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PubMed1992

Septate gallbladder with cholelithiasis: a cause of chronic abdominal pain in a 6-year-old child.

This report describes the case of a 6-year-old girl with septate gallbladder and cholelithiasis without cholecystitis, an uncommon condition associated with chronic abdominal pain. The absence of smooth muscle components within the gallbladder septae supports an embryogenic abnormality that may have occurred early during the maturation of the gallbladder lumen. In concert with other predisposing factors, the septa may have induced gallstones and, thus, the patient's symptoms. Although rare, gallbladder abnormalities may cause abdominal pain in children and should be included in the differential diagnosis. Early ultrasound should be obtained as part of a workup if gallbladder abnormalities are suspected. Elective cholecystectomy is curative.

Abdominal Pain↗
PubMed1983

Effect of Clostridium butyricum on the formation and dissolution of gallstones in experimental cholesterol cholelithiasis.

The effect of oral administration of Clostridium butyricum Miyairi on the formation and dissolution of gallstones was examined in a mouse model of cholesterol cholelithiasis, in comparison with that of chenodeoxycholic acid (CDCA). A diet containing cholesterol and sodium cholate was used as a lithogenic diet. The feeding of the lithogenic diet containing 1.0 X 10(8) cells of this bacterium per g for five weeks prevented the formation of gallstones, resulted in lower values of the gallstone index, incidence and cholesterol content of gallstones than those of untreated group by 46, 43 and 46%, in order. Furthermore, after mice were maintained on the lithogenic diet for five weeks, subsequent bacterial treatment exhibited a marked gallstone dissolution effect. The feeding of 10(8) cells/g was effective for the prevention of gallstone formation and dissolution of gallstones, but that of 10(6) cells/g was not significantly effective. The gallstone index of the bacterium-treated group was lower than that of CDCA-treated group during the period of experiment, but there was no difference in the cholesterol content of gallstones between these two groups, which suggests a different mechanism of action of the bacterium from that of CDCA.

Animals↗
PubMed1990

Cholelithiasis and teenage mothers.

Between 1980 and 1988, 23 female adolescents were hospitalized at the Bronx-Lebanon Hospital Center for symptomatic cholelithiasis. The known risk factors for gallstone formation in adolescents were considered. In ten of the patients (43%), none of the risk factors was present. All ten patients, however, had in common a recent history of pregnancy. This finding is consistent with the current literature on the possible mechanism of gallstone formation during pregnancy.

Adolescent↗
PubMed1995

[Cholelithiasis in infants with spontaneously favourable course].

BACKGROUND: Nonoperative interventional treatment of cholelithiasis has been performed in young infants suffering from jaundice. CASE REPORT: A neonate was admitted because he suffered from severe anemia and jaundice due to Rh incompatibility. He developed cholestasis when he was 7 weeks-old; ultrasonography showed nonshadowing echogenic material in the gallbladder suggesting biliary sludge. A second ultrasonography performed 24 hours later showed a normal gallbladder while sludge had migrated into the lower part of the common bile duct. This biliary sludge spontaneously resolved in a few days. CONCLUSIONS: Biliary sludge, even symptomatic in infants, may resolve without surgery or nonoperative interventional treatment. Ultrasonography is useful in following migration.

Cholelithiasis↗
PubMed2005

Treatment of suspected symptomatic cholelithiasis with glycopyrrolate: a prospective, randomized clinical trial.

STUDY OBJECTIVE: Glycopyrrolate is advocated for the treatment of acute pain from suspected symptomatic cholelithiasis. However, there is no clinical evidence to substantiate its use. This study is designed to evaluate the efficacy of glycopyrrolate in relieving acute abdominal pain of suspected biliary tract origin. METHODS: Between July 2002 and April 2003, a convenience sample of patients presenting to the emergency department with upper abdominal pain of suspected biliary tract origin was randomized to receive either intravenous glycopyrrolate or placebo (normal saline solution). Pain level was assessed at baseline using a visual analog scale, with a repeat assessment 20 minutes after intervention. Patients and clinicians were blinded to the study drug. RESULTS: Because of difficulty with patient enrollment, the trial was terminated before achievement of the initial goal of 54 patients. On analysis of the 38 patients completing the study protocol, glycopyrrolate and placebo groups had similar demographic and baseline characteristics. There was no significant difference in pain relief between patients receiving glycopyrrolate and those receiving placebo (median decrease in visual analog pain scale pain 3 mm [95% confidence interval -2 to 17 mm] versus 8 mm [95% confidence interval -2 to 20 mm], respectively). CONCLUSION: Although limited by small size and convenience sampling, these results fail to demonstrate any improvement in pain of suspected biliary tract origin with the administration of glycopyrrolate. Further study is needed to determine whether intravenous glycopyrrolate has any significant analgesic effect for patients with this condition.

Adult↗
PubMed2004

Laparoscopic cholecystecomy in a 16-day-old infant with chronic cholelithiasis.

A 16-day-old girl with demonstrated evidence of cholelithiasis was treated initially conservatively on the assumption that the gallstone would resolve spontaneously. However, when repeat ultrasound scan showed a large gallstone and intrahepatic ductal dilatation indicative of antenatal common duct obstruction, the infant underwent laparoscopic cholecystectomy with an intraoperative cholangiogram. The patient did well postoperatively and was on regular feeding by postoperative day 1. An intraoperative cholangiogram showed an impacted stone in the infidibulum of the gallbladder. Gross and histopathologic findings indicated chronic cholecystitis. Based on an extensive review of the literature, this case appears to be the first reported incidence of chronic cholecystitis in a neonate and that of the youngest patient to undergo a laparoscopic cholecystectomy with intraoperative cholangiogram.

Cholecystectomy, Laparoscopic↗
PubMed1993

Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis.

With the advent of laparoscopic cholecystectomy, optimal management of common duct stones remains controversial. Seven hundred six patients underwent laparoscopic cholecystectomy in our institution from January 1990 through January 1992. From this group of patients, 50 were identified as having clinical or radiographic evidence of common duct stones. Thirty-one patients demonstrated preoperative risk factors for common duct stones and underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP). The risk factors included jaundice (19%), pancreatitis (23%), elevated liver function tests (52%), and ultrasound evidence of choledocholithiasis (6%). Preoperative ERCP was performed in 94% of patients. There were two failures due to periampullary diverticula. Common duct stones were identified in 18 patients (62%) and successfully removed by endoscopic sphincterotomy in all of these patients. Nineteen patients were found to have unsuspected common duct stones on intraoperative cholangiography. Eighteen patients (95%) underwent successful ERCP and endoscopic sphincterotomy with stone extraction. Overall, major morbidity was 2% and included one patient who experienced endoscopic sphincteroplasty. The three endoscopic failures were managed by open common duct exploration, laparoscopic duct exploration, and combined laparoscopic and open common duct exploration. We conclude that combined laparoscopic and endoscopic therapy is a viable option for the management of cholelithiasis with choledocholithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

[Absence/disappearance of gallbladder in a patient diagnosed with cholelithiasis].

We report the case of a patient with preoperatively demonstrated cholecystitis due to cholelithiasis but with no presence of gallbladder at laparoscopy or on conversion to open surgery. Gallbladder ectopy was ruled out and the possibility of gallbladder agenesia was discussed. However, four preoperative ultrasound scans performed within a protocol of treatment with octreotide, in the setting of acute cholecystitis, ruled out this possibility. We discuss the possibility of gallbladder destruction and digestion after a severe inflammatory process, as well as Frey's criteria for gallbladder agenesia. We believe that this is a case of complete gallbladder lysis due to an inflammatory process.

Adult↗
PubMed1996

Ovarian cholelithiasis after laparoscopic cholecystectomy associated with chronic pelvic pain.

OBJECTIVE: To report a case of chronic pelvic pain associated with ovarian cholelithiasis and discuss prevention and management of this condition. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 39-year-old woman who presented with right lower abdominal pain after a laparoscopic cholecystectomy. INTERVENTION(S): Diagnostic laparoscopy followed by laparotomy with lysis of adhesions and removal of three to four dozen gallstones. MAIN OUTCOME MEASURE(S): Patient's subjective report of pain. RESULT(S): Resolution of patient's pain. CONCLUSION(S): Gallstones spilled into the peritoneal cavity may migrate and adhere to the dependent portions of the pelvis, potentially resulting in pelvic pain or infertility. This suggests the importance of removing inadvertently spilled gallstones at the time of surgery or using nonsurgical methods of gallstone management in reproductive-aged females.

Adult↗
PubMed1988

Cholelithiasis in childhood: a follow-up study.

Fifteen children with cholelithiasis who were treated at the Royal Hospital for Sick Children, Glasgow between 1973 and 1985 are reviewed. Ten patients had idiopathic gallstones and five had gallstones in association with hereditary spherocytosis. All patients have been followed up for between 4 months and 12 years (mean 4.1 years): ultrasonography has been carried out on 13. Fourteen patients underwent surgery of whom only seven had symptoms from their gallstones. Nine patients had cholecystostomy and removal of gallstones, four patients had cholecystectomy (one had negative exploration of the common bile duct in addition) and one patient with choledocholithiasis underwent choledochotomy with transduodenal sphincterotomy. One patient did not have surgery; she has remained asymptomatic and ultrasound examination confirms that she still has a solitary gallstone in her gallbladder. Clinical review with ultrasonography shows that cholecystostomy with removal of gallstones appears to be an acceptable alternative to cholecystectomy.

Adolescent↗
PubMed1978

Cholelithiasis and Wilson disease.

We have studied three children with Wilson disease who had clinical symptoms suggestive of cholecystitis as well as radiologic evidence of gallstones, subsequently proven at the time of laparotomy. The gallstones from the patients with Wilson disease had an appreciably higher content of cholesterol than gallstones from age-matched children with hemolytic disease. Since gallstones may be present for years before they produce clinical symptoms, young patients with Wilson disease should undergo routine investigation for the presence of stones; cholelithiasis should also be considered in the differential diagnosis of abdominal pain in such patients.

Child↗
PubMed1974

Effect of glycerophosphate on lithogenic bile. A new approach to treatment of cholelithiasis.

Previous studies in animals showed a twofold increase of bile-phospholipids when glycerophosphate, a precursor of phospholipids, was incorporated in chow diet. The present study evaluates the effect of short-term administration of beta-glycerophosphate on bile composition in patients with lithogenic bile. 10 patients with lithogenic bile were selected for study; 9 had cholelithiasis. Fasting hepatic and gallbladder bile before and after treatment with beta-glycerophosphate (6 g. daily for six days) was analysed for molar ratios of cholesterol (Ch.), total bile-salts (B.S.), and total phospholipids (P.L.). The molar ratios of Ch. divided by B.S. + P.L. in hepatic bile decreased in 9 of the 10 patients (P less than 0.01). Thus in all but 1 of the 10 patients the hepatic bile became less lithogenic. This observation was confirmed by plotting the molar percentages on triangular coordinates. The results suggest no change in cholesterol concentrations but an increase of phospholipid and bile-salt concentrations. The composition of the gallbladder bile did not change. These preliminary studies indicate that beta-glycerophosphate should be evaluated as a potential new therapeutic agent for dissolution of cholesterol gallstones in man.

Administration, Oral↗
PubMed1996

Comparison of mutagenic activity of bile between Chilean and Japanese female patients having cholelithiasis.

The mutagenic activity of bile was compared between Chilean and Japanese female patients having cholelithiasis by the Ames assay using Salmonella typhimurium tester strain TA98 in the presence of S9 mix with blue rayon adsorption technique. A reason for conducting the present investigation is that Chile and Japan have the highest mortality rates for the gallbladder cancer (GBC) in the world. Of 24 bile samples collected in Chile, 20 (83.3%) samples showed mutagenicity. In the case of Japanese bile, 21 (80.8%) of 26 and 5 (19.2%) of 26 cases were mutagenic in samples from high- and low-risk areas for GBC, respectively. Therefore, both the Chilean and the Japanese samples collected in high-risk areas showed higher mutagenic rates than the Japanese ones in a low-risk area, with a statistical significance (p < 0.001), chi-square test). The average number of revertant colonies were 128 +/- 92 (mean +/- SD), 62 +/- 14 and 66 +/- 13, respectively, when the blue rayon extracts of 200 microliters bile were applied to the Ames test. Thus, Chilean bile had a tendency to show a higher mutagenic activity than Japanese.

Adult↗
PubMed1996

Cholelithiasis, cholecystitis, and pancreatitis.

Cholelithiasis, cholecystitis, and pancreatitis are common conditions in the adult patient population that may be challenging to recognize because of their variable clinical presentations and broad differential diagnoses. This article discusses the pathophysiology of each condition and its common complications. The clinical presentation and evaluation of patients is reviewed with emphasis on current diagnostic tests used to identify severity of illness and the presence of complications. Treatment options are presented for straightforward as well as complicated initial management and disposition.

Cholecystectomy↗
PubMed2001

Pathological pancreatic exocrine function and duct morphology in patients with cholelithiasis.

Most authors claim alcohol consumption to be the only relevant reason for chronic pancreatitis. However, gallstones might cause this disease, as they do cause acute pancreatitis. In this study 91 gallstone patients and 94 age-matched controls were investigated concerning exocrine pancreatic function (fecal elastase-1 concentrations). Furthermore x-rays of 100 consecutive ERCP patients were evaluated for differences concerning pancreatic duct changes between patients with and without evidence of cholelithiasis. Pathological elastase 1 levels were more frequent in gallstone patients (30,8%) as compared to age-matched controls (19%). Symptoms such as upper abdominal pain, bloating, and fat intolerance were reported more often in gallstone patients. In ERCP of gallstone patients (N = 60), 77% were found to have chronic pancreatitis according to the Cambridge classification, while in nongallstone-patients (N = 32) 47% had chronic pancreatitis. In conclusion, according to these data a pathophysiological connection between gallstones and chronic pancreatitis appears to be probable.

Adult↗
PubMed1998

Similarity in gallstone formation from 900 kcal/day diets containing 16 g vs 30 g of daily fat: evidence that fat restriction is not the main culprit of cholelithiasis during rapid weight reduction.

Diets containing essentially no fat, 1-2 g fat per day, have resulted in cholesterol gallstones. Greater fat may result in less gallbladder stasis. Do gallstones form with greater fat content? We studied 272 moderately obese subjects who had normal gallbladder ultrasonograms. The 900 kcal/day liquid diets contained either 16 g fat (N = 94) or 30 g fat (N = 178) each day for 13 weeks. A second gallbladder ultrasound was performed. Sixteen of 94 (17.0%) of the 16-g fat group developed stones with a weight loss of 18 (+/- 7) kg and a body mass index (BMI) decrease of 6 (+/- 2) kg/m2. Twenty of 178 (11.2%) of the 30-g fat group developed stones (P = 0.18, no difference in stone formation) with similar weight loss of 20 (+/- 7) kg (P = 0.08) and BMI decrease of 7 (+/- 2) kg/m2 (P = 0.04). Substantial fat for rapid weight-reducing diets resulted in gallstone formation. Since experiments have shown that our higher fat diet, containing 10 g fat per meal, results in maximal gallbladder emptying, cholelithiasis from rapid weight loss may not be solely attributable to gallbladder stasis.

Case-Control Studies↗
PubMed2001

Tract microflora in Saudi patients with cholelithiasis.

OBJECTIVES: To identify the microflora in the gallbladder of patients undergoing laparoscopic cholecystectomy for gallstones, and the antibiotic susceptibility pattern of the isolates, as well as the usefulness of Gram staining of bile at the time of operation. METHODS: Bile samples were obtained from 112 patients undergoing elective laparoscopic cholecystectomy for gallstones and inoculated directly into aerobic and anaerobic blood culture bottles in the operating theatre. Samples were also collected in sterile universal containers for Gram staining of a centrifuged deposit. Isolates were identified and their in-vitro susceptibilities determined by Kirby Bauer technique. RESULTS: Of 112 bile samples examined, 28 (25%) were culture positive, four of which contained more than one organism. The most common organisms isolated were Escherichia coli 9 (28.1%), Enterococcus faecalis 5 (15.6%) and Pseudomonas aeruginosa 3 (9.4%). In one sample we found Aeromonas hydrophilia and Enterobacter cloacae. No anaerobes were detected but Candida albicans was isolated in one case. In 19 bile samples (67.8%) organisms were identified on Gram stain. Positive bile cultures were found statistically significant (P < 0.05) in patients over the age of 50 (13/32), in patients who developed post-operative fever (6/12) and patients who developed leucocytosis (5/6). CONCLUSION: Age over 50 years was the only significant pre-operative factor associated with positive bile cultures (P < 0.05). In view of the microflora of the gallbladder and the susceptibility pattern of our isolates we would suggest that antibiotic prophylaxis recommended for laparoscopic cholecystectomy for gallstones needs to be reviewed and the role of bacteribilia in the surgical management of cholelithiasis requires further study.

Adolescent↗