluid bilirubin concentration was below that of serum, and no bile pigment was detected; however, bile acids were significantly higher in the abdominal effusion compared with the serum concentration. This case describes an anicteric gallbladder rupture in a dog with concomitant cholecystitis and raises the question about the sensitivity of bile acid evaluation as a tool for diagnosis of gallbladder rupture and bile peritonitis in dogs.

Combined EUS-guided gallbladder drainage with rendezvous ERCP for treatment of concomitant cholecystitis, cholelithiasis, and choledocholithiasis.

Video 1EUS-guided gallbladder drainage followed by rendezvous ERCP.

Candidal Liver Abscess and Fungemia with Concomitant Cholecystitis and Pancreatitis in an Immunocompetent Non-Diabetic Patient

Candidal Liver Abscess and Fungemia with Concomitant Cholecystitis and Pancreatitis in an Immunocompetent Non-Diabetic Patient

Acalculous Cholecystitis in Acute Hepatitis B Infection - A Forgotten Complication

As physicians we are no strangers to viral hepatitis and its penchant for infecting hepatocytes. Even though the virus preferentially targets hepatocytes, it has been shown to infect the biliary epithelium lining the gallbladder and the biliary tree. We present a case of a 32-year-old male with acalculous cholecystitis secondary to Hepatitis B infection. The patient presented to our facility with complaints of right upper quadrant (RUQ) pain, nausea, vomiting and a sense of malaise for 2 days. Upon physical examination, the patient had mild scleral icterus and RUQ tenderness with a negative Murphy's sign. He had an alanine transaminaseof 3569 IU/L, aspartate transaminase of 1868 IU/L, alkaline phosphatase of 117 IU/L, total bilirubin of 6.5 mg/dl and a direct of 4.3 mg/dl. Urine urobilinogen was 0.2 mg/dl (reference range 0.2-1.0 mg/dl). He underwent abdominal imaging on the day of presentation with ultrasound and computed tomography (CT). The CT scan demonstrated prominent enhancement of the gallbladder mucosa with mild gall bladder wall thickening and pericholecystic fat stranding. No biliary stones were seen on either the CT or the ultrasound. The patients abdominal pain persisted leading to a magnetic resonance cholangiopancreatography (MRCP) which showed a distended gallbladder with wall thickening measuring up to 4.6 mm and pericholecystic fluid. An unremarkable biliary tree was seen, confirming a diagnosis of acalculous cholecystitis. He was managed conservatively with antibiotics. Given the disproportionate elevation of liver enzymes, a hepatitis panel was performed which was positive for the Hepatitis B surface antigen and core antibody. Hepatitis e antigen, e antibody and surface antibody was negative. Hepatitis B DNA levels were undetectable. The patient responded to conservative management and was discharged with follow up at the hepatology clinic. Acalculous cholecystitis in viral hepatitis is attributed to infection of the epithelial cells as well as functional changes in biliary flow. In our review of literature, we found sporadic case reports describing this entity however, it may be underreported due to a lack of imaging and self-limited nature. In a series by Karacaer, Z., et al, in 852 patients with viral hepatitis, 0.4% had concomitant cholecystitis, leading us to believe that it may be more common than anticipated. With this case, we aim to reinforce that concomitant viral hepatitis and cholecystitis may not be as rare as thought

Three modalities on management of choledocholithiasis: A prospective cohort study

BackgroundCholedocholithiasis can be managed by endoscopic retrograde cholangiopancreaticography/endoscopic sphincterotomy (ERCP/EST) or laparoscopic common bile duct (CBD) exploration by transcystic (TC) or transductal (TD) stone extraction. ObjectiveThe aim of this study was to evaluate the safety and effectiveness of common bile duct stones extraction by ERCP/EST, TC approach and TD approach for choledocholithiasis, with specific emphasis on ERCP/EST, TC approach versus TD approach. MethodsBetween January 2011 and June 2014, a total of 161 patients were scheduled for two-stage (preoperative ERCP/EST followed by cholecystectomy, ERCP group, n = 52)or single-stage (laparoscopic exploration of the CBD combined with cholecystectomy, n = 109) treatment for choledocholithiasis with concomitant cholecystitis. Laparoscopic common bile duct exploration was performed by TC approach (TC group, n = 63)or TD approach (TD group, n = 46). T-tube insertion was performed in selected patients. Patients were regularly followed up at bimonthly intervals or more frequently in presence of any symptom. Primary outcomes measures included length of hospital stay, successful bile duct clearance, postoperative/procedural morbidity and mortality. ResultsSuccessful bile duct clearance was 100.0% in TD group, 93.7% in TC group and 92.3% in ERCP group. 4 cases in the TC group and 4 cases in the ERCP group required an extra choledocholithotomy due to impacted stones. 9 patients underwent T-tube drainage in TD group comparing to 1 case in ERCP group and no cases in TC group. Comparing to TC group, there was more postoperative morbidity in TD and ERCP group. Bile leaks were more frequent in TD group (8.7%) than TC (3.2%) and ERCP group (3.8%), which prolonged hospitalization in TD group than TC and ERCP group. 2 patients in ERCP group suffered duodenal perforation and one of them died because of the complication. However, total procedural morbidity was 0% in TC and TD group. ConclusionTD stone extraction has a higher stone clearance but with a higher risk of bile leaks. Procedural morbidity is more often happened in ERCP/EST, which may result in serious consequences. TC stone extraction, which seems an effective approach with lower complication rates, is accessible techniques simplifying the operation procedure by avoiding choledocholithotomy and subsequent T-tube insertion.

Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively.

A Case of Concomitant Perforated Acute Cholecystitis and Pancreatitis

Introduction. Concomitant cholecystitis and gallstone pancreatitis is an infrequent clinical encounter, reported sparsely in the literature. Concurrent acute cholecystitis and pancreatitis complicated by gall bladder perforation has not been reported before. Presentation of Case. We report a 39-year-old female presenting with concomitant cholecystitis and acute pancreatitis, complicated by gallbladder perforation. Discussion. There is much controversy surrounding the timing of cholecystectomy following gallstone pancreatitis, with the recent literature suggesting that “early” operation is safe. In the current case, gallbladder perforation altered the “routine” management of gallstone pancreatitis and posed as a management dilemma. Conclusion. Clinical judgement dictated timing of operative management and ultimately cholecystectomy was performed safely.