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At least 19 recordsLinked to original sources
PubMed1993

Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis.

Acute cholecystitis, acute cholangitis, and acute pancreatitis represent the most common biliary tract emergencies. Most are due to gallstones in the gallbladder and bile ducts. Acute cholecystitis is treated by surgery in most cases. Laparoscopic cholecystectomy combined with endoscopic sphincterotomy may become more common in the future for treatment of acute cholecystitis as well as in cases of acute cholangitis and pancreatitis if the bile ducts are cleared of gallstones. Although the role of either surgery or endoscopic treatment may be more clearly defined in some biliary tract emergencies, in other situations either modality may be appropriate or they may compliment each other. Most biliary emergencies should be managed by gastroenterologists, surgeons, and radiologists working together in a harmonious fashion.

Acute Disease↗
PubMedDate not supplied

[Laparoscopic treatment of acute cholecystitis].

Acute cholecystitis has been considered a contraindication for laparoscopic cholecystectomy after its affirmation as the golden standard for treatment of chronic cholecystitis. However, over time it has been proven that acute cholecystitis could also be managed laparoscopically, although it was technically demanding procedure, burdened with relatively high conversion rates. In this study we present our series of 26 patients, urgently admitted for acute cholecystitis. They are presented with clinical findings typical for acute cholecystitis. The diagnosis was determined using ultrasound examination, and confirmed postoperatively by pathohistological findings. In all 26 cases we managed to perform laparoscopic cholecystectomy, there were no conversion. Mean operative time was 73 +/- 21 minutes. Postoperatively, we haven't recorded any significant complications. Mean hospital stay was 4.8 +/- 2.5 days. Even though laparoscopic treatment of acute cholecystitis is technically more demanding and lengthier procedure than laparoscopic treatment of chronic cholecystitis, we consider acute cholecystitis to be a laparoscopically manageable disease. During the operation, tissue edema and hyperemia presented main technical challenge. They presented a significantly greater problem if the symptoms lasted for more than 3 days prior to operation. Therefore we suggest that laparoscopic cholecystectomy should be carried out in the first 72 hours after the onset of symptoms, since any further delay will lead to development of tissue hyperemia and edema, thus making the operation technically more demanding.

Adult↗
PubMed1990

Predictive factors for bactibilia in acute cholecystitis.

Acute cholecystitis is well established as one of the high-risk factors bactibilla and wound infection. However, many patients with acute cholecystitis do not have bactibillia. Therefore, we analyzed 20 clinical and laboratory parameters in 49 patients with acute cholecystitis to determine which factor(s) predicted bactibilla. Twenty-one (42.9%) of 49 patients with pathologically proved acute cholecystitis had positive bile and/or gallbladder wall cultures. Univariate analysis suggested that a preoperative temperature greater than 37.3 degrees C, a total serum bilirubin level greater than 8.6 mumol/L, and a white blood cell count greater than 14.1 x 10(9)/L were the best predictors of bactibilia. Multifactorial analysis demonstrated that the 17 patients with zero or one predictive factor had a significantly lower chance of having bactibilia than the 32 patients with two or three predictive factors (6% vs 63%). We concluded that the culture status of patients with acute cholecystitis can be predicted preoperatively. We propose that patients with acute cholecystitis and zero or one of the predictive factors receive a single preoperative antibiotic dose. In patients with two or three predictive factors, antibiotics should be continued until culture data are available.

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↗
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↗
PubMed1981

Urgent real-time cholecystosonography in suspected acute cholecystitis.

Acute cholecystitis was suspected in 60 patients. Correct diagnoses were achieved by urgent real-time cholecystosonography in all the 38 patients that had acute cholecystitis. In about one-third of the other cases sonography revealed the pathological states responsible for the symptoms simulating those of acute cholecystitis. All of the examinations were technically satisfactory.

Acute Disease↗
PubMed2000

Laparoscopic cholecystectomy for acute cholecystitis.

Acute cholecystitis was initially considered a contra-indication for laparoscopic cholecystectomy, but today the laparoscopic route is generally used even for severe acute cholecystitis. Several studies have shown that this is possible, although the conversion and complication rates are high, but there are no randomised controlled trials that evaluate the complications and costs of this technique compared with conventional open techniques. The timing of a laparoscopic cholecystectomy for acute cholecystitis is also a matter of debate as well as its use in elderly patients with this condition.

Acute Disease↗
PubMed1988

[Results of early operation of acute cholecystitis].

Acute cholecystitis is a frequent complication of cholelithiasis. Patients in advanced age are more often affected than others. Early operation has been widely accepted for treatment of acute cholecystitis, as it has proved to be effective as prophylaxis against perforation, sepsis, recurrent inflammation, and long-term sequels, such as enterocolic fistulae and abscesses. It should be acceptable to everyone, provided short-time individual preparation. Patients in advanced age are likely to draw particular benefit from no-delay surgery, since soon removal of the source of inflammation as well as short-time immobilisation and hospitalisation are good prerequisites for soon, definite healing. Operations for acute cholecystitis were performed von 257 patients, between 1977 and 1987. They accounted for 8.4 per cent of 3,059 gall surgery patients during the period under review. The lethality rate associated with early operations amounted to 1.6 per cent and was thus slightly below overall gall surgery lethality of 1.9 per cent during that period.

Acute Disease↗
PubMed1988

Acute cholecystitis.

Acute cholecystitis is a common cause of the acute abdomen. The diagnosis has been distinctly improved with the development of ultrasonography and hepatobiliary scanning over the past 20 years. The treatment is cholecystectomy, with early as opposed to delayed operation gaining increasing popularity nationwide. Acute acalculous cholecystitis and emphysematous cholecystitis are special features of acute cholecystitis occurring in more complicated cases and requiring diligence in diagnosis and great care in treatment.

Abdomen, Acute↗
PubMedDate not supplied

[Imaging of simple and complicated acute cholecystitis].

Acute Cholecystitis is a common disease and it needs to be treated in emergency. In case of complication, surgery is mandatory in 48-72 hours. Ultrasonography (US) is the first diagnostic step in that it allows to identify the signs of major complications, not always visible. Spiral CT identifies complications misdiagnosed at US and allows a correct classification. However, spiral CT is able to depict fluid collections or gas in the wall or in the lumen of the gallbladder or free air in the peritoneum, signs not always depicted by US and which also needs surgical treatment in emergency. If one or more signs of complications are present, CT is mandatory to identify complicated cholecystitis (phlegmonous or empyematous cholecystitis, abscesses, emphysematous, gangrenous, hemorragic or perforated cholecystitis) and to indicate its urgent surgery.

Cholecystitis, Acute↗
PubMed1983

The role of hepatobiliary scintigraphy in differentiating acute cholecystitis from acute nonbiliary pancreatitis.

Thirty-five patients with acute nonbiliary pancreatitis were studied with 99m-Technetium para isoproply iminodiacetic acid in order to determine its ability to differentiate acute nonbiliary pancreatitis from acute cholecystitis. Of acute nonbiliary pancreatitis patients 90.3% (28/31) visualized their gallbladder in 1 h, 9.7% (3/31) had delayed visualization of gallbladder, and no patient in this category failed to visualize their gallbladder. Two of four patients with acute episodes of pancreatitis superimposed on chronic pancreatitis visualized their gallbladder. Biliary scintigraphy remains to be a valuable tool in differentiating acute nonbiliary pancreatitis from acute cholecystitis.

Acute Disease↗
PubMed1979

99mTc-IDA imaging in the differential diagnosis of acute cholecystitis and acute pancreatitis.

99mTc-IDA (99mTc-dimethyl-acetanilide-iminodiacetic acid) hepato-biliary imaging was evaluated for its efficacy in distinguishing acute cholecystitis from acute pancreatitis. In a retrospective review, gallbladders were demonstrated by 99mTc-IDA in 13 of 15 patients (87%) with acute pancreatitis. This is significantly higher than reports on the frequency of gallbladder filling with oral and intravenous cholangiography in the presence of acute cholecystitis.

Acetanilides↗
PubMed1991

[The role of esophagogastroduodenoscopy in the differential diagnosis of acute cholecystitis and acute pancreatitis in diseases of the upper gastrointestinal tract].

The examination of 411 patients with diagnosis of acute cholecystitis (AH) and pancreatitis (AP) showed that 14% of the examinees had malignant or benign affections of the upper portion of the gastrointestinal tract. AH and AP were noted to occur frequently in combination with duodenal ulcer. As for gastric ulcer, it often simulates the above diseases.

Acute Disease↗
PubMed1979

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)].

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.

Acute Disease↗