Mucocele Of Gallbladder Research Articles

PREVALENCE OF MICROORGANISMS IN GALL BLADDER ASPIRATE IN PATIENTS UNDERGOING LAPAROSCOPIC/OPEN CHOLECYSTECTOMY FOR CHRONIC CALCULUS CHOLECYSTITIS IN A TERTIARY CARE CENTRE

Background: Gallstone disease remains one of the most common medical problems leading to surgical intervention. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. In the vast majority of cases, infection is due to bacteria originating from the biliary tract. The incidence and type of bacteria involved and their susceptibility to antibiotics can be accurately predicted by bacteriological examination of the bile and a suitable antibiotic regimen can then be selected to minimize post-surgical infections. Therefore, it is important to know the microbiological ora of the gallbladder before prophylactic antibiotics are given. Materials and Methods: Study design: Study area: A descriptive study. Ramakrishna Mission Seva Pratishthan Hospital, Kolkata. from October 2017 to April 2019 (18 months). Sample size: 300 patients admitted in the Department of General Surgery undergoing Laparoscopic/Open Cholecystectomy. Inclusion criteria: Patients diagnosed with Chronic Calculous Cholecystitis belonging to any age or sex. Exclusion criteria: Patients with acute cholecystitis, empyema gallbladder, mucocele of gallbladder, gallstones along with bile duct stones. Methodology: Intraoperatively, 2ml bile from gallbladder was aspirated and sent for microbiological analysis. Each specimen was inoculated on two blood agar plates and one MacConkey agar plate. Growth was conrmed from colony characteristics, by Gram's staining, biochemical reactions and any special tests required conrming the particular bacterium. Antibiotic sensitivity was done by Kirby-Bauer method. Results: Bile Culture was positive in 39(13%) patients, of which majority were Females(61.5%) and majority were in the 61-80 age group for both. The most common organism cultured in Bile was E.coli(59%), followed by Klebsiella (25.6%). Majority were sensitive to Cefuroxime (28.2%), followed by Ciprooxacin (20.5%). Metronidazole was found sensitive in 12.8% cases whereas, Levooxacin, Meropenem and Piperacillin-Tazobactam were sensitive in 10.3%, 12.8 and 5.1% cases. 3 cases (7.7%) were found to contain microorganisms resistant to commonly used antibiotics. Conclusion: Biliary cultures were positive in 13% of cases with enterobacteria being the most frequent isolate.

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.

Case series of 200 laparoscopic cholecystectomy, their intra-operative finding and post-operative complication

Background: In the current era of laparoscopic procedure, laparoscopic cholecystectomy are most commonly performed surgery all over the world. The biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. So adequate recognition and awareness of anatomical abnormalities of encounter during laparoscopic cholecystectomy can decrease the morbidity and mortality related to surgery.Methods: It is prospective study including 200 patients based on intra-operative finding and their postoperative complication in Bhopal Memorial Hospital and research centre Bhopal, during period of Jan 2017 to Jan 2019.Results: In 200 cases 154 were Female and 46 were male. Mucocele of gallbladder in 22 cases, pyocele of gall-bladder in 7 cases. Gallbladder wall thickened and fibrosis in 13 cases. Gallbladder with duodenal fistula in 1case, gall bladder with colon and gall bladder with stomach fistula both in 1 case, and gall bladder with stomach fistula in 1 case. In one case there is absent gall bladder but patient havingCBD stone. Cystic artery cant separated from cystic duct and clipped along with cystic duct in 16 cases. In 3 cases there were gall bladder malignancy two were suspected intra-operatively and procedure abandoned other one after post lap cholecystectomy, confirm with biopsy report. Two cases develop post op incisional hernia. In 8 cases lap cholecystectomy converted into open cholecystectomy.Conclusions: This case series of laparoscopic cholecystectomy will help surgeons to be aware of such intra-operative finding and complication, so as to prevent undesirable outcome.

Clinicopathological Study of Gallbladder Lesions

Background: Gallbladder is one of the most frequently surgically resected organs which stores and concentrates the bile and is involved by both non neoplastic as well as neoplastic diseases. Chronic calculous cholecystitis is the most common benign lesion of gallbladder and pain abdomen is the commonest clinical presentation. Both non neoplastic and neoplastic lesions have similar clinical presentation and overlapping radiological findings. Methods: Total 550 cholecystectomy specimens were received in pathology department. Grossly, formalin fixed specimens were examined carefully and section were given from neck, fundus and body of gallbladder. Whenever it was necessary, additional sections were given. After processing, the H&E stained sections were studied thoroughly. All the clinical details were taken from case papers. Result: The commonly seen non neoplastic lesions were chronic calculous cholecystitis (405 cases), chronic cholecystitis (85 cases), Acute on chronic cholecystitis with or without stones (18 and 3 cases), acute necrotizing cholecystitis (2 cases), eosinophilic cholecystitis (3 cases), follicular cholecystitis (3cases), lymphoplasmacytic cholecystitis (1case), xathogranulomatous cholecystitis (9 cases), cholesterosis (4 cases), mucocele of gall bladder (2 cases), adenomyomatosis (3 cases) and gallbladder cholesterol polyp with cholecystitis (2 cases). Among neoplastic lesions 1 case was adenoma with severe dysplasia and 9 cases were adenocarcinoma. Conclusion: Chronic calculous cholecystitis was the most common lesion and out of 9 cases of carcinoma, 7 cases were diagnosed incidentally. Therefore, histopathological evaluation plays a critical role in identifying incidental gallbladder carcinoma for proper management of patients.

Changing trends in the epidemiology and presentation of gall stone disease in Bundelkhand region of Northern India

Background: Gallstone disease is fairly prevalent and expensive ailment, demanding approximately 700,000 cholecystectomies annually. Its complications expenses are over $6.5 billion in the United States. In developed countries, at least 10% of white population harbor cholesterol gallstones; women have twice the risk, and increasing age increases the prevalence in both sexes. Objectives: To evaluate the epidemiology and demographics of gall stone disease in Bundelkhand region and comparative analysis of changing trends with respect to its presenting population. Methods: This comparative study was conducted in a tertiary care centre teaching hospital between September 2012 to September 2014. 150 consecutive patients who fit into the inclusion criteria were included in the study. Random allocation of patients presenting with symptoms suggestive of gall bladder disease with confirmatory USG study was done and patients are allocated into 2 arms. ARM 1- CC with CL (Chronic cholecystitis with cholelithiasis) ARM 2-Others-Mucocele, Empyema GB, Acute cholecystitis with cholelithiasis(AC with CL), Xanthogranlumatous cholecystitis. The details of all are recorded in a proforma (Annexure). Statistical analysis was carried out and all the observations and results were evaluated to arrive at a conclusion. Results: Majority of presenting patients were in age group 30-40 years(33%). Youngest patient included in the study is 14yrs, oldest being 85yrs. 25% of the operated patients were males and 75% females and there was no significant difference among the two groups. Interpretation & Conclusion: Age group presenting with cholelithiasis to our centre is significantly younger(30-40yrs) than age group documented in other studies(40-50yrs). As documented by other studies majority of patients present with chronic cholecystitis with cholelithiasis(90%). Other presenting pathologies are mucocele of gall bladder(5%), empyema(2%), acute cholecystitis with cholelithiasis(2%), xantogranulomato

English

AIMS & OBJECTIVES: To find out prevalence of gallbladder mass among the patients of gallbladder pathology & define morphological feature of gall bladder masses using real time gray scale ultrasonography and color Doppler flow imaging & power Doppler imaging to find out prevalence of gall stones among the patients of gall bladder mass. MATERIAL AND METHOD: 10424 patients were evaluated for gall bladder pathology with grey scale ultrasonography in between 1.10.12 to 30.09.2013 in Radiodiagnosis department of G.R.M.C. RESULT: 54 patients out of 10424 i.e. 0.5% were found to have gall bladder mass lesion. Among these 79.5% (43) of patients had gall bladder carcinoma, 9.3% (5) had gall bladder polyp, 87.4% (4) had mucocele of gall bladder 1.9% (1) had porcelain gall bladder and 1.9% (1) had gall bladder metastasis. The youngest patient in our study was 12 years old male presented with mucocele. Oldest patient in our study was 68 years old female presented with gallbladder carcinoma.7% of overall gall bladder mass lesion were encountered in females showing clear female preponderance. Gall Stone embedded in 70% of gall bladder mass. CONCLUSION: J.A. group of hospital and G.R. Medical College, Gwalior serve a good proportion of population of M.P. and adjoining area of U.P. and Rajasthan which is endemic for gall bladder pathology. The present study concludes that ultrasonography is a powerful readily available and cost effective tool in the diagnosis of gall bladder pathology.

Presence of Hartmann’s Pouch in Human Gallbladder

Context: Hartmann’s pouch is an out-pouching of the wall of the gallbladder, at the junction of the neck of the gallbladder and the cystic duct. It may be a site where gall stone impacts, which leads to mucocele of gallbladder. So its identification is useful in delineating biliary anatomy while performing a cholecystectomy. Objective: To identify the presence of Hartmann’s pouch in human gallbladder. Study Design: A cross-sectional type of study. Place and period of study: The study was carried out in the Department of Anatomy, Dhaka Medical College, Dhaka from July 2008 to June 2009. Materials: 70 postmortem gallbladder were collected from unclaimed dead bodies that were under examination in the morgue of the Department of Forensic Medicine, Dhaka Medical College, Dhaka. Methods: Formalin fixed gallbladder was washed with plain tap water to remove excess formalin and was kept on metallic tray. On observation Hartmann’s pouch in gallbladder was detected and noted. Results: In the present study 70 cadaver’s gallbladder were observed carefully in the neck region for Hartmann’s pouch. The Hartmann’s pouch was detected in 4 cases out of 70 (5.7%). Conclusion: Further studies to find out the gross anatomy and histological study of Hartmann’s pouch is recommended. DOI: http://dx.doi.org/10.3329/bja.v10i2.17283 Bangladesh Journal of Anatomy, July 2012, Vol. 10 No. 2 pp 57-58

Acquired mucocele of the gall-bladder in childhood.

Acquired mucocele of the gall-bladder in childhood.