Development Of Acute Cholecystitis Research Articles

Assessment of the risk for cholecystitis when performing laparoscopic cholecystectomy in a retrospective cohort study

Background/Aim: Acute cholecystitis most often occurs as an acute exacerbation of chronic cholecystitis. In over 90% of patients, the primary factor in the development of acute cholecystitis is the obstruction of the gallbladder or cystic duct with an impacted calculus. In less than 10% of patients, acute cholecystitis can be attributed to other causes: direct trauma to the biliary tract, torsion of the gallbladder, twisting of the vascular loop after surgical procedures on the abdominal organs, and Salmonella typhi infection. The aim of this study is to compare preoperative variables in patients with acute cholecystitis, which are not only important for diagnosis but also have significance in determining the severity of acute cholecystitis in the preoperative period. Methods: This retrospective systematic research included all clinical cases diagnosed with acute cholecystitis from January 2019 to December 2019, totaling 56 patients at CHC Kosovska Mitrovica. For the study, data from medical records were used for statistical analysis. Results: A total of 56 patients (mean age 53 years; 26 men and 30 women) were included in this study. Among them, 32 patients (57.15%) had characteristics of simple cholecystitis, while 24 patients (42.85%) had severe cholecystitis. The group with severe cholecystitis consisted of older patients, with equal representation of both sexes, and higher levels of WBC, NE%, PLT, ALT, GGT, total bilirubin, and CRP (P<0.05). Imaging studies showed that the group with severe cholecystitis exhibited significantly more wall distension, particularly in the stratified wall, compared to the group with simple cholecystitis (P<0.05). Severe cholecystitis was associated with statin use (79.2%) and triglyceride values of 1.55 (0.47); both variables showed a statistically significant association with severe cholecystitis (P<0.05). Conclusion: It is extremely important to skillfully identify patients with simple or severe forms of acute cholecystitis. Possible solutions include organizing campaigns to raise public awareness for faster consultations in cases of acute abdominal pain, establishing universal health coverage (diet), and improving technical platforms.

Acute Cholecystitis: An Emerging Complication in Spinal Cord Injury Patients in the United States.

Spinal cord injury (SCI) is a significant medical condition associated with various secondary complications, including cholelithiasis. Cholelithiasis can cause biliary duct obstruction and result in acute cholecystitis. The development of acute cholecystitis in SCI patients has been well studied in the Taiwanese population, showing an increased risk of acute cholecystitis in patients with SCI. The development of cholecystitis has not been well studied in the United States. A retrospective review was performed on 3,939 propensity score-matched patients aged 18 to 85 years who had SCI/surgery from 2000 to 2019. Patients were divided based on the development of postoperative complications, specifically cholecystitis with cholecystectomy. SCI consisted of quadriplegia (42%), paraplegia (53%), unspecified lesion of cervical spinal cord (3%), and thoracic spinal cord (2%). All groups were comparable regarding age, gender, body mass index, smoking status, and Charlson comorbidity Index. The incidence of acute cholecystitis with subsequent cholecystectomy among patients with SCI was 43.0 per 10,000 person-years (95% confidence interval: 41.51-44.49). Median follow-up was 36 months. The development of cholecystitis was comparable among females (54.5%) and males (45.5%), and among African Americans (52.5%) and Caucasians (47.5%). There is an association between SCI and development of acute cholecystitis among U.S. As SCI patients do not present with the classic signs of biliary colic, risk assessment for the development of acute cholecystitis will guide patient management and allow neurosurgeons to weigh the risks and benefits of prophylactic treatment for gallbladder complications.

Hybrid surgical interventions in treatment of cholangitis and biliary sepsis on the background of cholecystocholedocholithiasis

The OBJECTIVEof the study was to improve the results of treatment in patients with cholecystocholedocholithiasis complicated with acute cholangitis and biliary sepsis by analyzing the possibilities of hybrid surgery.MATERIAL AND METHODS. 126 patients with acute cholecystitis, cholangitis and biliary sepsis on the background of the cholecystocholedocholithiasis were treated during the period 2015–2018. We performed the comparative analysis of treatment results in different groups for evaluating the effectiveness of various hybrid operations.RESULTS.When analyzing the comparison of treatment results we determined that single-stage laparoscopic biliary tract lavage was more effective in the case of large or multiple bile ductus stones. Endoscopic transpapillary management performed by «Rendezvous» method was more effective than endoscopic papillosphincterotomy.CONCLUSION. With the development of acute cholecystitis, cholangitis and biliary sepsis on the background of cholecystocholedocholithiasis, the implementation of single-stage hybrid surgical interventions taking into a specificity for each of the methods was indicated.

Choice of tactics of surgical treatment of acute cholecystitis and its complications

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

Development of acute cholecystitis following laparoscopic partial cholecystectomy.

In cases where the dissection of Calot's triangle is difficult during laparoscopic cholecystectomy, laparoscopic partial cholecystectomy is an alternative to total cholecystectomy to prevent bile duct damage. However, recurrent symptoms and bile duct problems associated with the remaining gallbladder tissue may develop in patients over time. The case of a 45-year-old male who underwent laparoscopic partial cholecystectomy one year previously is presented here. In the postoperative period, as a result of tests for the continuing symptoms of cholecystitis, stones and surrounding abscess were detected in the remaining gallbladder tissue, so open completion cholecystectomy was applied. In acute cholecystitis, as severe inflammation of the hilar structures does not allow safe dissection, partial cholecystectomy can be applied. However, in these patients, there is a risk of recurrence of cholecystitis symptoms and the development of biliary pancreatitis and choledocolithiasis because of the remaining tissue. Therefore, it should not be forgotten that endoscopic and/or surgical intervention may be necessary at least in some patients.

Role and outcomes of laparoscopic cholecystectomy in the elderly

Introduction: Laparoscopic cholecystectomy is the standard of treatment for gallstones disease and acute colecystitis. The prevalence of this disease increases with age and the population is aging in industrialized countries. So, in this study we report our experience in the treatment of gallstone disease in elderly patients, particularly analyzing the outcomes of laparoscopic approach. Methods: Between January 2010 and May 2014 we performed a total of 1227 cholecystectomies. In this retrospective study age group was the primary independent variable: 351 patients were 65–79 years of age and 65 were 80 years of age or older. Results: Only 65 patients (5.3%) of all population had primary open cholecystectomy, but the rate in young group was 3.7% respect the highest frequency (9.2%) in the elderly group. The conversion rate was higher (1.2%) in the older group but there was no significant difference with younger group. LC in emergency setting was performed in 10.3% of young patients and in 13.8% of elderly group. Conclusion: Laparoscopic cholecystectomy is a feasible and safe procedure in elderly patients and might be performed during the same hospitalization like definitive treatment of gallstone disease. The old age and subsequent comorbidity are the fundamental predictor of surgical outcomes. Elective treatment should be recommended when repeated gallstone symptoms have occurred in the elderly patient before the development of acute cholecystitis and related complications.

Internal gallbladder drainage prevents development of acute cholecystitis in a pig model: a randomized study

BackgroundAcute cholecystitis can be the result of retention of bile in the gallbladder with possible secondary infection and ischaemia. The aim of the present study was to investigate whether internal drainage of the gallbladder could protect against the development of acute cholecystitis in a pig model.Materials and methodsTwenty pigs were randomized to either internal drainage (drained) or not (undrained). Day 0 acute cholecystitis was induced by ligation of the cystic artery and duct together with inoculation of bacteria. Four days later the pigs were killed and the gallbladders were removed and histologically scored for the presence of cholecystitis. Bile and blood samples were collected for bacterial culturing and biochemical analyses.ResultsThe histological examination demonstrated statistical significant differences in acute cholecystitis development between groups, the degree of inflammation being highest in undrained pigs. There were no differences in bacterial cultures between the two groups.ConclusionInternal drainage of the gallbladder protected against the development of acute cholecystitis in the present pig model. These findings support the theory that gallstone impaction of the cystic duct plays a crucial role as a pathogenetic mechanism in the development of acute cholecystitis and suggest that internal drainage may be a way to prevent and treat acute cholecystitis.

Hepatobiliary and pancreatic: Cystic duct obstruction after metallic stents

A 58-year-old man was admitted to hospital with jaundice and abdominal pain. The diagnosis of pancreatic cancer was confirmed on a fine-needle aspirate at the time of endoscopic ultrasonography and he was treated with an uncovered metallic biliary stent. Subsequently, his liver function tests returned to normal. After 5 months, he was readmitted to hospital with fever and abdominal pain. At endoscopic retrograde cholangiography, the stent appeared to be occluded and a second uncovered metallic stent was placed within the first stent. Six days later, he developed abdominal discomfort and abdominal distension. On physical examination, there was distension and tenderness in the right abdomen (Figure 1). A computed tomography scan showed that distension was caused by an enlarged gallbladder with a thickened gallbladder wall (Figure 2). After treatment with antibiotics, the gallbladder remained enlarged but was asymptomatic. An enlarged gallbladder in the presence of malignant obstruction of the bile duct is often called Courvoisier's sign. The sign develops because increases in intrabiliary pressure associated with obstruction of the lower bile duct are transmitted through the cystic duct to the gallbladder. However, the frequency of Courvoisier's sign in contemporary patients with malignant obstruction is only approximately 30%. A second mechanism for an enlarged gallbladder is obstruction of the cystic duct, often with the development of acute cholecystitis but sometimes with the development of a mucocele. One cause of cystic duct obstruction is plastic or metallic biliary stents. In relation to the latter, uncovered stents have a low frequency of migration but a higher frequency of stent obstruction by tumor ingrowth. In contrast, covered stents have a lower frequency of tumor ingrowth but a higher frequency of stent migration and perhaps cystic duct obstruction. In the patient described above, we assume that placement of a second uncovered stent resulted in obstruction of the cystic duct and the development of acute cholecystitis. When acute cholecystitis occurs in the setting of biliary stents, options for treatment include conservative measures with antibiotics, removal of the stent (and perhaps the use of a shorter stent) and cholecystectomy. As many of these patients are unwell, a trial of medical therapy is likely to be adopted in the first instance.

Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas

Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically. The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents are of large diameter, and have long-term patency (although they are expensive). For this reason, the use of metal stents is preferred for patients who are expected to survive for more than 6 months, whereas for patients who are likely to survive for less than 6 months, the use of plastic stents is not considered to be improper. Obstruction in a metal stent is caused by a tumor that grows within the stent through the mesh interstices. To overcome such problems, a covered metal stent was developed, and these stents are now used in patients with malignant distal biliary obstruction. However, this type of stent has been reported to have several shortcomings, such as being associated with the development of acute cholecystitis and stent migration. In spite of these shortcomings, evidence is expected to demonstrate its superiority over other types of stent.

Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

Gallbladder aspirate from a dog

A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid.

Laparoscopic cholecystectomy in geriatric patients

Background The results and advantages of laparoscopic cholecystectomy in the geriatric population have received minimal attention. Several early reports related high conversion rates complications and mortality. This case series review is focused on the results of laparoscopic cholecystectomy in the geriatric population in a private practice environment. Methods The records of all patients undergoing cholecystectomy by the author over the past 12 years were reviewed. The entire series consists of 248 patients in whom 239 procedures were completed laparoscopically, with 9 patients converted to an open cholecystectomy. This report identifies 82 patients who were aged 65 years or older at the time of the laparoscopic cholecystectomy. The results of this series are reported in three progressive geriatric age groups: 65 to 74, 75 to 84, and 85 to 95 years. Results All 82 geriatric patients reported from this series were symptomatic from their gallbladder disease. A majority of all patients in all age groups were female. Gallstones were present in 77 patients, and 5 patients had a gallbladder ejection fraction of less than 35%. In this series of laparoscopic cholecystectomy, 26.8% had an emergent procedure for acute cholecystitis and the remainder had an elective or semielective procedure for symptomatic cholecystitis. The majority of patients between the ages of 65 and 84 years had elective procedures whereas the majority of patients over age 85 had an emergent procedure. There were 2 deaths. The first death (age 86 years) was from extensive metastatic cancer from the gallbladder, and the second patient (age 91 years) died of sepsis and multiple system organ failure. Each patient in this entire series had an attempt at laparoscopic removal of the gallbladder. The conversion rate was 3.6% in the entire series of 248 patients and also 3.6% in the geriatric series. Ninety-one percent of the patients in this geriatric series were discharged home after only 24 to 48 hours of postoperative observation. Conclusions Laparoscopic cholecystectomy is a safe procedure in the geriatric population. The procedure should be recommended for all geriatric patients who have symptomatic cholecystitis before the development of acute cholecystitis or severe fibrosis with dense adhesions from chronic cholecystitis.

Acute septic cholecystitis in patients with burn injuries.

Acute cholecystitis continues to be a life-threatening complication in patients after trauma. In an 18-month period we have recognized and treated five patients with burn injuries who had acute cholecystitis. They ranged in age from 13 to 40 years. Four of the five patients had positive blood cultures and all five patients had positive bile cultures. The diagnosis was made on the basis of unexplained sepsis and an abnormal sonogram or hepatobiliary scan. Four patients underwent cholecystectomy and one patient underwent a cholecystostomy. Four patients survived and were discharged from the hospital. All five patients were receiving nutritional support. Factors such as prolonged fasting, dehydration, narcotic administration, and sepsis have been suggested as contributing factors in the development of acute cholecystitis. Acute cholecystitis is a serious complication in such patients and must be considered and treated promptly. Serial ultrasound studies have been helpful in managing patients suspected of having acute septic cholecystitis.