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PubMed1993

[Etiology of cholelithiasis].

The incidence of gallstone has been gradually increased in the last few decades in Japan and the recent study revealed that approximately 15% of the autopsy cases had biliary stones. In the last 25 year interval, the nature of gallstones was greatly changed. In detail, the incidences of cholesterol gallstone and black stone were increased from 46.7% to 66.9% and from 0.8% to 12.1%, respectively, whereas that of calcium bilirubinate stone was decreased from 41.5% to 21.0% of the whole cholelithiasis cases. The factors influencing these changes were probably due to recent increase of fat diet intake and decrease of ascariasis by improvement of environmental hygiene. However, the factors that caused the change in black stone has not been defined.

Adolescent↗
PubMed1993

[Diagnosis of cholelithiasis].

Evaluation of the patient with suspected cholelithiasis has been changed dramatically recently, to make accurate prediction of composition of the gallstone. That is mainly because of improvement and development of all kinds of diagnostic imaging modalities and development of several nonsurgical options. If we do the initial evaluation of the patient, it is natural to choose the ultrasonography first, because of its easiness and noninvasiveness. But it is important to choose the most appropriate modality following ultrasonography, in order to complete the integrated imaging diagnosis. Here we describe the gross feature of the each modality, and how we choose it in order to make accurate diagnosis and to arrive at a treatment plan best suited for each patient.

Bile Duct Diseases↗
PubMed1993

[Ultrasonography in cholelithiasis].

Ultrasonography has become the first line examination in the diagnosis of cholelithiasis. As for the gallbladder, extracorporeal ultrasonography is the most useful and the safest procedure. Ultrasonic properties of gallstones even suggest the feasibility of dissolution therapy. The detectability of choledocholithiasis is, however, not satisfactory. This deficiency has been overcome by combining endoscopy with ultrasound. Endoscopic ultrasonography, as well as ERCP, is a useful tool for examining the extrahepatic bile duct and the pancrease. Recently, with the development of laparoscopic cholecystectomy, intraoperative ultrasonography during laparoscopic surgery has considerably improved with introduction of new probes and may replace most of the methods of intraoperative cholangiography in the future.

Cholecystectomy, Laparoscopic↗
PubMed1993

[Diagnostic imaging of cholelithiasis--CT & MRI].

CT and MRI are inferior to ultrasound for detection of gallstones. CT and MRI however, might have distinctive features for diagnostic imaging of the cholelithiasis. The CT is sensitive, as regard with calcification of the gallstones, and able us to diagnose the composition of the gallstones manipulate the CT number. Then spiral CT, which is a new technique, is expected to improve the accuracy of detection of gallstones. Three-dimensional CT reconstruction images are useful in the sense of the anatomy of the biliary system. MRI is superior to evaluate bile juice concentration, so that it appears to make it possible to evaluate gallbladder function. Furthermore, the MRI has the potential advantage for acquisition the new knowledge relating to stone lysis.

Biliary Tract↗
PubMed1993

[Non-surgical biliary drainage for cholelithiasis].

Non-operative methods to treat obstructive jaundice and cholangitis caused by cholelithiasis are endoscopic and percutaneous biliary drainage. Usually, endoscopic papillotomy and stone removal by basket catheter is available for treating choledocholithiasis. It is necessary to place a drainage catheter into the bile duct in patients who have severe cholangitis or remaining stones. On the other hand, percutaneous biliary drainage is useful in case of emergency and in patients reconstructed by the Billroth II method. Biliary drainage is necessary to treat severe cholangitis as soon as possible, for it sometimes causes endotoxin shock, disseminated intravascular coagulation (DIC) and multiple organ failure (MOF).

Cholelithiasis↗
PubMed1993

[Cholelithiasis in children: apropos of 14 cases].

Between 1980 and 1990, we have diagnosed fourteen cases of cholelithiasis in children at our hospital. Abdominal pain was the most common symptom. Diagnosis was made by abdominal ultrasonography in all of the cases. Risk factors were found in 4 children. Family history was present in four patients. The treatments performed included cholecystectomy in five cases, extracorporeal lithotripsy in one case and a dietary regimen with regular clinical reviews in eight patients.

Adolescent↗
PubMed1993

Cholelithiasis in children with homozygous sickle cell anaemia in northern Nigeria.

The prevalence of gall stones was studied prospectively by abdominal ultrasound examination in 65 consecutive children with sickle cell anaemia (SCA) aged 5-13 years, 35 males and 30 females, in Jos, northern Nigeria. The prevalence of cholelithiasis was 4.6%. This rate was similar to previous studies from southern Nigeria and higher than that reported in American children with SCA. The different dietary habits of children in southern and northern Nigeria appear not to play any role in the prevalence rate. None of the children followed up for more than 12 months had upper quadrant abdominal pain that warranted surgery.

Child↗
PubMed1995

[Celioscopic treatment of cholelithiasis in benign acute biliary pancreatitis].

OBJECTIVES AND METHODS: To evaluate the laparoscopic treatment of cholelithiasis in mild acute gallstone pancreatitis, 35 patients with gallstone pancreatitis and less than 4 Ranson's prognostic signs at 48 h were retrospectively included. RESULTS: Eight patients underwent preoperative endoscopic retrograde cholangiopancreatography. Surgery was performed a median of 15 (range: 4-60) days after the onset of pancreatitis, and included laparoscopic cholecystectomy with intraoperative cholangiography that was successful in 30 out of 32 cases (93%). A common bile duct stone was present in 4 patients (11%). Conversion to open surgery was necessary in 3 patients (8%). Choledocholithiasis was successfully removed by laparoscopy in two cases, and by laparotomy and postoperative endoscopic sphincterotomy in one case each. CONCLUSION: Laparoscopic treatment can be recommended as the primary treatment within a few days after the onset of mild gallstone pancreatitis.

Acute Disease↗
PubMedDate not supplied

Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the standard treatment for symptomatic cholecystolithiasis; however, there is debate on the management of patients with concomitant common bile duct stones. Several options have been suggested; endoscopic sphincterotomy and laparoscopic common bile duct exploration seemed to be the preferred methods at this moment. MATERIALS AND METHODS: We performed endoscopic sphincterotomy prior to laparoscopic cholecystectomy in 51 cases of acute symptomatic cholelithiasis. RESULTS: Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy procedure-related complication rate was 5.4%, including 1 pancreatitis, 1 cholangitis, and 2 major bleeds. After follow up period of 15-42 months, recurrent stones were found in 2 patients. CONCLUSION: Endoscopic sphincterotomy combined with laparoscopic cholecystectomy is a safe and effective therapy for symptomatic cholecystolithiasis with concomitant choledocholithiasis. Recurrent stones did occur, but further studies are needed to compare the incidence of recurrent stones after endoscopic sphincterotomy and after laparoscopic common bile duct exploration.

Acute Disease↗
PubMed1996

[The effect of co-existing diseases with cholelithiasis on the course and results of laparoscopic cholecystectomy].

Six hundred laparoscopic cholecystectomies have been performed in patients with cholelithiasis. Co-existing chronic diseases have been noted in 28% of the operated patients. All these diseases have been known to increase operative risk in classic (open) cholecystectomy (hypertension, coronary disease, cardiac arrhythmias, diabetes mellitus, bronchial asthma). Statistical analysis of the body temperature following laparoscopic cholecystectomy, morbidity and duration of the postoperative hospitalization has revealed that there has been no significant increase in operative risk for laparoscopic cholecystectomy in these patients.

Adolescent↗
PubMed1996

[Severe hemolytic-uremic syndrome complicated by cholelithiasis treated with laparoscopic cholecystectomy in a 12-year old boy].

A case of a 12-year old boy with hemolytic-uremic syndrome complicated with cholelithiasis is presented. Due to severe course of the hemolytic-uremic syndrome (enhanced catabolism, coagulation disorders) a laparoscopic cholecystectomy as a new, modern surgical technique has been considered. Postoperative period has been uncomplicated. Therefore, laparoscopic cholecystectomy proved useful and is recommended in patients with high postoperative risk.

Child↗
PubMed1997

Bacteriology of cholelithiasis in infants and children.

Today, laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the standard treatment of symptomatic cholelithiasis in children. We reviewed the bile cultures and postoperative course of 30 children who underwent laparoscopic cholecystectomy with the aim of establishing a routine policy for perioperative antibiotic treatment and for the management of biliary leak during that procedure. A positive bile culture was found in only one child (Salmonella Group D). All patients, including six children with intraoperative bile spillage, had a completely normal and uneventful postoperative course. We concluded that the use of preoperative antibiotic treatment should be limited in laparoscopic cholecystectomy in children and is probably not required at all, awaiting proof from a further study. The present study further showed that intraoperative bile spillage is of no clinical significance and can be treated simply with local saline irrigation during the laparoscopic procedure.

Abdomen↗
PubMed1997

[New approaches to diagnosis and treatment of cholelithiasis in young occupational groups].

Cholelithiasis was treated in 107 pilots. Cholesterol choleliths were effectively treated with ursosan. In bilirubin or calcium stones ursosan combination with shock-wave lithotripsy is more effective. Promising is dissolving of the stones in the gall bladder by chemical solvents delivered through special drainage or catheters. In lithogenic bile it is recommended to conduct early prophylaxis of the stones with ursodeoxycholic acid compounds.

Adult↗
PubMed1996

Spontaneous resolution of cholelithiasis in an infant.

Cholelithiasis is an extremely unusual finding in infancy. Hemolytic disease, bile duct abnormalities, intestinal malabsorption have been implicated. Recently, an association of prematurity, bronchopulmonary dysplasia, total parenteral nutrition and furosemide has been reported. Rarely, sonographic discovery of idiopathic gallstones and their subsequent spontaneous disappearance has been reported. We report a case of an 11-week-old infant whose initial sonogram displayed evidence of true gallstone, that later showed resolution on follow-up examinations. In the absence of clinical or imaging evidence of biliary tract disease, we suggest an initial conservative management and follow-up sonograms.

Age Factors↗
PubMed1997

[Surgery for cholelithiasis in cirrhotic patients].

Although biliary tract surgery for cholelithiasis is performed frequently, cirrhotic patients require special consideration. The prevalence of postoperative severe complications, such as hepatic failure and biliary peritonitis caused by insufficient fistula formation after removal of the T-tube, is higher than non-cirrhotic patients. We suggest that definitive surgery can be carried out safely, in Child's A and B cirrhotic patients, either electively or as an emergency. However, a more conservative approach is advisable in Child's C patients with acute conditions and definitive surgery is recommended as an elective procedure after liver function has improved. And for the treatment of choledocholithiasis in patients with severe cirrhosis, avoiding surgical intervention through the use of such techniques as endoscopic papillotomy is recommended whenever possible.

Adult↗
PubMed1997

Cholelithiasis and cholecystitis in a dairy cow.

A 9-year-old Holstein cow was evaluated for colic and decreased milk production of 2 days' duration. Preoperative serum biochemical results suggested hepatic damage and cholestasis. On the basis of persistent signs of abdominal pain that were nonresponsive to analgesics, exploratory laparotomy was performed. The cow was found to have choleliths. Cholecystocentesis was performed, and samples were submitted for cytologic examination and bacterial culture. Bacterial culture yielded Escherichia coli and Clostridium perfringens. Using digital pressure, choleliths were reduced until they could be passed through the bile duct into the duodenum. The cow recovered from surgery without complications, and all serum biochemical test results returned to reference ranges. Cholelithiasis is rare in cattle but can result in signs of abdominal pain.

Abdominal Pain↗
PubMed1998

[Cholelithiasis--laparoscopy or laparotomy?].

Between 10% and 15% of the adult population have gallstones and therefore symptomatic cholelithiasis is the second most common indication for surgery in general practice. It's diagnosis depends on the patients history, clinical findings, laboratory tests and ultrasound. In case of symptomatic gallstones surgery offers the only permanent cure and specific complications due to gallstones such as ileus or fistula are becoming rare. With the introduction of minimal invasive surgery at the end of this century laparoscopic cholecystectomy is now considered to be the standard treatment for symptomatic gallstones. This approach can be offered to > 90% of patients in elective cases and in between 60%-80% of patients having acute cholecystitis with a low morbidity and mortality rate. The main advantages of the laparoscopic approach are the overall increased patients comfort with less postoperative pain, shorter hospital stay, recovery and off work time. Although the rate of common bile duct injury appears to be increased using this minimal invasive approach, this rate is still sufficiently small to justify the use of laparoscopic cholecystectomy for symptomatic disease. Open cholecystecomy remains the treatment of choice for complicated gallstone disease (i.e. cancer, Mirizzi syndrome, severe inflammation) and high risk patients. In case of acute cholecystitis the laparoscopic treatment with all it's advantages may also be offered to many patients. However, in those cases the conversion rate to the open approach may be markedly increased which has not to be considered as a complication of the laparoscopic approach but as a maximization of safety and effectiveness of the treatment.

Adult↗