A RARE CASE REPORT OF GALLBLADDER ASCARIASIS

Hepatobiliary ascariasis is found in subtropical or tropical countries and is prevalent geo-helminth infection. Ascariasis lumbricoides are found mainly in the small intestine. Rarely the worm may migrate to the pancreatic duct or common bile duct but rarely to the gallbladder due to cystic duct which is strait and tortuous. The gall bladder ascaris can cause obstructive features due to lithiasis or calcified worms. The management is usually conservative if the worm is alive or else it can be removed by surgery

A case of idiopathic eosinophilic cholecystitis / 대한내과학회지

Eosinophilic cholecystitis is a rare form of cholecystitis that is clinically indistinguishable from the predominant form of calculous cholecystitis. Histologically, it is characterized by a dense, transmural leukocyte infiltrate composed of more than 90% eosinophils. A 60-year-old woman complained of right upper quadrant pain. She had no allergic or medicine history. An abdominal CT scan revealed thickened gallbladder wall but no cholelithiasis, and a cholecystectomy was performed. Histologic examination showed transmural eosinophilic infiltration of the gallbladder wall.

CT Findings of Acute Gangrenous Cholecystitis

PURPOSE: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. METHODS: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. RESULTS: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. CONCLUSION: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis

Clinical Predictive Factors for Acute Gangrenous Cholecystitis

PURPOSE: The postoperative morbidity and mortality for acute gangrenous cholecystitis (AGC) are higher than for acute nongangrenous cholecystitis (ANGC). However, preoperative predictive factors for the outcome of gangrenous cholecystitis have not been identified. The goal of this study was to determine the preoperative clinical predictive factors for the outcome of surgical treatment for acute gangrenous cholecystitis. METHODS: From January 2005 to December 2006, the medical records of 173 patients who underwent laparoscopic cholecystectomy for acute cholecystitis were reviewed and analyzed retrospectively. RESULTS: Among 173 patients with acute cholecystits, 57 (32.9%) had pathologically confirmed gangrenous cholecystits. Six variables were found to be associated with gangrenous cholecystits by univariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, fever (> or =37 degrees), an increased white blood cell count (> or = 15,450/mm3) and glucose. Four variables were identified that were associated with gangrenous cholecystits by multivariate analysis: an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3). CONCLUSION: The results of this study suggest that patients with an age > or = 55 years, the presence of associated diseases, hypertension, and an increased white blood cell count (> or =15450/mm3) have an increased risk of gangrenous cholecystitis and require immediate surgery.