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PubMed1986

Cholescintigraphy in the detection of cholelithiasis: a review of 23 cases and a case report demonstrating the sequential evolution of the appearance of the gallbladder defect.

Cholescintigraphy of cholelithiasis has been reported as a defect or photon deficient area in the gallbladder. We present the case of a patient with gallstones whose cholescintigraphic study showed a sequential evaluation of the scan appearance from a defect, to a septation, a hole, and finally a filled-in appearance. Cholescintigrams and histopathologic findings after cholecystectomy of another 22 patients with cholelithiasis were also retrospectively reviewed. The results of the study concluded that: cholelithiasis is rarely demonstrated by cholescintigraphy and nonvisualization of the gallbladder may be due to acute or chronic cholecystitis associated with cholelithiasis.

Cholecystitis↗
PubMed1996

Risk of pancreatic cancer associated with cholelithiasis, cholecystectomy, or gastrectomy.

Current data regarding an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer are conflicting. We evaluated the frequency with which these factors were present in 720 patients with newly diagnosed pancreatic cancer and in 720 matched controls. All subjects were interviewed personally and in detail about their clinical history. Cholelithiasis was present in 126 patients with pancreatic cancer (17.5%) and in 95 controls (13.2%), constituting a statistically significant association (odds ratio, 1.39; 95% confidence interval, 1.04-1.86); however, considering only the patients and controls in whom the diagnosis of cholelithiasis was made more than one year before cancer diagnosis or interview, the association was no longer significant (odds ratio, 1.04; 95% confidence interval, 0.75-1.44). Cholecystectomy had been performed in 93 patients with pancreatic cancer (12.9%) and in 71 controls (9.9%). When all subjects were considered, the odds ratio was mildly, although not significantly, increased (odds ratio, 1.35; 95% confidence interval, 0.97-1.87); when only subjects who underwent cholecystectomy one year or more before the cancer diagnosis or interview were considered, the odds ratio fell to unity. Gastrectomy had been performed in 28 patients with pancreatic cancer (3.9%) and in 25 controls (3.5%); analysis revealed no significant association between these two factors (odds ratio, 1.14; 95% confidence interval, 0.64-2.05). In conclusion, our study, one of the largest on this topic, has found no evidence for an association between cholelithiasis, cholecystectomy, or gastrectomy and pancreatic cancer.

Adult↗
PubMed1984

Cholelithiasis in ileostomy patients.

A retrospective study of 152 ileostomates with inflammatory bowel disease (IBD) revealed that 16 patients (10.5 per cent) had diagnoses of cholelithiasis before, at the time of, or after having ileostomies. Of the remaining patients, 69 were followed for possible cholelithiasis, most of those with sonographic examination. Sixteen of this latter group of patients (23.2 per cent) were found to have cholelithiasis, usually in an asymptomatic stage. Among women over 50 years old, seven of 11 (63.6 per cent) had gallstones. Due to this high prevalence of cholelithiasis, gallbladder imaging is recommended as a part of the preoperative workup and follow-up of ileostomates. Prophylactic cholecystectomy may be carefully considered in female patients with IBD at the time of proctocolectomy.

Adolescent↗
PubMed1997

Pseudohypo-aldosteronism and cholelithiasis: coincidence or pathogenetic correlation?

Cholelithiasis is being documented with increasing frequency in the paediatric age group. Causes of gallstone formation in infants and neonates seem to differ from those in older children and adolescents. Two infants with pseudohypo-aldosteronism and cholelithiasis are reported. Salt-wasting and dehydration in pseudohypo-aldosteronism are suggested to be the pathogenetic mechanisms leading to gallstone formation possibly beginning in fetal life. The diagnosis of pseudohypo-aldosteronism may be missed, when salt-wasting is transitional. Cholelithiasis may go undetected when asymptomatic. CONCLUSION Pseudohypo-aldosteronism should be considered in infants with cholelithiasis even without obvious salt-wasting signs. Routine ultrasonographic screening for gallstones should be performed in patients with pseudohypo-aldosteronism.

Cholelithiasis↗
PubMed1983

Increased risk of cholelithiasis with prolonged total parenteral nutrition.

Patients who receive hyperalimentation undergo prolonged periods of fasting which may alter bile composition and lead to gallbladder stasis, both important factors in gallstone formation. Therefore, we tested the hypothesis that patients who receive long-term TPN are at increased risk for cholelithiasis by performing cholecystosonography on adult patients who had received a minimum of 3 months of intravenous hyperalimentation during 1981. Seventy-one patients whose mean age was 41.9 years, 41 percent of whom were men, met these criteria. Gallstones had been diagnosed in 11 of the 71 patients (15 percent) before the initiation of parenteral nutrition. Twenty-one of the remaining 60 at risk patients (35 percent) were discovered to have cholelithiasis after hyperalimentation was started. The 45 percent prevalence of gallstones in our 71 patients was significantly higher (p less than 0.001) than predicted from autopsy data. In addition, the 49 percent prevalence of cholelithiasis in our 53 patients with ileal disorders was significantly greater (p less than 0.02) than predicted from a study of patients with similarly defined ileal disorders. This analysis strongly suggests that patients who receive long-term TPN are at increased risk for the development of cholelithiasis.

Adolescent↗
PubMed1994

Impact of laparoscopic cholecystectomy on the management of cholelithiasis in children with sickle cell disease.

Children with sickle cell disease, well known to have a high incidence of cholelithiasis, are frequently admitted to the hospital for episodes of abdominal pain. Before the advent of laparoscopy, few children with sickle cell and cholelithiasis underwent cholecystectomy unless absolutely necessary, because of the high morbidity of an open cholecystectomy (OC). We reviewed our records of all children with sickle cell disease and cholelithiasis treated from 1985 to 1992 to investigate the impact of laparoscopic cholecystectomy (LC). During that period, 32 children underwent cholecystectomy: 10 OC and 22 LC (all since December 1990). Before December 1990, all children had either classic biliary tract symptoms or abdominal pain of unknown etiology. However, of the 22 LC children, five had asymptomatic cholelithiasis. Only three of the 32 patients had choledocholithiasis, although 30 of 32 had elevated total bilirubins. Two LC children presented with choledocholithiasis and were initially treated with endoscopic sphincterotomy and stent placement. A standard intraoperative cholangiogram (IOC) through the cystic duct was performed in all OC cases. In 19 of 22 LC cases, an IOC through the gallbladder was performed before any dissection; unsuspected choledocholithiasis was not found, but the IOC did allow visualization of the course of the cystic duct, facilitating its subsequent dissection. Total operative length was comparable between the two groups, but the LC patients' postoperative length of stay was half that of the OC patients (2.1 v 4.6 days). Postoperative complications in the OC group included three children who had severe pain, atelectasis, fever, and hypoxemia (30%).

Adolescent↗
PubMed2006

Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study.

BACKGROUND/PURPOSE: Inflammation has been implicated in functional gastrointestinal disorders, including functional dyspepsia and irritable bowel syndrome. This study was undertaken to evaluate gallbladder wall inflammatory cells in children with abdominal pain related to gallstones and biliary dyskinesia to determine the candidate cell types that may be contributing to the pathophysiology of these entities. METHODS: Gallbladder specimens from 20 patients with cholelithiasis, 20 biliary patients with dyskinesia, and 12 autopsy controls were evaluated in a blinded fashion. Eosinophil, tryptase-positive, and CD3+ cell densities were determined for the lamina propria and muscularis mucosa layers and compared between groups. RESULTS: Patients with biliary dyskinesia and cholelithiasis had a 9- to 12-fold increase in mean and peak mast cell densities, respectively, in both layers as compared with controls. Peak (13.7 vs 8.4) and mean (9.2 vs 5.2) CD3+ cell densities were increased in the muscularis mucosae of cholelithiasis specimens as compared with biliary dyskinesia specimens. CONCLUSION: Gallbladder wall inflammatory cell densities, particularly mast cells, differ between children with cholelithiasis, children with biliary dyskinesia, and controls. Future studies are warranted to define the roles for specific inflammatory cell types.

Adolescent↗
PubMed1994

Long-term evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis.

To define the risk of complications in cirrhotic patients with asymptomatic cholelithiasis and the possible benefit of incidental cholecystectomy during abdominal operations in these patients, a retrospective cohort of cirrhotic patients who had asymptomatic cholelithiasis and underwent abdominal operations for portal hypertension was analyzed. Of 338 patients operated on during the last 15 years, 34 patients were found with asymptomatic cholelithiasis, all of whom had long-term follow-up. At a mean follow-up of 70.5 +/- 8.6 months (SEM), 28 patients remained asymptomatic (82%), 6 patients have developed symptoms (18%), (4 patients had acute cholecystitis and 2 chronic cholecystitis), and 3 of these patients (8.8%) died due to complications of acute cholecystitis. The results suggest that the risk for the development of complications is low but that the mortality associated with acute episodes of cholecystitis is high. Incidental cholecystectomy is not justified in cirrhotic patients with asymptomatic cholelithiasis, but close follow-up with early elective operation when symptoms supervene should be recommended.

Cholecystectomy↗
PubMed2000

[Cholelithiasis in heart transplant patients].

UNLABELLED: The incidence of cholelithiasis is increased in heart transplant recipients. STUDY AIM: The aim of this retrospective study was to report a series of 27 heart transplant recipients operated for cholelithiasis and to assess the indications and safety of cholecystectomy in this population. PATIENTS AND METHODS: Over a 9-year period, from January 1991 to December 1999, 27 heart transplant recipients (21 men and 6 women; mean age: 54.6 years, mainly transplanted for ischemic or dilated cardiomyopathy) underwent cholecystectomy. All patients received immunosuppressive therapy with a combination of corticosteroids and cyclosporin and 10 also received azathioprine. Five patients admitted urgently with calculous acute cholecystitis and one patient with previous gastrectomy underwent laparotomy, while the other 21 patients were operated by laparoscopy. RESULTS: There were no postoperative deaths. In patients operated by laparoscopy, there was no conversion to laparotomy and oral immunosuppressive drugs were continued without interruption. There was one postoperative hemoperitoneum related to liver biopsy performed concomitantly. In patients operated by laparotomy, intravenous cyclosporin was necessary until return to bowel function and the only complication was a wound abscess. Mean length of hospital stay was 3.1 days after laparoscopy and 8.8 days after laparotomy. CONCLUSION: Systematic ultrasound screening of cholelithiasis after heart transplantation is necessary because cholelithiasis carries a risk of septic complications in these patients. Laparoscopic cholecystectomy, associated with a low morbidity, is justified even in asymptomatic cases. In patients with acute cholecystitis, "open" cholecystectomy must be preferred in order to minimize the risk of biliary complications which would be very serious in these immunosuppressed patients.

Adult↗
PubMed2000

EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis.

BACKGROUND: The aim of this study was to evaluate the use of endoscopic ultrasonography (EUS) in detecting occult cholelithiasis and determining a probable etiology in patients classified as having idiopathic pancreatitis by conventional radiologic methods. METHODS: A prospective study was performed in 89 consecutive patients with acute pancreatitis. Transcutaneous ultrasonography (US), CT, or both was performed on all patients within 24 hours of admission. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all patients with confirmed or suspected biliary pancreatitis. EUS was performed in patients classified as having idiopathic pancreatitis. RESULTS: Cholelithiasis was identified in 64 patients (72%) by conventional radiologic methods. Eighteen patients (20%) were classified as having idiopathic pancreatitis after evaluation by US (all 18 patients), repeated US (9 patients), CT (6 patients) and ERCP (13 patients). EUS performed in these 18 patients revealed small gallbladder stones (1 to 9 mm) in 14 patients; 3 were found to have concomitant choledocholithiasis. All stones were confirmed by subsequent ERCP and cholecystectomy. The remaining 4 patients in whom no etiology was identified had no clinical or radiologic evidence of cholelithiasis at a median follow-up of 22 months. CONCLUSION: Cholelithiasis is detected by EUS in a large number of patients classified as having idiopathic pancreatitis by conventional radiologic examinations. With identification of a biliary cause of acute pancreatitis, treatment can be initiated early, thereby reducing the risk of recurrent pancreatitis with its associated morbidity and mortality. EUS is a valuable diagnostic modality in the management of patients with acute pancreatitis.

Acute Disease↗
PubMed1997

Sequential endoscopic/laparoscopic management of cholelithiasis and choledocholithiasis in children who have sickle cell disease.

BACKGROUND/PURPOSE: Cholelithiasis and choledocholithiasis are common complications of sickle cell disease (SCD). With the recent advances in laparoscopic cholecystectomy (LC), which has been used successfully for the management of cholelithiasis in children who have SCD, exclusion of choledocholithiasis before LC is of great importance. METHODS: Eighteen children who had SCD, cholelithiasis, and choledocholithiasis were treated at our hospital. Seven were treated with open cholecystectomy (OC) and common bile duct (CBD) exploration, and two were treated with transduodenal sphincteroplasty. The remaining 11 patients underwent endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and stone extraction followed by laparoscopic cholecystectomy (LC). RESULTS: A dilated CBD noted on ultrasound, elevated alkaline phosphatase, elevated total bilirubin of more than 5 mg/dL, history of pancreatitis, either singly or in combination, should raise suspicion of choledocholithiasis, and these patients together with those who have choledocholithiasis detected on ultrasound should undergo ERCP to confirm and extract the stones before LC. CONCLUSION: This sequential approach of endoscopic sphincterotomy and stone extraction followed by LC is a safe and effective approach for the management of cholelithiasis and choledocholithiasis in children who have SCD.

Adolescent↗
PubMed1994

Symptomatic cholelithiasis following continent urinary diversion using ileocolonic bowel segments.

Cholelithiasis is uncommon prior to adulthood. Several risk factors have been identified as causing cholelithiasis but continent urinary diversion has not been considered a factor. To our knowledge there has been no other report of cholelithiasis developing after urinary tract reconstruction. Between 1979 and 1992, 116 patients younger than 23 years underwent urinary tract reconstruction at our clinic. Symptomatic cholelithiasis developed in 4 patients (3.4%) following continent urinary diversion with an Indiana pouch.

Adolescent↗
PubMed1998

Cholelithiasis and dietary risk factors: an epidemiologic investigation in Vidauban, Southeast France. General Practitioner's Group of Vidauban.

Dietary risk factors have been implicated in the development of cholelithiasis. The aim of this study was to determine in a homogeneous French population whether a particular type of diet may be lithogenic. Seventy-six subjects over 30 years of age (26 men, 50 women) with cholelithiasis detected by ultrasound were selected from a population sample of 830 subjects by drawing lots using the polling list. These were matched by 76 control subjects without cholelithiasis randomly selected from the same population. Univariate analysis was significant for a high calorie diet >2500 kcal/day (OR = 3.62, P = 0.0065), a diet rich in carbohydrates with a consumption > or = 55 g/day (OR = 2.98, P = 0.0067), and a diet rich in total lipids (OR = 4.97, P = 0.023) or saturated fatty acids (OR = 3.06, P = 0.0146). An alcohol consumption equivalent to 20-40 g/day was protective (P = 0.018). Multivariate analysis confirmed these results. Our study suggests that a change in dietary habits by limiting excess calories, saturated fats and carbohydrates could reduce the incidence of cholelithiasis.

Adult↗
PubMed2002

Cholelithiasis in infant and pediatric heart transplant patients.

There have been numerous studies which demonstrate a relatively high incidence of gallstones in adult solid-organ transplant recipients receiving cyclosporin A (CsA) immunosuppression. The purpose of the present study was to investigate our experience with cholelithiasis in babies and children undergoing heart transplant (HTx). From May 1985 to December 1998, 311 neonatal and pediatric cardiac transplants were performed at our institution. Routine abdominal ultrasound was performed at 3 months, 1 yr, and bi-annually thereafter on all transplant recipients. Asymptomatic or symptomatic gallstone development was detected during abdominal ultrasound in 10 of 311 patients (3.2%). Eight of these 10 patients (80%) were transplanted when younger than 3 months of age. Eight per cent of all infants transplanted at < 3 months of age developed cholelithiasis (p < 0.05 compared to older age at HTx). Fifty per cent of gallstones were detected and treated within 6 months post-HTx, while the remaining 50% of patients with gallstones underwent cholecystectomy 3-6 yr later. Only 20% (two of 10) had symptoms of cholelithiasis/cholecystitis. Five patients (50%) underwent laparoscopic cholecystectomy. Only one patient older than 1 yr of age, who was symptomatic, underwent open cholecystectomy. There were no complications from surgery. There were no differences in liver function tests or cholesterol levels in transplant recipients with or without gallstones, and all mean values were within normal limits. Hence, although the incidence of pediatric post-transplant cholelithiasis in infant and pediatric heart transplant recipients is low, almost all occurrences are associated with HTx during early infancy and, because of this, patients in this group should be routinely screened. Laparoscopic or open cholecystectomy are extremely well tolerated and we recommend that surgery be performed when cholelithiasis is found in pediatric heart treatment patients.

Child↗
PubMed2006

Hospitalization rates for cholelithiasis and acute cholecystitis doubled for the aged population in Greece over the past 30 years.

OBJECTIVE: Gallbladder disease is becoming increasingly prevalent in Western countries and is a common cause of hospitalization. The objective of this study was to determine time trends in cholelithiasis and acute cholecystitis for hospitalization and disease case fatality in Greece between 1970 and 1998. MATERIAL AND METHODS: Data were obtained from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. Percentage changes in time trends were estimated by comparing the median values of the initial (1970-78) to the last (1989-98) 10-year study period for cholelithiasis and acute cholecystitis at discharge and for all deaths attributed to the disease. RESULTS: Over the study period, age-standardized hospitalization rates for cholelithiasis increased. The median hospitalization rate between the initial and last (178 and 258 per 100,000 of the population, respectively) 10-year study period increased by 44.7%, but peaked to 70.1% and 208.3% for the 70-79 and >80 years age groups, respectively. Case fatality rate declined by 56.8% and the median value was 0.24 per 100 patients hospitalized during the last 10-year period. CONCLUSIONS: Hospitalization rates for cholelithiasis and/or acute cholecystitis increased by 45%, and doubled for elderly patients, while the case fatality rate of the disease halved in Greece over the past 30 years.

Adult↗
PubMed2000

An ultrasonographic evaluation of gallbladder emptying in patients with cholelithiasis.

Impaired gallbladder emptying producing biliary stasis may provide potent carcinogen, which comes in contact with gallbladder mucosa for a prolonged period, inducing carcinogenesis. The aim was to study gallbladder emptying pattern in cholelithiasis. Postprandial gallbladder emptying was measured ultrasonographically in terms of fasting volume (FV), postprandial residual volume at 30 minutes (PP30), 60 minutes (PP60), and 90 minutes (PP90), residual fraction, and ejection volume (EV) in 58 patients with gallstones. Patients were divided into two groups of poor and good contractors on the basis of 50% maximal postprandial gallbladder emptying. Malonaldehyde level was estimated in 15 patients with cholelithiasis. Twenty-nine patients (50%) were poor contractors. The FV in patients with cholelithiasis (mean, 30.08 mL) was larger than the controls (mean, 17.55 mL) and the difference was statistically significant (p < 0.02). The FV in the cholelithiasis group correlated significantly with the PP30 (r = 0.85, p < 0.001), PP60 (r = 0.85, p < 0.001), PP90 (r = 0.78, p < 0.001), and EV (r = 0.65, p < 0.001). Ejection volume was significantly less in poor contractors (p <0.001). Residual fraction was significantly higher in poor contractors (p < 0.001). The biliary malonaldehyde in poor contractors (2.27 micromol/mL) was higher than in good contractors (1.78 micromol/mL), but the difference was statistically not significant. Significantly larger volumes of PP30, PP60, PP90, and residual fraction and a low EV indicate poor contraction leading to biliary stasis.

Cholelithiasis↗
PubMed2000

Clinical presentations and predisposing factors of cholelithiasis and sludge in children.

BACKGROUND: In contrast to adults, little is known about the epidemiology and the best therapeutic regimen for cholelithiasis and sludge in children. METHODS: Eighty-two children with cholelithiasis detected by ultrasonography were studied from 0 to 18 years of age with regard to cause, symptomatology, and treatment outcome. Seventy-five children with sludge within the same age group were studied as well. RESULTS: Idiopathic gallstones were found in 19 (23%) patients, and 32 (39%) had gallstones in association with a hemolytic disease. Predominant factors associated with the development of gallstones and clinical presentation differed with age. In patients with sludge, total parenteral nutrition and systemic infection or administration of antibiotics were most frequently found to be possible predisposing factors. Sludge can develop and disappear within a few days. Complications of cholelithiasis were observed in 13 patients. Cholecystectomy was performed in 41 patients and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction in 9 patients; 32 children were not treated. After a follow-up (mean, 4.6 years) in 50 patients, 46% of the children who had cholecystectomy or therapeutic ERCP experienced clinical recurrence of abdominal symptoms. In the patients who did not receive surgical or endoscopic therapy during the follow-up, no complications occurred, and only one patient experienced abdominal symptoms during follow-up. CONCLUSIONS: The difference in associated conditions may indicate that the pathogenesis of cholelithiasis and sludge differ as well. Furthermore, sludge should be viewed as a dynamic condition not predisposing for the development of gallstones, per se. Cholecystectomy should not be performed routinely but only after careful selection in patients at risk for complications.

Adolescent↗
PubMed2005

Sludge ball, pseudolithiasis, cholelithiasis and choledocholithiasis from intrauterine life to 2 years: a 13-year follow-up.

OBJECTIVE: Evaluation and follow-up of infants with cholelithiasis and pseudolithiasis in a pediatric ward. PATIENTS & METHODS: Prospective study from April 1990 to October 2003 identified hospitalized infants younger than 2 years with ultrasonographic findings of cholelithiasis, choledocholithiasis or pseudolithiasis. Associated abnormalities or contributory factors were recorded and patients were followed for from 6 months to 13 years (mean, 4 years). RESULTS: Thirty-four patients were diagnosed between the age of 3 weeks and 24 months. Thirteen (38%) had been treated with third-generation cephalosporins. Other associated factors were dehydration in 10 (29%), urinary tract infection in two (6%) and one each for cholestatic liver disease, total parenteral nutrition, immunoglobulin A deficiency and prematurity. Six infants (17%) had no known risk factor. Six additional patients were diagnosed by antenatal ultrasound. CONCLUSIONS: Cholelithiasis in infants hospitalized for a variety of common pediatric conditions is not rare. Dehydration and treatment with third-generation cephalosporins are important associated factors. The classic risk factors of hemolysis and previous gastrointestinal surgery, were not found in our group. The overall prognosis was good. Pseudolithiasis disappeared in all infants. Of the 21 infants with cholelithiasis, only two developed cholecystitis. In nine infants, spontaneous resolution occurred. In the absence of other clinical or imaging evidence of biliary tract disease, conservative management is advised.

Anti-Bacterial Agents↗