Gallbladder Injury Research Articles

Radiofrequency Ablation (RFA) Combined with Transcatheter Arterial Chemoembolization (TACE) for Patients with Medium-to-Large Hepatocellular Carcinoma: A Retrospective Analysis of Long-Term Outcome.

BackgroundThe aim of this study was to investigate the prognostic value of radiofrequency ablation (RFA) plus transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients with tumor size ranging from 3.0 to 10.0 cm.Material/MethodsWe retrospectively analyzed data on 201 patients with medium-to-large HCC. According to treatment procedure, the patients were divided into the TACE group (n=124) and the TACE+RFA group (n=77). We recorded data on patient safety, subcapsular hepatic hematoma, large amount of ascites, liver abscess, gallbladder injury, and local skin infection. The overall survival (OS) and progression-free survival (PFS) in the 2 groups were analyzed and compared between groups.ResultsThe median PFS was 4.00 months (3.00–5.00 months) in the TACE group and 9.13 months (6.64–11.62 months) in the TACE+RFA group (P<0.001). Median OS was 12.00 months (8.88–15.13 months) in the TACE group and 27.57 months (20.06–35.08 months) in the TACE+RFA group (P<0.001). In the TACE+RFA group, multivariate Cox regression analysis showed that tumor size ≤5 cm) (HR: 1.952, 95% CI: 1.213–3.143, P=0.006), hepatitis B (HR: 2.323, 95% CI: 1.096–4.923, P=0.028), TACE times (1 or >1) (HR: 1.867, 95% CI: 1.156–3.013, P=0.011), alpha-fetoprotein (AFP) level >200 ng/ml (HR: 2.426, 95% CI: 1.533–3.839, P<0.001), and AST level >40 U/L (HR: 1.946, 95% CI: 1.196–3.166, P=0.007) were independent prognostic factors for overall survival.ConclusionsCombination therapy of TACE with RFA is a safe and effective treatment for patients with medium-to-large HCC, with the long-term beneficial effect of retarding tumor progression and improving PFS and OS.

SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

BACKGROUND &amp; OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy.&#x0D; METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated.&#x0D; RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study.&#x0D; CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

Isolated gallbladder injury following blunt abdominal trauma: a case report

Isolated gallbladder injury following blunt abdominal trauma: a case report

Biliary peritonitis caused by a gallbladder injury due to low-energy blunt trauma

Biliary peritonitis caused by a gallbladder injury due to low-energy blunt trauma

腹部鈍的外傷による外傷性胆囊損傷（avulsion）の1例

腹部鈍的外傷による外傷性胆囊損傷（avulsion）の1例

Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials.

To evaluate the comparative outcomes of three-dimensional (3D) versus two-dimensional (2D) imaging during laparoscopic cholecystectomy. We conducted a systematic search of electronic information sources and bibliographic reference lists and applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Procedure time, Calot's triangle dissection time, gallbladder removal time, gallbladder perforation, intraoperative bleeding, postoperative complications, conversion to open and intraoperative errors were the evaluated outcome parameters. We identified 6 randomised controlled trials (RCT) reporting a total of 577 patients who underwent laparoscopic cholecystectomy using 3D (n = 282) or 2D (n = 295) imaging. The 3D imaging was associated with significantly shorter procedure time (MD - 4.23, 95% CI - 8.14 to - 0.32, p = 0.03), Calot's triangle dissection time (MD - 4.19, 95% CI - 6.52 to - 1.86, p = 0.0004) and significantly lower risk of gallbladder perforation (RR 0.50, 95% CI 0.28-0.88, p = 0.02) compared to the 2D approach. No significant difference was found in gallbladder removal time (MD - 0.79, 95% CI - 2.24 to 0.66, p = 0.28), intraoperative bleeding (RR 1.14, 95% CI 0.68-1.90, p = 0.61), postoperative complications (RD - 0.01, 95% CI - 0.06 to 0.05, p = 0.85), conversion to open (RD 0.00, 95% CI - 0.02 to 0.03, p = 0.70) or intraoperative errors (RR 0.96, 95% CI 0.79-1.17, p = 0.70) between the two groups. Although our findings suggest that the use of 3D imaging during laparoscopic cholecystectomy may be associated with significantly shorter procedure time, Calot's triangle dissection time and gallbladder injury compared to the 2D imaging, the differences seem to be clinically insignificant. Moreover, both approaches carry s similar risk of postoperative morbidities. The impact of the surgeon's level of experience and difficulty of the procedure on the outcomes of each imaging modality remains unknown.

Gallbladder injury after blunt abdominal trauma: Imaging clues for diagnosis

Travmatik safra kesesi yaralanmalari nadirdir ve teshis edilmesi zordur. Ultrasonografi, bilgisayarli tomografi (BT) ve manyetik rezonans goruntuleme (MRI) gibi goruntuleme yontemleri kullanilsa bile safra kesesi duvarindaki defektleri tespit etmek oldukca zordur. Ameliyattan once safra kesesi rupturunun teshisi genellikle guctur. Kunt karin travmasi olan bir hastada, klinik takipte, sayilan ipuclari safra kesesi rupturunden suphelendirmelidir: Goruntulemesinde safra kesesi bolgesine uzanan hepatik laserasyon, takiplerinde artmis abdominal distansiyon ve abdominal agri, takip goruntulemelerinde hic dolmayan safra kesesi ve karin ici artmis sivi. Bu tur hastalara serbest sivi orneklemesi yapilmalidir. Burada, laparotomi uygulanan 33 yasinda trafik kazasi sonrasi karaciger laserasyonu bulunan bir kadin hastanin safra kesesi rupturu tanisi ve taniya goturen ipuclari takdim edildi.

Post-Traumatic Gallbladder Injury in Children: Case Rapport

Post-traumatic injuries of the gall bladder are rare. We report through a clinical description of its physio-pathological and evolutionary aspects. A 14-year-old boy was received 48 hours after a stabbing attack. After initial haemorrhage, the patient presented clinical improvement; then a sudden deterioration with vague symptoms and disturbance of the hepatic balance. The abdominal CT scan revealed a perivesicular hematoma with a focus on hepatic contusion. Laparoscopy showed a penetrating sore of the liver, but the exploration was limited by an important inflammation of the digestive tract. The diagnosis of gall bladder perforation was made during the operation. We performed a cholecystectomy by laparotomy. Postoperative evolution was simple, removal of the slides at D + 4 and discharged at D + 7 postoperative after improvement. At the 6th month, he presented an acute intestinal obstruction on bridles, managed at emergency by open surgery. After one year of follow up, the patient has no symptoms. We note that the vague clinical presentation and the limit of imaging examinations made the early diagnosis of a vesicular perforation a real challenge for the clinician. Cholecystectomy remains the optimal treatment.

2180 Why Is This Hemoperitoneum Orange? A Late Diagnosed Isolated Rupture of the Gallbladder Secondary to Blunt Abdominal Trauma

INTRODUCTION: The gallbladder is protected from blunt trauma by its unique anatomic position inferior to the liver and behind the rib cage. Biliary tree injuries are rare, occurring in approximately 2% of cases of blunt trauma. Isolated gallbladder injury is even rarer and the exact incidence is unknown. CASE DESCRIPTION/METHODS: 48 year old male with a history of alcohol abuse who was brought to the Emergency Department with right upper quadrant pain after falling over a fan. Labs showed stable chronic macrocytic anemia and elevated liver function tests. CT revealed ascitic fluid with suspected hemoperitoneum. Surgery managed the patient conservatively in light of stable serial hemoglobin values. Over the next 4 days, the patient developed shock with multi-organ failure. Primary team presumed deteriorating clinical status was related to alcoholic hepatitis and acute on chronic liver failure. Gastroenterology was then consulted and we recommended urgent diagnostic paracentesis. When smeared, the fluid was dark orange in color. A Medicine resident called the GI fellow and asked “why is this hemoperitoneum orange?” Ascitic bilirubin was 25 mg/dL. Surgery believed it was due to hemolysis of the hemoperitoneum. We transferred the patient for urgent ERCP that revealed external accumulation of contrast and bubbles in proximity to the gallbladder. A common bile duct stent was placed. Patient was taken for exploratory laparoscopy where a 5 cm defect on the anterior wall of gallbladder was noted and cholecystectomy was performed. Postoperative course was complicated by a 9 × 7 cm intra abdominal abscess. The collection was not amenable to Interventional Radiology drainage due to its proximity to the spleen. The patient underwent successful endoscopic cystogastrostomy with placement of a lumen apposing metal stent. DISCUSSION: Isolated gallbladder injury remains challenging to diagnose both clinically and radiologically. When suspected, percutaneous drainage is indicated to establish diagnosis even if radiological investigations are unrevealing. There is a high risk of morbidity and mortality secondary to a missed or delayed diagnosis. For patients in whom diagnosis is delayed, abdominal sepsis secondary to non-sterile biliary peritonitis can complicate the postoperative course. ERCP can be performed prior to surgery to reduce the pressure gradient between the biliary system and the duodenum allowing bile to drain preferentially into the duodenum.

Postoperative bile peritonitis after percutaneous nephrolithotomy: case analysis and treatment strategy

A case retrospective analysis of the gallbladder's injury during percutaneous nephrolithotomy was performed which occurred in the Sayansk Town Hospital. The data of instrumental examination, tactics of intra- and postoperative treatment are presented. For this topic, the literature of PubMed database for the last 25 years has been analyzed by keywords: percutaneous nephrolithotomy, kidney stone, gallbladder, cholecystostomy, trauma. 11 cases of gallbladder's injury during performing percutaneous nephrolithotomy was selected with 8 of which required cholecystectomy. In one case, conservative treatment of gallbladder's perforation was applied. Percutaneous cholecystostomy and papillosphincterotomy cases with retrograde cholangiopancreatography and stenting of the common bile duct are also described.

04:21 PM Abstract No. 188 Cholecystokinin-assisted microwave ablation of hepatic tumors near the gallbladder

To evaluate the safety and efficacy of cholecystokinin-assisted microwave ablation of hepatic tumors near the gallbladder. IRB-approved retrospective review of 4 patients who had received a total of 5 cholecystokinin (CCK)-assisted microwave ablations of hepatic tumors near the gallbladder fossa. Demographic and procedural information was reviewed including diagnosis, technical success, and 3 month follow-up. There was 80% (4/5) technical success with a single patient demonstrating poor gallbladder contractility in response to CCK administration who was later treated successfully with transarterial chemoembolization. There were no major complications with specifically no episodes of gallbladder rupture or any other significant gallbladder injury. One individual had post operative pain successfully managed with intravenous followed by oral narcotics. Finally, a single patient had residual versus recurrent enhancement on initial 3 month follow-up study and successfully underwent repeat CCK-assisted microwave ablation with no evidence of disease on repeat follow-up. The gallbladder was fully intact on all follow-up studies. Intravenous administration of cholecystokinin offers safe, effective, and noninvasive assistance in performing microwave ablation of hepatic tumors near the gallbladder.

Pancreaticobiliary Maljunction without Biliary Dilatation Diagnosed following Traumatic Gallbladder Injury

Pancreaticobiliary Maljunction without Biliary Dilatation Diagnosed following Traumatic Gallbladder Injury

交通外傷により腹腔内他臓器損傷を伴わない胆嚢損傷を来した1例―既報告27例の集計とともに―(Gallbladder perforation caused by a traffic injury: a case report)

要旨胆嚢は解剖学的に外力の影響を受けにくいため，鈍的外傷による胆嚢損傷はまれであり，また他臓器損傷を伴う場合が多い。我々は腹腔内他臓器損傷を伴わない外傷性胆嚢損傷を経験したので報告する。症例は76歳の男性。飲酒後に路上で臥床中，自動車に轢かれたところを目撃され，当院救命救急センターに搬送された。CTにて肝表面，Morrison窩，右傍結腸溝に少量の腹水を認め，経過観察としたが，第3病日のCTで経時的な増加を認め，第4病日に緊急開腹手術を行った。胆嚢体部に穿孔を認めたが腹腔内他臓器には損傷を認めず，胆嚢摘出術，腹腔内ドレナージ術を施行した。術後経過は良好であった。胆嚢は外力を受けにくい臓器であるが，飲酒は胆嚢の緊満と腹壁の弛緩をもたらすため，外傷性胆嚢損傷の誘因の一つとなりうる。本症例でも過量飲酒が一因となった可能性が示唆された。治療としては，原則的には可及的早期の外科的加療が望ましいと考えられる。

Man With Blunt Abdominal Trauma

A 39-year-old man presented to our emergency department with abdominal pain within 1 hour after injury. A piece of wood hit his right hypochondrium when he was cutting wood during landscape gardening. Vital signs were normal. Examination revealed rebound tenderness and guarding to the right hypochondrium. Blood tests showed elevated liver enzyme levels: aspartate aminotransferase 99 U/L and alanine aminotransferase 101 U/L. Other blood test results were normal. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) were performed (Figures 1 and 2).Figure 2Axial image of contrast-enhanced CT on delay phase. White arrow shows fluid collection around the gallbladder, and white arrowhead shows dense fluid within the gallbladder lumen.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Traumatic gallbladder avulsion and perforation. Abdominal ultrasonography showed swelling of the ventral gallbladder wall without Doppler color flow, which suggested that wall thickness was due to trauma rather than inflammation. Contrast-enhanced CT showed gallbladder dislocation, fluid around the gallbladder, and dense fluid within the gallbladder lumen on delay phase. These findings corresponded with gallbladder injury.1Wittenberg A. Minotti A.J. CT diagnosis of traumatic gallbladder injury.AJR Am J Roentgenol. 2005; 185: 1573-1574Crossref PubMed Scopus (27) Google Scholar Urgent laparotomy revealed biliary leakage, separation of the gallbladder from the fossa, and gallbladder perforation; a cholecystectomy was performed (Figure 3). An intra-abdominal drain was placed longer than usual because of the possibility of biloma. He was discharged from our hospital on day 10. Gallbladder injuries occur in less than 2% of blunt abdominal trauma and are classified as contusion, perforation, and avulsion.2Pavlidis T.E. Lalountas M.A. Psarras K. et al.Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature.J Med Case Rep. 2011; 5: 392Crossref PubMed Scopus (10) Google Scholar Gallbladder avulsion and perforation sometimes cause biliary leakage and bile peritonitis. CT and ultrasonography often contribute to the diagnosis of gallbladder injury. Although there are some reports of gallbladder injury treated with laparoscopic cholecystectomy,3Kohler R. Millin R. Bonner B. et al.Laparoscopic treatment of an isolated gallbladder rupture following blunt abdominal trauma in a schoolboy rugby player.Br J Sports Med. 2002; 36: 378-379Crossref PubMed Scopus (25) Google Scholar gallbladder injuries often complicate intra-abdominal injuries that require surgical intervention.2Pavlidis T.E. Lalountas M.A. Psarras K. et al.Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature.J Med Case Rep. 2011; 5: 392Crossref PubMed Scopus (10) Google Scholar In such cases, laparotomy is sometimes chosen as the initial treatment.

Gallbladder Injury During Percutaneous Nephrolithotomy

Gallbladder Injury During Percutaneous Nephrolithotomy

Fatal Event of the Gallbladder Rupture Following the Blunt Abdominal Trauma: A Case Report

The gallbladder traumatic injury rarely happens due to its anatomical location and includes 2%-5% of trauma cases. The diagnoses of isolated gallbladder rupture in the blunt abdominal trauma are usually delayed and mostly revealed during the surgeries. To diagnose gallbladder injuries, the probability of injury in an organ such as gallbladder in the blunt abdominal trauma should be considered and accordingly the detailed diagnostic method should be used. A 85-year-old female was referred to the hospital due to facial and abdominal trauma. There was a mild tenderness in the right upper quadrant (RUQ) area. The hydrops gallbladder was observed in the focused assessment with sonography. The patient was assessed by abdominal ultrasonography after 48 hours and reports liver extensive rupture and sub-capsular hematoma. The patient was assessed by abdominal ultrasonography after 48 hours and reports liver extensive rupture and sub-capsular hematoma. The following day, the patient had severe bradycardia and finally dead due to asystole and cardiac arrest. In autopsy, the gallbladder rupture caused the green purulent bile discharge released over the abdomen. The current paper reports a case on isolated gallbladder injury following the blunt abdominal trauma which was not diagnosed in post-traumatic evaluations and was revealed by autopsy after patient’s death. The best method to diagnose gallbladder injuries is the computed tomography (CT) of the abdomen.

A Case of Traumatic Gallbladder Injury

A Case of Traumatic Gallbladder Injury

When Domestic Violence Causes Gallbladder Injuries: A Case Report of Gallbladder Perforation

Traumatic injuries to the gallbladder are rare. This is attributed to its anatomical location and protection by the liver. Direct penetrating trauma is the commonest mechanism of injury. Here is the report of a 27-year-old otherwise healthy male who sustained gallbladder perforation following the penetration of abdominal injury in a domestic fight. A high index of suspicion is necessary for early diagnosis. He safely underwent an open cholecystectomy and his postoperative recovery was uneventful.

Gallbladder injury during percutaneous nephrolithotomy

Gallbladder injury during percutaneous nephrolithotomy

Gallbladder injury during percutaneous nephrolithotomy

Gallbladder injury during percutaneous nephrolithotomy