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PubMed1999

[Cholelithiasis and homozygote drepanocytosis in children in Dakar (Senegal)].

BACKGROUND: Cholelithiasis is a well recognized complication of sickle-cell anemia (SCA) because of chronic hemolysis. It is usually asymptomatic but may result in acute cholecystitis or cholangitis. The aim of this study was to assess prevalence of cholelithiasis and its associated factors among Senegalese children and adolescents with SCA. PATIENTS AND METHODS: We analyzed the follow-up records and results of systematic clinical, biological and ultrasonographic examinations in 106 patients with SCA aged 11 months to 22 years (median: 10 years, 6 months), followed up in the Albert-Royer Children's Hospital (Dakar). RESULTS: Cholelithiasis was detected in 9.4% of the patients. Gender, ethnic group, geographic origin and socioeconomic conditions did not have any association with cholelithiasis frequency. The youngest patient with cholelithiasis was 7 years old, and prevalence of cholelithiasis increased with age. The mean age at the beginning of SCA follow-up was higher among patients with cholelithiasis. They were more frequently transfused and tended to present more frequent pain crises and other complications of SCA. We found no spontaneous clinical manifestations attributed to cholelithiasis. Nevertheless, provoked right upper quadrant pain was more frequently observed in patients with cholelithiasis. Fetal hemoglobin, steady-state hemoglobin, reticulocytes count, serum bilirubin, alkaline phosphatase and transaminase levels were not significantly different in these patients, compared to the others. However, those with cholelithiasis had significantly higher mean red cell volume. CONCLUSION: Prevalence of cholelithiasis appears relatively low in Senegalese patients with SCA, probably owing to the tolerance of the Senegal haplotype. Advanced age and severe chronic hemolysis are etiologic factors in evidence. We recommend systematic abdominal ultrasound at least once a year for patients older than 5 years, or when right upper quadrant pain is observed. Cholecystectomy should be performed in cases of cholelithiasis in order to prevent complications.

Adolescent↗
PubMed2002

Clinical outcomes of naval aviation personnel with cholelithiasis.

BACKGROUND: This study examines the aeromedical outcomes of aviation personnel with asymptomatic cholelithiasis or those treated successfully with conventional (open) cholecystectomy (CC), laparoscopic cholecystectomy (LC), or extracorporeal shock wave lithotripsy (ESWL) for previous symptomatic cholecystitis. METHODS: The Biomedical Database of the Naval Aerospace Medical Institute was searched for waiver requests for asymptomatic gallstones, acute cholecystitis, and cholecystectomy. Microfiche records were then reviewed. The rates of development of symptomatic disease and need for cholecystectomy or ESWL were noted in aircrew granted waivers for asymptomatic cholelithiasis. The aeromedical outcomes of aircrew who underwent treatment for symptomatic disease by cholecystectomy (CC or LC) or ESWL were reviewed. RESULTS: A search of the Biomedical Database revealed waiver requests for cholelithiasis for 79 naval aviation personnel from April 1988 to August 2000. Waiver requests were for previous cholecystectomy in 56 (70.9%) and cholelithiasis in 23 (29.1%). No aviators had undergone ESWL. Of the 56 aviators with previous cholecystectomy, waivers were granted in 51 (91.1%) cases. Waivers were denied to five individuals, primarily for other medical problems. Of the 23 aviators with cholelithiasis, 11 (47.8%) were granted waivers. Waivers were denied in 12 aviators because of symptomatic cholelithiasis (5), asymptomatic cholelithiasis (1), common bile duct stone (1), other medical problems (3), or no explanation (2). The aviator with asymptomatic cholelithiasis and two of the aviators with symptomatic cholelithiasis were subsequently granted waivers after cholecystectomy (LC). The aviator with a symptomatic common bile duct stone received a waiver after cholecystectomy (CC). A total of 66 (83.5%) aviators received waivers. None were revoked during the study period because of symptomatic cholelithiasis or retained common bile duct stones. CONCLUSIONS: Aviation personnel who receive waivers for asymptomatic cholelithiasis or cholecystectomy rarely present with symptomatic biliary disease.

Absenteeism↗
PubMed2005

Analysis of 645 patients with primary hyperparathyroidism with special references to cholelithiasis.

UNLABELLED: OBJECTIVE The clinical picture of primary hyperparathyroidism (PHPT) has changed during the past 50 years. It is currently unknown whether or not PHPT is associated with an increased risk of cholelithiasis. PATIENTS: To determine the frequency of cholelithiasis in PHPT we analyzed 645 consecutive patients seen at Prague University Hospital from 1992 through 2002 and compared them with a of normocalcaemic control group. METHODS: We investigated 645 patients with proven PHPT (518 female and 127 males aged 20-80 years) during a period of 10 years. To determine the frequency of cholelithiasis in normal population we analyzed 2,015 patients receiving periodic health examination at an outpatient ward from January 1998 to December 1998 (1505 females and 510 males aged 24-85 years). A detailed history, physical examination, biochemical measurements and abdominal ultrasonography were done. RESULTS: Cholelithiasis was proven in 157 of 518 women (30.3%) and in 11 of 127 men (8.66%) with PHPT. Their mean age was 59.67+/-12 years in women and 56.0+/-10 years in men. In the control group 260 of 1505 women (17.27%) and 54 of the 510 men (10.58%) had cholelithiasis. The mean age was 64.55+/-13.8 years in women and 61.2+/-12.4 in men. Only in the case of women, the difference was highly statistically significant (p<0.001). There were no significant differences between the mean values for the serum calcium level, bone alkaline phosphatase, total cholesterol, urinary hydroxyproline and body mass index in hyperparathyroid patients with and without cholelithiasis. However the hyperparathyroid women with cholelithiasis had an increased concentration of parathyroid hormone (236.1+/-56 pg/ml) compared with hyperparathyroid women without cholelithiasis (179.0+/-45 pg/ml), p<0.01. CONCLUSION: The mechanism of PTH associated gallstone formation may involve inhibition of gallblader emptying, hepatic bile secretion and sphincter Oddi motility as well as modification of bile composition. While it might be difficult to prove it seems likely that the association of cholelithiasis with primary hyperparathyroidism in women with a high concentration of parathyroid hormone is more than merely coincidental and from our study it is obvious that a significant association exists.

Adult↗
PubMed2005

Association of UGT1A1 polymorphism with prevalence and age at onset of cholelithiasis in sickle cell anemia.

BACKGROUND AND OBJECTIVES: High levels of erythrocyte destruction in sickle cell anemia (SCA) result in chronic hyperbilirubinemia, with cholelithiasis occurring in a subset of patients. We investigated whether susceptibility to cholelithiasis in SCA was associated with the promoter polymorphism of the 5?-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene encoding a key enzyme in bilirubin catabolism. DESIGN AND METHODS: We determined the frequencies of UGT1A1 promoter alleles in 171 SCA children and 153 SCA adults regularly followed for a number of years at the Guadeloupe sickle cell center. These patients had undergone liver/biliary tree ultrasound scans every year. We analyzed the relationships between the various UGT1A1 promoter alleles and hemoglobin levels, steady-state total and unconjugated bilirubin concentrations and the frequency of cholelithiasis. RESULTS: In both children and adults, (TA)6 was less frequent and (TA)7 more frequent in patients with cholelithiasis than in those without this condition. Total and unconjugated bilirubin levels and the frequency of cholelithiasis were significantly higher in patients with (TA)7/(TA)7 and (TA)7/(TA)8 genotypes than in those with other genotypes. Those homozygous for (TA)6 or carrying at least one (TA)5 allele had the lowest total and unconjugated bilirubin levels and were least likely to have cholelithiasis. Patients with (TA)6/(TA)7 and (TA)6/(TA)8 genotypes presented intermediate values. Kaplan-Meier analysis of cholelithiasis-free survival in children demonstrated an early age-at-onset for cholelithiasis in patients with (TA)7/(TA)7 and (TA)7/(TA)8 genotypes. INTERPRETATIONS AND CONCLUSIONS: This study shows that the UGT1A1 gene promoter polymorphism is a major genetic risk factor modifying the frequency and age-at-onset of cholelithiasis in SCA patients.

Adolescent↗
PubMed1995

The aeromedical risk associated with asymptomatic cholelithiasis in USAF pilots and navigators.

BACKGROUND: The U.S. Air Force (USAF) aeromedical policy regarding incidentally discovered, asymptomatic cholelithiasis required the aircrew to undergo cholecystectomy prior to being considered for return to flying duties. HYPOTHESIS: The merit of continuing this USAF policy was evaluated at the request of the U.S. Air Force Surgeon General. METHODS: A medical literature review of the natural history of cholelithiasis in the general population was completed. The USAF aircrew waiver file (1972-92) and the Ellingson Aerospace Medicine Consultation Service (ACS) data file (1955-92) were reviewed for cases of USAF pilots and navigators with a diagnosis of cholelithiasis or cholecystectomy. Pilot and navigator annual manpower data were obtained from the Air Force Military Personnel Center (1972-92) and used in calculations involving the USAF aircrew waiver file. Surgical morbidity and mortality information was obtained from the Division of Surgery, Wilford Hall Medical Center. RESULTS: Literature review predicted a 1-4% annual rate of acute events in individuals with previous asymptomatic cholelithiasis. Based on KUB radiographs taken at ACS, the prevalence of asymptomatic cholelithiasis in USAF pilots and navigators was estimated to be 2-3%. Of 11,685 pilots and navigators evaluated at the ACS, 80 (0.7%) were diagnosed with cholelithiasis or cholecystectomy. Between 1972 and 1992, an estimated 16,232 man-years of pilot/navigator exposure to asymptomatic cholelithiasis occurred; however, only 50 cases with a diagnosis of cholecystectomy or cholelithiasis were reported in the USAF waiver file. Mortality and morbidity for cholecystectomy, whether performed by open or laparoscopic technique, were reported as 0.2% and 5%, respectively, in the general population. CONCLUSION: The overall incidence of acute cholecystitis within USAF aircrew would not be changed by aeromedical cholecystectomy being performed on aviators with incidentally detected asymptomatic cholelithiasis.

Adult↗
PubMed1982

Cholelithiasis and carcinoma of the colon.

Cholelithiasis and carcinoma of the colon have similar geographic distributions and common dietary and chemical pathogenetic factors. A study was done to test whether an association between cholelithiasis and colonic cancer existed in the population of Rochester, Minnesota. During the period from 1950-1969, 2413 new cases of cholelithiasis were identified in this population. Because the age- and sex-specific prevalence rates of colorectal cancer in this population were also available, the authors calculated the expected number of cases of colorectal cancer at the time of diagnosis of cholelithiasis. The relative risk (observed/expected) of colonic cancer among persons of all ages and both sexes with cholelithiasis was 1.52 (95% confidence interval, 1.1-2.0). Although the association seems significant, there is a potential bias in that the identification of asymptomatic cases of cholelithiasis might be facilitated in patients who have an operation or frequent follow-up examinations for colonic cancer. When the analysis was repeated separately for symptomatic and asymptomatic cases of cholelithiasis, all the excess (and statistical significance) was confined to the asymptomatic group, and apparent confirmation of the suggested bias. Therefore, the authors believe that no real association exists between cholelithiasis and carcinoma of the colon.

Adult↗
PubMed2005

Management of asymptomatic cholelithiasis for patients awaiting renal transplantation.

BACKGROUND: There is no consensus regarding the most appropriate management of asymptomatic cholelithiasis in patients awaiting renal transplantation. Cholecystectomy is considered before renal transplantation because of potential worsened complications from cholelithiasis with posttransplantation immunosuppression. This study reviewed the outcomes for operative and nonoperative management of asymptomatic cholelithiasis in patients awaiting renal transplantation. METHODS: A retrospective chart review of all patients who received renal transplant at the authors' institution during the period 1994 to 2000 was completed. All patients underwent pretransplantation abdominal ultrasound. RESULTS: Of the 411 patients receiving renal transplants (242 men and 169 women with a mean age of 45.7 years), 32 had cholelithiasis at the pretransplantation workup (7.8%), and 35 had gallbladder abnormalities (8.5%): polyps, thickened wall, sludge, bile duct dilation. Before transplantation, 12 of the 32 patients (38%) with cholelithiasis underwent uncomplicated cholecystectomy. None of the remaining 19 patients with cholelithiasis required cholecystectomy after renal transplantation (mean follow-up period 6.2 years). Of the 35 patients with gallbladder abnormalities, 2 required post transplantation elective cholecystectomy. CONCLUSIONS: No evidence was found for increased morbidity related to cholelithiasis or gallbladder abnormalities after renal transplantation. As in the general population, the risks associated with asymptomatic cholelithiasis do not appear to warrant prophylactic cholecystectomy for patients awaiting renal transplantation.

Adult↗
PubMed2001

Management of cholelithiasis in pediatric patients who undergo bone marrow transplantation.

PURPOSE: The aim of this study was to determine the incidence, risk factors, and proper management for asymptomatic cholelithiasis in children undergoing bone marrow transplantation (BMT). METHODS: The authors reviewed retrospectively the records of 575 children who underwent bone marrow transplantation at a University bone marrow transplantation unit (BMT) unit between February 1991 and October 1999. Of these patients, 235 underwent abdominal ultrasonography for evaluation of jaundice, sepsis, abdominal pain, or metastasis. To identify risk factors for cholelithiasis, the authors stratified the patients based on their disease and treatment regimen. Finally, the authors analyzed the natural history and management of BMT children with cholelithiasis. RESULTS: The authors identified 20 cases of cholelithiasis (8.5%) in the 235 BMT patients who underwent ultrasonography. Children who underwent BMT to treat bone marrow failure showed a significantly increased risk of cholelithiasis compared with children treated for malignancy (27% v 7.4%; P<.01). Most children (85%) with gallstones did not require surgical intervention. Specifically, 9 (45%) died from their primary disease, 5 (25%) showed sonographic resolution of their gallstones, and 3 (15%) underwent follow-up nonoperatively with persistent cholelithiasis. Three of the 20 patients with gallstones (15%) had signs of acute cholecystitis and underwent surgery. There were no surgical complications or deaths in the operative group. CONCLUSIONS: Cholelithiasis occurs at a high incidence in pediatric bone marrow transplant patients. Children undergoing BMT for bone marrow failure are at higher risk of having gallstones than those being treated for malignancy. Finally, these data support a strategy of nonoperative management for asymptomatic cholelithiasis in this highly selected group of patients.

Bone Marrow Transplantation↗
PubMed1998

[Cholelithiasis and cholecystectomy for colorectal cancer: a retrospective analysis].

OBJECTIVE: To study the relationship between cholelithiasis and previous cholecystectomy for colorectal cancer. METHOD: Retrospectively, the frequency of occurrence of gallstones and cholecystectomy for 238 patients with colorectal cancer diagnosed pathologically was compared with that of 395 matched controls for age and sex. The patients were checked by type B ultrasonography or had cholelithiasis and underwent cholecystectomy. RESULT: The relative risk (OR) of cholelithiasis and prior cholecystectomy associated with colorectal cancer was 2.95 (95% confidence limits 1.89 - 4.59, chi(2) = 22.31, P < 0.01). The ratio of cholelithiasis to cholecystectomy was 40 vs 13 (P < 0.01) patients. Nine of the 13 patients were over 60 years old (P < 0.01). The incidence of cholelithiasis associated with colon cancer was 36.2% (42/116), but it was only 9% (11/122) with rectal cancer (P < 0.01), and OR of cholelithiasis accompanied with colon cancer and rectal cancer was 1.37 and 1.99 respectively in female male. Cholelithiasis was more common in right-sided colonic cancer than in the left-sided in female (OR = 2.1) but there was no significant difference. CONCLUSION: Cholelithiasis other them cholecystectomy increases the risk of large bowel cancer, in addition, the relative risk of colorectal cancer is increased in patients of above 60 years old having previous cholecystectomy.

Adult↗
PubMed2002

Abdominal aortic aneurysmorrhaphy and cholelithiasis in the era of endovascular surgery.

The incidence of acute cholecystitis complicating standard abdominal aortic aneurysm (AAA) repair has been reported between 0.3 and 18 per cent. This has prompted considerable debate regarding the management of cholelithiasis discovered incidentally during open aortic reconstruction. This study seeks to determine the incidence of cholelithiasis and acute cholecystitis after endovascular AAA repair and evaluate options for management. Between February 1996 and October 2001 492 patients underwent endovascular AAA repair. All the procedures were performed in the operating room under fluoroscopic guidance. Epidural (98.9%), local (0.5%), or general (1.7%) anesthesia was used during these cases. The incidence of cholelithiasis and acute cholecystitis was evaluated by CT scan and abdominal ultrasound. Serum measurements of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total and direct bilirubin, and amylase were performed and clinical assessment was conducted at 1, 6, and 12 months postoperatively and annually thereafter. The mean age of these patients was 76.6 years; 84% were male. Comorbid medical conditions were present in all patients (average 3.5 conditions/patient). Follow-up ranged from 2 to 35 months (mean 12.8 months). Endovascular stent graft deployment was successful in 486 of the 492 patients (98.8%). Six patients were converted to standard open repair because of inability to achieve successful endovascular aneurysm repair. The perioperative major morbidity rate was 14.9 per cent. Minor morbidity rate was 8.5 per cent. The perioperative mortality rate was 1.9 per cent. No deaths were related to biliary disease. Cholelithiasis was identified in 64 (13%) patients preoperatively. One of 64 patients with a prior Billroth II reconstruction for peptic ulcer disease developed jaundice 8 days after AAA repair as a result of choledocholithiasis that required surgical repair. One patient without gallstones developed acute acalculous cholecystitis on postoperative day 16 as determined on pathologic analysis of the gallbladder. A third patient who had gallstones identified on preoperative CT scan developed calculous cholecystitis 16 months after endovascular AAA repair. These two patients underwent uncomplicated laparoscopic cholecystectomy and recovered uneventfully. The incidence of postoperative symptomatic cholelithiasis is 1.6 per cent (one of 64). The incidence of postoperative acute cholecystitis was 0.2 per cent (one of 486) and was unrelated to the presence of gallstones. The incidence of delayed symptomatic cholelithiasis was 1.6 per cent (one of 64). Endovascular repair of AAA does not appear to predispose the patient to the development of symptomatic cholelithiasis during the perioperative period. Therefore a preoperative or intraoperative diagnosis of cholelithiasis does not necessitate cholecystectomy in the setting of planned endovascular AAA repair. Patients who develop cholecystitis after endovascular AAA repair may be effectively treated by standard laparoscopic techniques.

Acute Disease↗
PubMed2003

Clinical epidemiological study on intrahepatic cholelithiasis: analysis of 8585 cases.

OBJECTIVE: To investigate the clinical epidemiology of intrahepatic cholelithiasis in Guangxi area, China. METHODS: 8585 cases of cholelithiasis proved by surgery in a period of 19 years were analyzed retrospectively. Data were collected and analyzed by computer software package PEMS. RESULTS: Cases of intrahepatic cholelithiasis accounted for more than one third of cases of cholelithiasis treated in the same period. The prevalence of intrahepatic cholelithiasis in farmers increased from 23.4% out of all cases with gallstone in 1981-1985 to 55.8% in 1991-1999. The constituent ratio of intrahepatic cholelithiasis in males was nearly the same in females. The peak prevalence age of patients with intrahepatic cholelithiasis ranged from 31 to 40 years, and the mortality was the highest among all bile stone cases. CONCLUSION: Intrahepatic cholelithiasis is by no means a vanishing disease, especially in rural area.

Adolescent↗
PubMed1984

Cholelithiasis and aortic reconstruction.

Identification of cholelithiasis during abdominal aortic reconstruction with placement of a vascular prosthesis provides cause for hesitation in performing a simultaneous cholecystectomy because of the potential contamination of the graft. However, the association of cholelithiasis with cholecystitis is well established and was observed in a group of patients who had known cholelithiasis following aortic reconstruction. Cholelithiasis was noted in 50 of 250 patients who underwent reconstruction of the abdominal aorta or its major branches. Seventeen of the 50 patients with cholelithiasis underwent a cholecystectomy prior to aortic reconstruction. Sixteen patients underwent a cholecystectomy at the time of aortic reconstruction and experienced no morbidity related to the cholecystectomy. Seventeen patients with cholelithiasis did not undergo cholecystectomy. All were asymptomatic. Nine of these individuals developed cholecystitis or symptoms related to their gallstones following aortic reconstruction. A subsequent cholecystectomy was performed in all nine patients. The interval between aortic reconstruction and cholecystectomy was from 2 weeks to 108 months. The remaining eight patients with cholelithiasis have been followed up for 17 to 50 months. Six of these patients remain asymptomatic. The two patients followed up for the longest period (42 and 50 months, respectively) have become symptomatic. If there are no mitigating circumstances, cholecystectomy is advised for patients undergoing aortic reconstruction with associated cholelithiasis.

Aged↗
PubMedDate not supplied

[Cholelithiasis in patients with liver cirrhosis].

We retrospectively studied 67 cirrhotic patients hospitalized in the service of gastroenterology of Hospital Daniel A. Carrión, Callao, Perú, between June 1993 and July 1995, aimed to determine the frequency of cholelithiasis and its main clinical and epidemiological features. Twelve out of 67 cirrhotic patients (17.91%) had cholelithiasis. 24% of women and 14.3% of men were affected (p > 0.05). The mean age of women and men were 57.33 and 57.5 years old respectively (range: 41-67 years old). The frequency of cholelithiasis did not increase with age and the proportionally most affected age group was 41-50 years (33.33%). Alcoholic etiology was the most often in cirrhotic patients with cholelithiasis (41.67%). The severity of liver disease influenced in the cholelithiasis frequency (p = 0.001) and 33.33% of patients with gallstones were in grade C of Child Pugh Score. Two thirds of patients were asymptomatic. We conclude: 1. Cholelithiasis in our cirrhotic patients more prevalent than in general population (17.91% vs 0.7-5%). 2. Age did not influence in cholelithiasis prevalence in our cirrhotic patients. 3. The severity of liver disfunction influenced in highly significant way (p = 0.001) on cholelithiasis prevalence. 4. Cirrhotic patients with gallstones had mostly (66.67%) an asymptomatic course.

Adult↗