ABSTRACT
Background: Xanthogranulomatous cholecystitis is a benign, uncommon, localized or diffuse inflammatory pathological condition of the gallbladder and a catastrophic distinct transformation of chronic cholecystitis. Macroscopically distinguished by multiple yellowish with lipid packed tumor like foamy masses [nodules or streaks] in the wall of the gallbladder. Microscopically, it is distinguished by a number of bubbly histiocytes with acute or chronic inflammatory cells, while in upcoming phase manifest with tremendous fibrosis. The present study was undertaken to analysis of the histopathology reports to see the frequency of incidental xanthogranulomatous cholecystitis after elective cholecystectomy
Methods: 1522 cholecystectomies performed from January 2011 to December 2015, at tertiary care single centre Ziauddin University and Hospitals Karachi Pakistan. On Histopathology of ten gallbladder specimens after elective cholecystectomy revealed xanthogranulomatous cholecystitis. These histologically confirmed cases are identified from the retrospective analysis of patient's record
Results: During the study period 1522 patients underwent cholecystectomy. Histopathologically confirmed xanthogranulomatous cholecystitis in ten patients [0.65% of all cholecystectomies]. The mean age and standard deviation of patients with xanthogranulomatous cholecystitis was 54 +/- 17.19 years [range 29-85], with male to female ratio is 1:1. The most common clinical features were abdominal pain and tenderness in the right hypochondrium. Biliary colic and acute cholecystitis were the most common preoperative diagnostic features. Ultrasonogram was performed in all patients
Conclusion: Xanthogranulomatous cholecystitis is a scarce variant of cholecystitis with marked topographical discrepancy and preoperative clinical uncertainty and a per-operative diagnosis is a challenging task. Many times diagnosis is a histopathological revelation
ABSTRACT
Background: Appendicitis is one of the common cause of abdominal pain and surgical emergency. The diagnosis is mainly clinical, augmented by the imaging modality in which ultrasound still is a first paradigm. This study aims to assess the accuracy of ultrasound strategy in the diagnosis of acute appendicitis
Methods: This retrospective cross-sectional validation study was conducted in General Surgery Department, Ziauddin University and Hospitals, Karachi Pakistan from 2012 to 2015 on patients who underwent Appendectomy. It concerned 200 cases of appendectomy following, prior ultrasound examination of lower right abdomen. In 126 cases ultrasonography clearly showed the acutely inflamed appendix. In 59 cases the appendix was not visualized. In15 cases ultrasound showed periappendicular fluid collection. Among 200 patients later shown in surgery to have appendicitis, ultrasonography was unequivocally positive in 114 patients [Sensitivity 95%] and 24 patients in whom appendicitis was definitely excluded according to ultrasound examination [specificity 70%]
Results: The gold standard for the diagnosis of appendicitis still requires histopathological confirmation after appendicectomy. Pooled sensitivity is 95% and specificity is 70%, ultrasound still remains the first line and extremely accurate measurement in the diagnosis of acute appendicitis
Conclusion: We conclude that ultrasonography is our first line useful aid in patients referred with clinically suspected acute appendicitis. Ultrasonography has high accuracy in diagnosing acute appendicitis and reduces negative appendectomies. A non-compressible tubular structure of 7-9 mm in diameter of the appendix is the most accurate ultrasound finding