Postcholecystectomy State Research Articles

The role of appendectomy and cholecystectomy in the pathogenesis of colorectal carcinomas

BackgroundSeveral alterations in the gastrointestinal tract which occur after appendectomy or cholecystectomy have been suggested to raise the risk of developing colorectal carcinoma. Given the frequency that these procedures are performed, we sought to determine whether a history of either cholecystectomy or appendectomy increased the risk of future colorectal carcinoma. MethodsWe determined the number of patients with a history of appendectomy and cholecystectomy who developed colorectal carcinoma between January 2018 and February 2021, as well as the latency time between the two diseases. Secondly, we carried out a data-collection spanning 15 years after the primary surgery (January 2005–December 2006). ResultsThe post-cholecystectomy state is significantly more frequently observed in patients treated for colorectal carcinomas (both male and female), especially among those who developed right-sided or left-sided colon cancer, as opposed to anorectal cancer (p = 0.53). However, the time elapsed between the two diseases is 20–25 years, which appears to be markedly long regarding such a multifactorial disease as the colorectal carcinoma. No similar extra risk was observed among patients having appendectomy. Secondly, we found no extra risk during the first 15 years after cholecystectomy. ConclusionAlthough a statistically higher risk of colon cancer is observed after the removal of the gallbladder, but the latency time is long. Thus, cholecystectomy may not be an independent risk factor for colorectal carcinogenesis. Altogether, the patient is not exposed to a higher risk of colorectal carcinogenesis after having cholecystectomy.

Acute Hepatitis B versus Autoimmune Hepatitis: A Clinical Conundrum

A 42-year-old Hispanic male presented with10 days of right upper quadrant pain, fatigue and jaundice. Past medical history was significant for gallstone pancreatitis s/p cholecystectomy and papillary thyroid cancer s/p thyroidectomy. He denied smoking, drinking alcohol or use of illicit substances. He had no family history of liver disease. He was from Mexico and most recently visited there one year prior. His only medication was levothyroxine and denied use of acetaminophen, NSAIDs or herbal medications. Physical exam revealed normal vital signs, jaundice and mild RUQ tenderness. Labs were remarkable for ALT of 4136 U/L, AST 3609 U/L, alkaline phosphatase 223 U/L, total bilirubin 17.3 mg/dl, direct bilirubin of 15 mg/dl, and INR of 2.2. All other laboratory tests were unremarkable. Ultrasound was unremarkable except for post-cholecystectomy state. MRCP showed mild peri-portal edema and enlarged peri-portal lymph nodes consistent with acute hepatitis. HBV IgM core Ab and HBV surface Ag were positive while HbSAb was negative. The remainder of the hepatitis viral panel was negative. Hepatitis B PCR showed viral load of 44844 IU/ml. Anti-Smooth muscle antibody (ASMA) also came back positive (1:320). ANA, Immunoglobulin, anti-mitochondrial Ab, anti-LK microsomal Ab were negative. Iron panel and ceruloplasmin were unremarkable. Liver biopsy showed minimal portal inflammation along with diffuse hepatocyte balloon degeneration non-specific for either autoimmune hepatitis or acute hepatitis B infection. He was started on tenofovir as well as prednisone, and liver function tests (LFTs) were monitored. With this dual therapy approach, LFTs improved and INR trended down. He was discharged from hospital and down trending LFTs and INR were confirmed during subsequent clinic visits. There are sporadic reports of antigen mimicry between HBV DNA polymerase and smooth muscle protein. In a study of 31 patients with acute Hepatitis B infection, 22 also had positive ASMA. Only 2 had a titer greater than 1:200 and only 1 had titer greater than 1:400. This leads to clinical uncertainty about the diagnosis of acute hepatitis B infection vs. autoimmune hepatitis in a patient with high ASMA titer. This patient had evidence of acute HBV, however given ASMA titer as high as 1:320 and non-diagnostic biopsy, no clear guideline exists for management in this scenario. We opted for management of both conditions with short term clinic follow up which confirmed favorable response.Figure: Diffuse hepatocyte ballooning and degeneration.Figure: Portal and periportal fibrosis.

Choledocholithiasis: Clinical Manifestations and Associated Conditions

Background: More than 98% of all biliary tract disorders are in some way related to gallstones. Choledocholithiasis refers to the presence of gallstones within the common bile duct (CBD). It represent a clinical problem often involving severe infection, cholangitis and cholestasis. Investigations on the etiology of CBD stones are, however, scarce because of the difficult access to CBD stones and bile. In a clinical series of CBD stones, we studied the symptomatology and associated conditions of CBD stones. Methodology: A total number of 115 patients with CBD stones confirmed by imaging technique who underwent Endoscopic retrograde cholangipancreatography (ERCP) were included in this study and grouped as, Group 1- Patients with CBD stones with Gall Bladder (GB) stones. Group 2- Patients with CBD stones with no stones in GB. Group 3- Patients with CBD stones in postcholecystectomy state. Using standard proforma demographic and clinical details were collected. The statistical software package SPSS for Windows version 15 was used to analyse the data. Results: Out of 115 patients, 51 were males and 64 were females. Mean age of presentation was 49.91 years. Most common presentation of CBD stones was abdominal pain 60.86% followed by jaundice 38.26%.Charcots triad was seen in 33.04%. Most common associated condition was distal CBD stricture (16.5%). In this study 54% of patients had associated GB stones,22% had isolated CBD stones and 24% had CBD stones in postcholecystectomy state. Conclusion: There was no statistically significant difference in clinical presentations, associated features in all the three groups of choledocholithiasis. (P value > 0.238).

What Should Be Done with a Dilated Bile Duct?

Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigations in patients with incidentally identified modest ductal dilatation without symptoms or laboratory abnormalities. Additional investigations are more likely to identify clinically relevant findings in patients with more pronounced dilatation. EUS is highly accurate, low-invasive, and useful in this setting, whereas ERC should be reserved for cases likely to require therapeutic intervention.

Effects of Bile Acid Binding on Colonic Transit in Irritable Bowel Syndrome with Diarrhea

Purpose: Bile acid malabsorption is recognized in up to 70% of patients with chronic diarrhea. Bile acid binding with cholestyramine is used empirically to treat functional diarrhea, but compliance is poor. Our aim was to measure the effects of the bile acid binder colesevelam hydrochloride on gastrointestinal and colonic transit, bowel function, intestinal and colonic permeability in IBS-D. Methods: In a randomized, double-blind, placebo-controlled study, we compared transit effects of colesevelam, 1.875g/day, or placebo for 14 days in 24 female patients (12/group balanced on BMI) with IBS-D. We also measured bowel frequency and consistency (by Bristol stool form scale daily) and ease of stool passage (scale 1-7, where 4 is normal and 5 is urgent without pain). Treatment effects were compared using analysis of covariance with BMI as covariate. Results: There was 100% compliance with medication intake. Figure shows effect of colesevelam and placebo on overall colonic transit at 24h in individual patients. In IBS-D, there was a tendency for a treatment effect of colesevelam (p=0.18) on overall colonic transit at 24h (table). Moreover, 7/12 patients on colesevelam had >0.7 geometric center (GC) unit retardation of colonic transit at 24h. Colesevelam was associated with greater ease of stool passage (p=0.047) and numerically firmer stool consistency (p=0.12). Post-cholecystectomy state did not affect the Results: 2/4 improved on placebo; 2/2 improved on colesevelam. The most common side effects were headache, nausea, and flatulence. No safety issues were identified and no patients stopped the study drug.FigureConclusion: In IBS-D patients, not selected for bile acid malabsorption, colesevelam shows a tendency to slow colonic transit and ease stool passage. Bile acid binding with colesevelam deserves further study in IBS-D.Table

The relationship between gallbladder disease and smoking and drinking habits in middle-aged Japanese

Few studies have investigated the association between smoking and ultrasonographically diagnosed gallbladder (GB) disease, and their results were uncertain. This study was conducted to examine the association between smoking and drinking and GB diseases. A total of 9,947 subjects (age, 30-69 years; 4,953 men and 4,994 women) voluntarily received a paid medical check-up at our center in Yamanashi Prefecture in Japan. All of the subjects underwent abdominal ultrasonographic (US) examination, a demographic check, and a biochemical test, and answered a self-administered questionnaire asking about smoking habits and alcohol consumption. Of the 9,947 subjects, 483 had gallstones, 819 had gallbladder polyps, and 169 were in a state of postcholecystectomy. We compared the findings in this group with the findings in 8,417 people (4,144 males and 4,273 females) with normal gallbladder. Multiple regression analysis among males showed that cigarette smoking was inversely related to GB polyps (odds ratio, [OR], 0.76; 95% confidence internal [CI], 0.59-0.98 and OR, 0.74; 95% CI, 0.56-0.98, respectively, for current and ex-smokers). Ex-smokers a showed positive association with the postcholecystectomy state (OR, 2.56; 95% CI, 1.18-5.52). Light drinkers showed an inverse relation to GB stones (OR, 0.69; 95% CI, 0.49-0.99), and heavy drinkers showed an inverse relation to GB polyps (OR, 0.68; 95% CI, 0.51-0.90). Current drinkers showed an inverse relation to the postcholecystectomy state (OR, 0.48; 95% CI, 0.28-0.83). Cigarette smoking was inversely related to gallbladder polyps in males and was positively related to the postcholecystectomy state. Drinking was inversely related to gallstones, GB polyps, and the postcholecystectomy state in males.

Gallstone disease among Japanese men in relation to obesity, glucose intolerance, exercise, alcohol use, and smoking.

Risk factors for gallstones are not fully understood, especially in men. Obesity and other risk factors for gallstone disease were investigated in Japanese men based on gallbladder ultrasonography. Forty-one men with gallstones, 31 with postcholecystectomy state, and 2044 with a normal gallbladder were identified among 2228 men aged 49-55 years who received a retirement health examination at three hospitals of the Japan Self-Defense Forces between 1991 and 1992. Glucose tolerance was determined with a 75-g oral glucose tolerance test. Body mass index was not associated with gallstones, although it was significantly, positively related to postcholecystectomy. Waist to hip circumference ratio tended to be weakly associated with gallstones. Diabetes mellitus was associated only with postcholecystectomy. Smoking, alcohol intake, and physical activity were not measurably related to either gallstones or postcholecystectomy. The present study failed to substantiate an association of gallstone risk with either obesity or any other risk factor. Further observation is needed in view of the limited study power.

Prevalence of gallstone disease in relation to smoking, alcohol use, obesity, and glucose tolerance: a study of self-defense officials in Japan.

Risk factors of gallstone disease were investigated in male self-defense officials who received, between October 1986 and December 1990, a retirement health examination at the Self-Defense Forces Fukuoka Hospital, Fukuoka, Japan. Gallbladder ultrasonography, successfully performed with 2,739 of 2,756 men, found 61 men with gallstones and 38 men with previous removal of the gallbladder; the overall prevalence of gallstone disease was 3.6%. Multiple logistic regression analysis assessed the risk of gallstone disease in relation to smoking, alcohol use, body mass index, glucose tolerance, and rank. Alcohol use was associated with a decreased risk, and body mass index was positively related to gallstone disease. Men with impaired glucose tolerance had a slightly elevated risk, whereas diabetes mellitus was not associated with gallstone disease. Analysis for prevalent gallstones and the postcholecystectomy state showed an inverse association of alcohol use with the latter; a positive association with impaired glucose tolerance was also confined primarily to the latter condition. These findings provide little support for a protective effect of alcohol use in the formation of gallstones. It was inconclusive whether impaired glucose tolerance was associated selectively with postcholecystectomy.

In Vitro Measurement of the Length of the Sphincter of Oddi

A study to determine the length of the sphincter of Oddi was performed using 148 autopsy specimens with adjacent structures obtained from adults. The median diameter of the common bile duct was 7 mm (range 4-13 mm). The median intramural length of the sphincter measured at gross examination of 75 specimens was 14 mm (range 7-22 mm); the median length of the common channel between the common bile and pancreatic ducts was 3 mm (range 0-9 mm). Longitudinal histological preparations for microscopic examination were made of 73 specimens. The median extramural length of the sphincter was 5 mm (range 1-11 mm). No associations were found between the length of the sphincter, intramural or extramural, and the diameter of the common bile duct, age, sex, presence of stones in the gallbladder or the postcholecystectomy state, nor was there an association between the intramural and extramural length of the sphincter (p greater than 0.05).

Influence of Graded Distension of the Gallbladder on Sphincter of Oddi Activity in Dogs

In this study the relationship between the gallbladder pressure (GBP) and sphincter of Oddi (SO) activity was studied in dogs. The GBP was modulated by varying the volume content in a reservoir placed within the gallbladder at ranges corresponding to physiological GBP ranges. For SO manometry a low compliance high fidelity system was used. Firstly the influence of alternating gallbladder emptying and filling on SO activity was studied. A clear relationship was seen in all dogs so that an increase in GBP inhibited SO activity. Subsequently, stepwise increases in GBP from 0 to 38 mm Hg in consecutive 10-min measuring periods showed a definite inverse relationship between GBP and SO frequency, baseline pressures and wave amplitude. It is concluded that a reflex relationship between the gallbladder and the SO exists, operating within physiological ranges of GBP so that increased GBP inhibits SO activity. The importance of this relationship in bile flow dynamics and the possible consequence in the postcholecystectomy state is mentioned.

Prevalence of Gallstones at Autopsy at the Institutes of Forensic Medicine in Aarhus and Copenhagen, Denmark, in 1944-1985

The prevalence of gallstones and the post-cholecystectomy state in a material of forensic autopsies was reviewed in five series from 1944-46 to 1985, with a total of 5031 cases. Analysed in a multiple logistic regression program with gallstones and post-cholecystectomy state as response variable, and sex, age, manner of death, and calendar years as explanatory variables, the data showed no interactions, with the exception of the manner of death, which may have a different effect (NS) on the two sexes. The prevalence, which was more than halved from 1954-56 to 1985 (p less than 10(-4], was more than twice as high for women as for men, and it increased with age (p less than 10(-4]. However, the later the calendar period, the less steep the prevalence increase with age. A subdivision in accordance with the cause of death (natural or by accident) showed an association between death-causing disease and gallstones for men (p = 10(-3] but no significant difference for women.

Gallstones, serum lipids, and glucose tolerance among male officials of Self-Defense Forces in Japan.

The relationships of gallstones and the postcholecystectomy state with serum total cholesterol, serum triglycerides, glucose tolerance, and obesity were examined in male officials of the Self-Defense Forces in northern Kyushu, Japan. The study population had rather low rates of gallstones (2%) and prior cholecystectomy (3%). A strong relationship between obesity and gallstones was confirmed. Glucose intolerance was associated with the risk of gallstones independent of obesity. No relation between gallstones and either serum total cholesterol or triglycerides after adjustment for obesity and glucose tolerance was evident. However, the serum concentration of total cholesterol among men having had a cholecystectomy was less than that of those without gallstones.

Chronic gastritis in cholecystectomized patients.

Duodenogastric reflux is considered to be a possible cause of chronic gastritis. This reflux, however, is reported to be common after cholecystectomy. In the present investigation we have studied the possible relation between chronic gastritis and prior cholecystectomy in 106 symptomatic outpatients with prior cholecystectomy and in 131 controls without cholecystectomy. We surveyed their endoscopic biopsy specimens from antral, body, and esophageal mucosa. We found that the mean score and prevalence of chronic antral and body gastritis in cholecystectomized patients was the same as or slightly lower than that in controls. The mean progression of gastritis, when compared with the progression of gastritis in the general population, was slightly slower than expected in the cholecystectomized patients. This slow progression was seen in body gastritis in cholecystectomized patients with a coexisting esophagitis. We conclude that there is no positive correlation between chronic gastritis and prior cholecystectomy. In contrast, this correlation may be negative, especially in patients with esophagitis, in whom an association of the postcholecystectomy state and a possible duodenogastric reflux with normal, nongastritic and nonatrophic body mucosa may facilitate mechanisms favoring the pathogenesis of esophagitis.

The normal post-cholecystectomy sonogram: gas vs. clips.

Although both gas and heavy metals create multiple reverberations, they can be distinguished both in vivo and in vitro by the differences in origin (focus) and the duration (persistence) of the artifact. A phantom experiment showed that surgical clip artifacts emanate from short echogenic foci, and are persistent, whereas gas foci are either long or short, with evanescent artifacts. In 78 consecutive post-cholecystectomy patients, 96 per cent (24/26) of the patients with clips demonstrated multiple reverberation artifacts, whereas 6 per cent (2/31) of the patients without clips demonstrated several reverberation artifacts. Analyzing these characteristics as well as the positional relationships of reverberation artifacts in the porta hepatis and gallbladder fossa should enable one to suspect the post-cholecystectomy state and differentiate from an abnormal gas collection.

Postcholecystectomy Syndromes: A Clinical Approach to Etiology, Diagnosis, and Management

In his preface, Dr Schein states that incidence of postcholecystectomy dissatisfaction is in the 10-30% range and prepares us for first comprehensive consideration of the entire spectrum of postcholecystectomy disorders. In fact, the book turns out to be as amorphous as those introductory comments. It is an inclusive potpourri of anatomy, physiology, clinical experience, case reports, and specific technical details relating not only to the postcholecystectomy state but to pancreatic cancer, acute and chronic pancreatitis, common duct stones, cholecystostomy, cholecystoenterostomy, and, in short, anything that seems vaguely related to the gallbladder, whether or not it has been removed. Unhappily, one also suspects that sections have been added to inflate the text to book size (eg, technical details of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography). The book is neither systematically constructed nor well organized for reference when specific problems are of interest. The material related to a given

THE USE OF “BILIGRAFIN” IN INVESTIGATION OF THE POST‐CHOLECYSTECTOMY STATE: THE RESULTS IN 224 CHOLECYSTECTOMIES AT SAINT VINCENT'S HOSPITAL, SYDNEY

Medical Journal of AustraliaVolume 1, Issue 7 p. 197-200 Original Article THE USE OF “BILIGRAFIN” IN INVESTIGATION OF THE POST-CHOLECYSTECTOMY STATE: THE RESULTS IN 224 CHOLECYSTECTOMIES AT SAINT VINCENT'S HOSPITAL, SYDNEY Justin Fleming M.S., F.R.C.S., F.R.A.C.S., F.A.C.S., Justin Fleming M.S., F.R.C.S., F.R.A.C.S., F.A.C.S. Department of SurgerySearch for more papers by this authorR. J. Healey M.B., B.S., R. J. Healey M.B., B.S. Department of SurgerySearch for more papers by this authorJ. H. Hood M.B., B.S., D.D.R., M.C.R. (Aust. and N.Z.), J. H. Hood M.B., B.S., D.D.R., M.C.R. (Aust. and N.Z.) Radiologist in Charge Department of Diagnostic Radiology, Saint Vincent's Hospital, SydneySearch for more papers by this author Justin Fleming M.S., F.R.C.S., F.R.A.C.S., F.A.C.S., Justin Fleming M.S., F.R.C.S., F.R.A.C.S., F.A.C.S. Department of SurgerySearch for more papers by this authorR. J. Healey M.B., B.S., R. J. Healey M.B., B.S. Department of SurgerySearch for more papers by this authorJ. H. Hood M.B., B.S., D.D.R., M.C.R. (Aust. and N.Z.), J. H. Hood M.B., B.S., D.D.R., M.C.R. (Aust. and N.Z.) Radiologist in Charge Department of Diagnostic Radiology, Saint Vincent's Hospital, SydneySearch for more papers by this author First published: 01 February 1957 https://doi.org/10.5694/j.1326-5377.1957.tb49613.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume1, Issue7February 1957Pages 197-200 RelatedInformation