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PubMed2004

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly.

OBJECTIVE: To evaluate the clinical efficacy and outcomes of percutaneous cholecystostomy as an alternative treatment option for elderly and critically ill patients who have acute cholecystitis. PATIENTS AND METHODS: The medical records of patients who underwent emergency percutaneous cholecystostomy at the North District Hospital, Hong Kong from September 1999 to July 2002 were reviewed. Indications for the procedure, patient demographics, and other clinical details were recorded. RESULTS: A total of 25 patients (10 male, 15 female) with a median age of 81 years (range, 39-97 years) presented with acute cholecystitis and underwent percutaneous cholecystostomy with ultrasound guidance. Two patients required emergency cholecystectomy on day 1 after the procedures because of deteriorating conditions. The rest of the patients clinically improved after drainage. There was no major periprocedural complication, and four patients had their catheter accidentally dislodged but did not require re-insertion. There were five in-patient mortalities, although the majority of these deaths were from unrelated illness. Subsequently, only six patients underwent elective cholecystectomy, one open and five laparoscopic. Two patients were offered percutaneous endoscopic cholecystolithotripsy, one defaulted and the other could not tolerate the procedure. Eleven patients declined further intervention due to the high surgical risks, three of these patients developed biliary symptoms, one had acute cholecystitis, and the other two had cholangitis. The rest of patients had no symptoms related to the gallstones. The median follow-up period was 81 weeks (range, 27-162 weeks). CONCLUSION: Percutaneous cholecystostomy is a viable treatment option for elderly and critically ill patients presenting with acute cholecystitis. It has a high success rate with minimal procedure-related complications. Elective cholecystostomy is the treatment of choice for low-risk patients after the initial acute cholecystitis.

Adult↗
PubMed2004

[The role of stomach epithelial cells being immunopositive for NO synthase in the formation of chronic cholecystitis].

The article provides information on 145 patients with chronic acalculous cholecystitis and 62 patients with chronic calculous cholecystitis subjected to a study of the quantitative characteristic of gastric antral epithelial cells immunopositive for NO synthase. The increased number of NO synthase immunopositive gastric epithelial cells at chronic cholecystitis was discovered. Most of them were discovered at the calculous process. The study discovered the relation between the gallbladder inflammatory activity, bile lithogenicity and the number of NO synthase immunopositive gastric epithelial cells. The clinical, biochemical and morphologic analyses showed that the application of Hepabene for treating patients with chronic acalculous cholecystitis produces a clinical and biochemical remission in a shorter term. Bile lithogenicity decreases; the quantitative characteristic of NO synthase immunopositive gastric epithelial cells normalizes. The study results make it possible to recommend Hepabene as a highly efficient drug for treating patients with chronic acalculous cholecystitis.

Acalculous Cholecystitis↗
PubMed1991

Indium-111-leukocyte imaging in acute cholecystitis.

Eleven patients with suspected acute cholecystitis underwent sequential 99mTc-iminodiacetic derivative (IDA) and 111In-white blood cell (WBC) imaging to determine if 111In-WBCs accumulate within an acutely inflamed hemorrhagic gallbladder wall and, thus, could be employed as a reasonable alternative to 99mTc-IDA scintigraphy in detecting acute cholecystitis. Seven patients had surgically confirmed acute cholecystitis. Of these cases, five had a true-positive 99mTc-IDA and 111In-WBC, one an indeterminate 111In-WBC and true-positive 99mTc-IDA, and one a true-positive 111In-WBC and false-negative 99mTc-IDA scan. The remaining four patients did not have acute cholecystitis. All visualized their gallbladder within 1 hr after 99mTc-IDA administration and none had 111In-WBC gallbladder wall uptake. Both 111In-WBC and 99mTc-IDA scintigraphy accurately detected acute cholecystitis: hepatobiliary scintigraphy demonstrated a cystic duct obstruction and 111In-WBC imaging detected the inflammatory infiltrate within the gallbladder wall. The sensitivity and specificity of each was 86% and 100%, respectively.

Acute Disease↗
PubMed1990

Acalculus lymphoeosinophilic cholecystitis associated with interleukin-2 and lymphokine-activated killer cell therapy.

A case of unusual cholecystitis that developed on completion of interleukin-2 and lymphokine-activated killer cell therapy is described. A 62-year-old man was treated with interleukin-2 and lymphokine-activated killer cells for disseminated renal cell carcinoma. During the course of the immunotherapy, his serum alkaline phosphatase level increased, as did the peripheral eosinophil count (0.31). Subsequently, clinical and radiologic evidence of acute cholecystitis was noted. The removed gallbladder showed acalculus cholecystitis with extensive diffuse infiltrates of numerous eosinophils and T lymphocytes, but sparse polymorphonuclear leukocytes. The authors name this unusual cholecystitis acalculus lymphoeosinophilic cholecystitis and believe it to be associated with interleukin-2 and lymphokine-activated killer cell therapy. The pathogenic relationship is discussed.

Cholecystitis↗
PubMed1990

[Evaluation of disorders of the heart conduction system as risk factors in the surgical treatment of cholecystitis].

The author examined 1,144 patients with cholecystitis and found that 144 (12.6%) had heart block (HB)--atrioventricular block (AVB) and intraventricular block (IVB) were found in 11 and 133 patients, respectively. In some cases of cholecystitis, HB was combined with hypertensive disease, coronary heart disease, rheumatic heart disease. Patients with cholecystitis and HB underwent an exercise test (stepwise test) which was one of the principal criteria for the decision concerning the possibility of operating on the bile tract. A total of 864 (75.5%) patients with cholecystitis were operated on, 104 of whom had HB. No unfavourable outcomes were seen. Stable Stages I and III AVB (with an implanted cardiac pacemaker) and localized and complete block in the system of the right bundle branch without hemodynamic disorders were considered not to be a reason for rejecting surgery of cholecystitis. Surgery is inadvisable in block of some branches and complete (bilateral branch) block in the system of the left bundle branch, as well as in combination of Stage I AVB with IVB without performance of a graded physical exercise whose power should be at least 60% of the normal exercise, or 123 Wt, 750 kgm/min (the normal exercise being 100%, 176 Wt, and 1080 kgm/min).

Adult↗
PubMedDate not supplied

Chronic cholecystitis with lymphoid hyperplasia.

The clinico-pathologic features of six cases of chronic cholecystitis with focal lymphoid hyperplasia (CCLH) are described and compared with five examples of malignant lymphoma involving the gallbladder. The clinical presentation of CCLH was identical to that of conventional chronic cholecystitis with cholelithiasis. Microscopically there was chronic inflammation and fibrosis in the wall of the gallbladder as well as extensive lymphoid hyperplasia with many lymphoid follicles having germinal centers. The five patients with malignant lymphoma also had chronic cholecystitis; four had a previous diagnosis of lymphoma established by a lymph node biopsy and were also found to have liver involvement during cholecystectomy. The gallbladders with malignant lymphoma showed acute and chronic cholecystitis and a monotonous lymphoid proliferation easily distinguishable from CCLH. We conclude that CCLH displays characteristic pathologic features and should be separated from the chronic and xanthogranulomatous types of cholecystitis.

Aged↗
PubMed1985

Intravenous cholecystography and ultrasonography in the diagnosis of acute cholecystitis. A prospective comparative study.

In a consecutive series of 120 patients with clinically suspected acute cholecystitis, intravenous cholecystography and gray scale sonography were performed for comparative evaluation in a prospective study. Acute cholecystitis was diagnosed in 71 patients and gallstones without signs of acute cholecystitis in 12, while in 37 patients no gallstone disease could be detected. Intravenous cholecystography could not be performed in 28 cases because of jaundice, iodine allergy or pregnancy, and in ten other patients there was no proof of hepatic excretion of the contrast medium. Though the results in the cases with interpretable cholecystograms were excellent, the clinical usefulness was only 68%. Ultrasonography was feasible in all cases and the accuracy was 93%. Ultrasonography has the additional advantages of noninvasiveness and no irradiation problems. Sonographic findings such as thickening of the gallbladder wall, distension, and tenderness on compression of the gallbladder were diagnostically helpful in acalculous cholecystitis and in distinguishing between acute and chronic gallbladder disease. Ultrasonography is recommended as the initial screening procedure in suspected acute cholecystitis.

Acute Disease↗
PubMed1985

[Acute noncalculous cholecystitis following gastrectomy for gastric cancer--study by ultrasonic examination].

In 190 patients who were operated for gastric cancer, incidence of post-operative noncalculous acute cholecystitis was studied. Twenty four patients was diagnosed as postoperative acute cholecystitis mainly by ultrasonic examination. As the sonographic appearance of 24 diagnosed cases, gallbladder distention was observed in 6 cases (25%), a thickened gallbladder wall in 19 cases (79%), intraluminal echoes within the gallbladder in 20 cases (83%) and sonolucent layer around the gallbladder in 14 cases (58%). In many cases clinical symptoms were so mild that without ultrasound they might be dealt with fever of unknown origin. With regard to treatment, conservative therapy by antibiotics was performed in 18 cases and ultrasonically guided percutaneous transhepatic gallbladder drainage in 6 cases. In many cases, sludge demonstrated during the initial stage of acute cholecystitis remained for long period. In 6 cases, intraluminal echoes gradually changed into gallstones. Frequency of postoperative acute cholecystitis was 12.6% (24/190)--Subtotal gastrectomy: 8.4% (11/131), total gastrectomy: 23.0% (11/48) and proximal gastrectomy: 18.2% (2/11). In cases of Appleby operation, incidence was especially high--27.0% (10/37). Acute cholecystitis after gastrectomy for gastric cancer is not so rate complication as considered previously.

Acute Disease↗
PubMed1985

[Non-calculous cholecystitis as a surgical problem].

Experience with the surgical treatment of 263 patients with acalculous cholecystitis is presented. Planned and postponed operations were fulfilled on 188 patients. 75 operations were performed for urgent indications. Gangrenous cholecystitis was found in 25 of the patients, phlegmonous cholecystitis--in 46 patients, catarrhal acalculous cholecystitis in 4 patients. Three patients died from severe concomitant diseases. The authors point to the considerable incidence of destructive forms of acute cholecystitis (especially in elderly and senile patients) which requires active surgical measures after failure of a complex medicamental treatment of the attack.

Acute Disease↗
PubMed1984

[Acute cholecystitis].

Acute cholecystitis is a non-rare disease, the incidence of which was increasing in the last years parallel to biliary lithiasis, which in 90% of cases is the first cause of such pathology. From the anatomopathological standpoint, we distinguish three types of acute cholecystitis: catarrhal, suppurative and gangrenous. The most frequently remarked symptom is ache at right hypochondrium. Only in 30% of cases cholecyst can be palpated, in form of ovoid mass; typical is the positiveness of Murphy's manoeuvre; constant is fever, but not subicterus. The introduction of new methods of ascertainment, exempt from any risks, simple to be performed and remarkably careful, made the diagnostics of acute cholecystites easier: parietal cholecystotomography, hepato-biliary scintigraphy, echotomography (first approach investigation), computerized axial tomography and laparoscopy almost always succeed in dispelling doubts. By using more than one of these investigations, a diagnostic accuracy, touching on 100%, can be reached. The differential diagnosis should be placed with: peptic ulcer, acute pancreatitis, acute appendicitis, gonococcus perihepatitis, virus hepatitis, acute pyelonephritis, right basal pneumonia. The complications an acute cholecystitis can occur are: perforation (localized, in free peritoneum or in a hollow organ), choleperitonaeum, necrosis of hepatic parenchyma, acute pancreatitis. Due to the possible arising of such complications, the mortality unfortunately is not indifferent (5%), especially in patients already weakened by other chronic diseases. Still discussed is the question as to when performing operation. In fact, there are three trends: intervention in immediate emergency, in postponed emergency, or in remote time (preceded by a medical treatment). The Authors prefer the intervention in postponed emergency, as, in their experience, they remarked the poor effectiveness of the delay medical treatment, also involving a greater difficulty in the technical execution of the intervention and a longer stay in hospital. From 1973 up to 1983, 241 cases of acute cholecystitis (158 women and 83 men) were hospitalized at the First Aid Surgical Centre of the Catania University. Eight patients refused the surgical intervention. The remaining 233 underwent, depending upon the seriousness of the affection, the associated diseases and the different reactiveness to the medical treatment, operation: in immediate emergency (26.1%); in postponed emergency (67.8%; in remote time (6.1%). The mortality was 2.2%, with the lowest percentage in the second group.

Acute Disease↗
PubMedDate not supplied

[Cholecystitis and cholecystolithiasis in children].

The study included 1880 necropsies and 8,217 biopsies and surgical pieces seen at the Pathology Department of the Hospital Infantil de México from 1968 to 1977. Among necropsies, two cases (0.10%) of cholecystitis and/or cholecystolithiasis were found and among surgical pieces there were seven (0.08%). Seven cases were females and two males. The symptoms most frequently found were: abdominal pain, jaundice, vomiting and leukocytosis. Morphologically, there were three cases of chronic cholecystitis with cholecystolithiasis, two cases of acute cholecystitis without calculi, two cases of chronic cholecystitis without calculi, one case of acute and chronic cholecystitis without calculi and another one cholecystolithiasis without inflammatory manifestations of the gallbladder. As etiological or predisposing factors we found: obesity, infections, parasitosis, hematologic disturbances, dilatation of the choledochus and one case with diaphragm of the 4th portion of the duodenum.

Adolescent↗
PubMed1994

The applicability of micro- and minilaparotomy in the management of obstructive cholecystitis.

There are conflicting opinions concerning the management of acute cholecystitis, with particular reference to the optimal time for surgical intervention in the course of minimally access surgery. The present study was undertaken to elucidate the applicability of micro- and modern minilaparotomy in the management of obstructive cholecystitis and to ascertain the optimum time for surgical intervention. A total of 607 consecutive cholecystectomies were performed by micro- and modern minilaparotomy between 11 December, 1990 and 11 December, 1993 at our department: 202 (33.3%) with obstructive cholecystitis. The patients were divided into five groups on the basis of time passing from the onset of the acute symptoms to surgery. Comparing the data of the first 3 groups to the 4th and 5th groups, data demonstrate that those operations which were done up to 10 days following the onset of acute cholecystitis were technically difficult in 16% of the patients. However, the technical difficulties increased up to 56% (group 4) and 59% (group 5) by the delay of surgical intervention to more than ten days or six weeks after the onset of the acute symptoms of obstructive cholecystitis.

Acute Disease↗
PubMed1993

Cholescintigraphy and biochemical tests in cholecystitis--an evaluation with discriminant analysis.

The biochemical values of 76 patients with suspected cholecystitis were subjected to discriminant analysis. The final diagnoses, i.e. acute cholecystitis, chronic cholecystitis and non-biliary disease, were used as the grouping variable. Cholescintigraphy identified patients with acute cholecystitis. Routine preoperative biochemical tests were found to be of limited value. Only alkaline phosphatase was of help in predicting common-duct stones, especially in patients with acute cholecystitis. The conclusion is that many biochemical tests presently in common use could as well be dispensed with.

Acute Disease↗
PubMed1994

[Acute cholecystitis and laparoscopic cholecystectomy. Comparison with non-complicated cholelithiasis].

Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis. However, the indication of the laparoscopic approach for acute inflammation of the gallbladder in unclear and further analysis of the results is required. The aim of our study was to compare the results of laparoscopic cholecystectomy after uncomplicated cholelithiasis and after acute cholecystitis. Data from 201 patients who underwent laparoscopic cholecystectomy were collected prospectively. Uncomplicated cholelithiasis was present in 149 patients and 52 individuals had acute cholecystitis. No differences in age, sex distribution or associated diseases were observed between groups. The mean operative time was significantly higher in patients with acute cholecystitis. However, no difference was observed regarding conversion rate (7.3%-7.6%) and morbidity rate (8.7%-9.6%). No mortality has occurred in any group. The average hospital stay after laparoscopic cholecystectomy was greater when acute cholecystitis was present (2.6 days-4.9 days; p < 0.01). But in this case hospitalization was shorter than after elective conversion (8 days; p < 0.001 and p < 0.05). We conclude that patients with acute cholecystitis can undergo laparoscopic cholecystectomy safely, with low morbidity and mortality rates and reduced hospital stay.

Acute Disease↗
PubMed1993

Acalculous cholecystitis associated with cytomegalovirus and sclerosing cholangitis in a patient with acquired immunodeficiency syndrome.

Intra- and extrahepatic bile-duct strictures, papillary stenosis and acalculous cholecystitis have all been described in ill patients with acquired immunodeficiency syndrome (AIDS). Acalculous cholecystitis associated with cytomegalovirus (CMV), Cryptosporidium or Campylobacter organisms has typically been described in critically ill or moribund patients. The authors report a case of acute acalculous CMV cholecystitis in a 28-year-old man who presented with abdominal pain. The patient was infected with the human immunodeficiency virus (HIV) but was ambulatory and had had no AIDS-defining illness. The patient did not have any well-recognized risk factors for acalculous cholecystitis, showing that this entity can occur in relatively healthy HIV-infected patients as well as in the terminal stages of AIDS. The diagnosis should be considered when such a patient presents with abdominal pain. Furthermore, this patient had sclerosing cholangitis of the intra- and extrahepatic bile ducts as well as papillary stenosis. The cause of the acalculous cholecystitis was presumed to be CMV, but the disease progressed despite therapy with foscarnet.

AIDS-Related Opportunistic Infections↗
PubMed1996

[The ultrasonic diagnosis of acute enzymatic cholecystitis].

Acute enzymatic cholecystitis is a rare form of an acute enzymatic-inflammatory process of the gallbladder. In 782 patients with ultrasound signs of cholecystitis, acute enzymatic cholecystitis has been found in 10 cases (1.2%). The authors describe the most common ultrasound signs of acute enzymatic cholecystitis and its morphologic interpretation. The data given in the article help early diagnosis of acute enzymatic cholecystitis and to start the treatment in time.

Acute Disease↗
PubMed1997

[Video laparoscopic cholecystectomy in acute cholecystitis: when,how and why?].

Acute cholecystitis has been previously considered as contraindication for laparoscopic cholecystectomy (LC), but recently, several studies have demonstrated that the laparoscopic approach can also be effective in such cases, although iatrogenic lesions of the biliary tree have been increasingly reported. Aim of this study was to verify the effectiveness of LC in patients presenting with acute cholecystitis on the basis of preoperative and intraoperative findings, postoperative mortality and morbidity, in order to assess those conditions which still can be considered as contraindications for LC. From September 1992 to January 1995, 133 patients have been consecutively admitted and operated for LC. 46 cases (36.5%) had histologically proven acute cholecystitis. Moreover we have compared preoperative date (clinical history, laboratory findings, Rx and ultrasound evaluation) with intraoperative findings to assess a correlation with intraoperative difficult conditions evaluated according to De Manzini score. Our results demonstrate that clinical data significantly correlate with intraoperative difficult situations. Hepatobiliary ultrasound also has shown good correlation between the thickness of gallbladder wall and difficult operations (73.9 sensibility-70.1 specificity). Therefore, in patients with clinically severe acute cholecystitis, and thickened gallbladder demonstrated by ultrasound it is very likely that the surgeon will experience difficult in intraoperative situations. In these conditions laparoscopy may be considered mainly as a diagnostic procedure in order to evaluate the entity of inflammatory changes considering the possibility of an open conversion that must be done before any iatrogenic lesion occur. This policy has allowed us to avoid in our series postoperative complications such as lesions of the biliary tree. In conclusion we believe that LC for acute cholecystitis should be considered as a therapeutical option only for selected cases.

Acute Disease↗
PubMed2005

DNA sequences and proteic antigens of H. pylori in cholecystic bile and tissue of patients with gallstones.

BACKGROUND: Although Helicobacter pylori DNA sequences have been detected in cholecystic bile and tissue of patients with gallstones, controversial results are reported from different geographic areas. AIM: To detect H. pylori in cholecystic bile and tissue of patients with gallstones from a previously uninvestigated geographic area, southern Italy. Detection included both the bacterial DNA and the specific antigen (H. pylori stool antigen) identified in the stools of infected patients for diagnostic purposes. PATIENTS AND METHODS: The study enclosed 33 consecutive patients undergoing laparoscopic cholecystectomy for gallstones. DNA sequences of H. pylori were detected by polymerase chain reaction in both cholecystic bile and tissue homogenate. Moreover, we assayed H.pylori stool antigen on gall-bladder cytosolic and biliary proteins after their extraction. Bacterial presence in the stomach was assessed by urea breath test in all patients and Deltadelta13CPDB value assumed as marker of intragastric load. Fisher's exact probability and Student's t-tests were used for statistical analysis. RESULTS: DNA sequences of H. pylori in bile were found in 51.5% and significantly correlated with its presence in cholecystic tissue homogenate (P<0.005), H. pylori stool antigen in gall-bladder (P=0.0013) and bile (P=0.04) proteins, gastric infection (P<0.01) and intragastric bacterial load (P<0.001). No correlation was found, however, with sex and age of the patients. CONCLUSIONS: Our prevalence value of bacterial DNA in bile and gall-bladder of patients with gallstones agreed with that of the only other Italian study. The simultaneous presence of both bacterial DNA and proteic antigen suggests that the same prototype of bacterium could be located at both intestinal and cholecystic level and, therefore, the intestine represents the source of biliary contagion.

Aged↗