Normal ultrasonographic dimensions of the gallbladder and common bile duct in neonates

Background: Ultrasound (US) is the first choice of imaging in neonates presenting with persistent jaundice to exclude surgically correctable causes and differentiate obstructive from nonobstructive causes. Previous studies on normal dimensions of gallbladder (GB) and common bile duct (CBD) recruited adults and children spread across a wide age group.Aims: This study aimed to determine GB and CBD normal dimensions in a large homogeneous neonatal population as well as guide decision regarding pre-US fasting in neonates who require GB evaluation.Materials and Methods: Five hundred and twenty-eight healthy newborns were recruited between May 2009 and May 2011. The widest intraluminal anterior-posterior diameters of GB and CBD were measured. Neonatal age in days, sex, birth weight, weight and height, gestational age at delivery, and time interval since last feed recorded.Results: The mean age was 9.56 ± 7.66 days, and 50.6% were males. The mean CBD diameter was 1.16 ± 1.61 mm while the mean GB diameter was 4.42 ± 2.16 mm. GB and CBD were clearly seen and measurable in 297 (55.8%) neonates and 237 (44.38%) neonates, respectively. There was a significant correlation between CBD diameter and GB diameter (P = 0.04) but no correlation with any demographic parameter. GB visualization was not dependent on time interval from last feed.Conclusion: Mean neonatal values for CBD and GB were established, but neonates have a wider range of GB diameters compared with older children, so GB diameter may not be a reliable parameter for neonatal GB pathologies. GB visualization was not dependent on time interval from last feed; hence, a recent feed should not delay emergency scans, especially in ill neonates

Histopathological changes in gallbladder mucosa associated with cholelithiasis: A prospective study

Background and Aims: Cholelithiasis is known to produce diverse histopathological changes in the gallbladder mucosa. In the present study, we aimed to find the correlation between various gallstone characteristics (i.e., number, size, and morphological type) with the type of mucosal response in gallbladder mucosa (i.e., inflammation, hyperplasia, metaplasia, and carcinoma). Methods: The present study was conducted prospectively on 100 patients undergoing cholecystectomy for symptomatic cholecystitis. Gallstones were assessed for various parameters, i.e., number, size, and morphological type. Gallbladder mucosa was subjected to histopathological examination. Sections were taken from body, fundus, and neck of gallbladder. Results: Of 100 cases, maximum type was of mixed stones (54%) and was multiple in number (46%). However, gallstone type and number are nonsignificant variables to produce precancerous lesions (i.e., hyperplasia and metaplasia). Statistically significant results were obtained while comparing the mucosal response with gallstone size (P = 0.012). Conclusion: As the gallstone size increases, the response in gallbladder mucosa changes from cholecystitis, hyperplasia, and metaplasia to carcinoma. Gallstone type and number are nonsignificant variables to produce precancerous lesions

Gall bladder volume and contractility in type 2 diabetes mellitus

The aim of this study was to sonographically evaluate gall bladder changes in type 2 diabetes. One hundred type 2 diabetic subjects (50 with neuropathy and 50 without neuropathy) and 50 healthy controls un-derwent sonographic evaluation of the gall bladder. Fasting and postprandial gall bladder volumes (FGBV and PPGBV) were measured; and the gall bladder contractility index (GBCI) calculated. The presence of gallstones was also noted. It was found that patients with diabetic neuropathy had a significantly higher FGBV and PPGBV; and lower GBCI; compared with diabetic patients without neuropathy; PPGBV and GBCI also differed significantly from non-diabetic controls. Gallstones were present in 22% of diabetic patients with neuropathy; in 10% of those without neuropathy; and in 8% of controls. We conclude that diabetic patients with neuropathy have significant abnormalities of gall bladder function; presumably due to autonomic nerve dysfunction. These patients also have a higher prevalence of gallstones; suggesting that ultrasound screening may be worthwhile

Primary Carcinoma of the Gall Bladder in University of Port Harcourt Teaching Hospital

Background: Carcinoma of the gall bladder [CaGB] is an uncommon but deadly cancer of the biliary tract Aim: To report experience in the management and the treatment outcome of patients managed for an uncommon tumour. Methods: Case notes of 215 patients who had gallbladder surgery between 1989 and 2009 in the Department of Surgery were retrieved. Demographic data; treatment and treatment outcome were retrieved from these case notes. Results: There were 18 cases of proven primary carcinoma of the gallbladder. There were 14 (77.8) females and 4 (22.2) males with a female/male ratio of 3.5:1. The patients aged between 52 and 70 years. The mean age at diagnosis was 61.3 years. The presenting symptoms were related to the associated gall stones and they are dyspepsia; anorexia; right hypochondrial pain; palpable gall bladder mass; weight loss; jaundice; pruritus; palpable liver and ascites. Five (27.8) cases were diagnosed correctly pre- operatively while 2 (11.1) cases with distended gall bladder were misdiagnosed as gastric outlet obstruction. Eleven (61.1) cases were diagnosed during surgery and were confirmed post operatively from the histopathological reports. Attempt at curative treatment was possible for only 8 (44.4) patients with early disease (stages I and II) .Fourteen cases (77.8) were well or moderately differentiated adenocarcinoma while 4 cases were undifferentiated adenocarcinoma and squamous cell carcinoma. Conclusion: From this report; we deduced that the treatment outcome of patients with gall bladder carcinoma is highly dependent on the stage of the tumour and the feasibility of a curative treatment

Prevalence of Gall Bladder Stones among Type 2 Diabetic Patients in Benghazi Libya: a Case-Control Study

Background: Diabetes mellitus and gall bladder stones are both common and costly diseases. Increasing age; female gender; overweight; familial history of the disease and type 2 diabetes mellitus is all associated with an increased risk of gallstones. Several studies from around the world reported an increased prevalence of gall bladder stones in patients with diabetes mellitus. Aims and objectives: The aim of this study was to define the frequency of gall bladder stones among Libyan diabetics and to evaluate the possible associated risk factors in these patients. Patients and methods: A case-control study was performed during 2007 at Benghazi Diabetes and endocrinology Center. The study involved 161 randomly selected type-2 diabetic patients under regular follow up at the center; and 166 age and sex matched non-diabetic outpatients at the 7th of October teaching hospital. Real-time abdominal ultrasound was performed by two radiologists to examine the abdomen after an overnight fast. Results: About 40 of the diabetic cohort had gall bladder stones as compared to 17.5of non-diabetic patients. Females were significantly more affected than males. Patients with gall bladder stones were significantly older and had a significantly higher body mass index than those without stones. Conclusion: The prevalence of gallstones in Libyan diabetic patients is higher than the rates reported in other parts of the world. Libyan diabetic patients with gallstones tend to be older and more obese than those without gallstones. Duration of diabetes mellitus and type of treatment does not seem to influence the frequency of gall bladder stones among Libyan diabetics

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10 years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Epidemiology of Gallstone Disease in Gondar University Hospital; as seen in the Department of Radiology

Background: Gallstone disease is a world wide problem and remains to be one of the most common health problems leading to surgical intervention. The magnitude of Gallstone disease in Ethiopia is not well known. Objective: To assess the magnitude of gallbladder stones in Gondar university hospital among patients visiting at the department of radiology for ultrasound examination. Methods: A retrospective observational study design was used over the period of September 2004 to January 2006 at the department of radiology; Gondar university hospital. Patients above the age of 14 years and whose Gallbladder was examined by ultrasound were considered as the study subjects. Results: Among a total of 1603 study subjects; the proportion of patients with cholelithiasis was 5.2. Of the patients with gallstone disease 55 were females and 28 were males with a ratio of 2:1. The prevalence of cholelithiasis in the age group 35-64 was 7.3; 10.1for females and 4.8for males. The ratio of symptomatic to asymptomatic cholelithiasis was 1:1 (34/34). The prevalence of cholelithiasis among patients clinically suspected to have cholelithiasis was 27.2. Of the 68 patients with cholelithiasis; 22.1had evidences of complication; 5 (7.4) choledocholithiasis; 3 (4.4) acute cholecystitis; 4 (5.9) chronic cholecystitis; 2 with gallbladder (GB) hydrops and one patient with porcelain GB. Conclusion: The prevalence of cholelithiasis (5.2) in Gondar university hospital suggesting that cholelithiasis is not an uncommon disease in the area. A further community based and multi centered study is recommended to determine the prevalence of gallstone disease in Ethiopia

The Effect of Moderate Alcohol Intake on Gallblader Motility: a Milk Ultrasonographic Study

Objectives: To assess the effect of periodic and moderate alcohol intake on gallbladder motility. Methods: The ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Results: Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. Conclusion: The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying

Gallbladder Carcinoma Unassociated with Cholelithias

Carcinoma of the gallbladder is a rare and often over looked cause of right upper abdominal quadrant pain. Diagnostic delay is common as the clinical features are confused with those of chronic cholecystitis. We report two cases of gallbladder carcinoma not associated with gallstones occurring in two middle-aged women. To our knowledge this is the first report in Nigeria of gallbladder carcinoma unassociated with cholelithiasis. We conclude that there should be a high index of suspicion in patients presenting with weight loss and chronic cholecystitis syndrome

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant enAfrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)